INTRODUCTION

This appendix will define and give a broad overview of the most commonly used, useful and researched therapies in children’s care. The potential benefits and aims of complementary therapy integration will be discussed, as well as possible disadvantages. Questions concerning models of delivery and consent will also be considered.

DEFINING COMPLEMENTARY THERAPY

In the 1990s, the term complementary and alternative medicine (CAM) was widely used. As complementary therapy integration into orthodox medicine becomes more widespread, there is a move to re-badge the field as ‘complementary and integrated medicine’ (CIM) (Rankin-Box 2005). Within the context of nursing care, the term ‘complementary therapies’ (CTs) is preferred, implying that the most appropriate form of integration is for therapies to be an adjunct, not alternative, to conventional care. One of the most widely used definitions of complementary medicine is that from the House of Lords (2000):

… a diverse group of health-related therapies and disciplines which are not considered to be part of mainstream medical care.

PREVALENCE OF COMPLEMENTARY THERAPIES IN CHILDREN’S CARE

Complementary medicine continues to increase in popularity among the UK general population (Ernst & White 2000, Hollinghurst et al 2008, Ritchie 2007) and orthodox healthcare is now seeing greater integration of complementary therapies (Prince of Wales’s Foundation for Integrated Health 2003). Unsurprisingly, the literature relating specifically to children is scarce and primarily from overseas, but it would appear that children and families are also using complementary medicine (Box 5.1). Therapies are commonly used for chronic illnesses, where orthodox medicine has only limited success in offering sustained relief or has unpleasant side-effects such as those for musculoskeletal disorders, skin, oncological and respiratory disease (Lueng & Verhoef 2008, Loman 2003, Robinson et al 2008, Sencer & Kelly 2007, Shaw et al 2008, Simpson & Roman 2001). It is apparent also that children and families value complementary medicine for the psychological support it can provide (Barlow et al 2007, Buckle 2003, Fearon 2003).

The debate around the quantity and quality of complementary research is ongoing. Complementary therapies present particular difficulties for traditional research methods. For most complementary therapy, there is no standardised treatment protocol. Every patient is treated individually every time with potentially different prescriptions, therefore the orthodox ‘gold standard’ of the double blind randomised control trial is simply not possible. Despite being hampered by lack of funding and fierce competition with orthodox medicine for existing funding, considerable time and effort is being invested into developing rigorous quality research methods appropriate for the field.

POTENTIAL BENEFITS AND POSSIBLE DISADVANTAGES OF THERAPIES

Box 5.2 outlines the potential benefits of complementary therapies for children. Although there are many perceived benefits of therapies for children, there are also some possible disadvantages. For example, many families do not disclose the use of therapies to conventional healthcare professionals – over 50% of parents ‘don’t tell’ (Robinson et al 2008). This may be cause for concern about adverse reactions from their healthcare professionals to their choice of complementary treatment or simply that it does not occur to them to mention it and their conventional healthcare team never ask about therapy use. Parents may also self-medicate their children with over the counter (OTC) remedies rather than consult a trained therapist. Robinson et al (2008) found that over 80% of the London study population bought OTC remedies. Such treatments can bring the risk of toxicity, adverse reactions and interactions with conventional drugs. Occasionally, unscrupulous complementary practitioners have taken advantage of vulnerable families. Ramsay et al (2003) tested 24 samples of a herbal cream supplied to families by a Chinese herbalist. Of these, 22 illegally contained potent corticosteroids. Some alternative (as opposed to complementary) practitioners may advocate that parents cease conventional medication in favour of alternative approaches and there is a risk that parents may ‘force’ unpalatable complementary medications/diets onto their children. Cost is also a potential disadvantage of a complementary approach, as many such treatments are not widely available on the NHS.

MINIMISING THE RISKS AND DISADVANTAGES

It is possible to take steps to reduce the risks. For example:

• Establish if complementary treatment is something your patients are considering or actually doing

• Encourage open and honest discussion about therapies with children and families

• Have a basic understanding of what the therapy options are

• Signpost families to sources of reliable information.

A programme of voluntary self-regulation among those complementary therapies not yet regulated by statute is progressing well, part-funded by the department of health and led by The Prince’s Foundation for Integrated Health (www.fih.org.uk). This should reduce some of the issues around identifying a properly qualified and competent therapist.

MODELS OF COMPLEMENTARY THERAPY PROVISION

WHO SHOULD PROVIDE THERAPIES?

There are several options for provision of complementary therapies into children’s care. For example 50% of GP practices and 43% of primary care trusts offer some kind of access to complementary therapies – although this may not include provision for children. However, over 90% of people who use therapies do so outside the NHS (Thomson 2005). In primary care, models of provision and providers may include: enhanced service via GP – funded by charity, PCT grants, patients’ contributions; or provision may be by complementary practitioners, the GPs themselves, practice nurse or other orthodox healthcare professional such as health visitor, nursery nurse or healthcare assistant.

Within secondary care, provision may be by healthcare staff qualified in a specific therapy and providing an actual therapy service. Alternatively, they may provide the therapy as part of their healthcare role if qualified to do so and it is within their job description. Some secondary services may contract in therapy services from a qualified therapy practitioner.

In any of these scenarios, when incorporating complementary therapies, it must be done carefully and within a robust policy framework if integration is to be successful (Fearon 2006). It is important to consider carefully if administration of a complementary therapy is appropriate to the nursing role or better delivered by a complementary therapy practitioner. For example it is highly unlikely a nurse would find time to be able to provide a full aromatherapy assessment and treatment within the scope of a normal nursing role, even if qualified to do so. Working together with a complementary practitioner would probably be a better option. However, there are many complementary therapy techniques, which can be legitimately incorporated into nursing care, e.g. a simple head massage during a hair wash, a brief foot massage to relax a child in preparation for sleep (Richardson 2001).

If nurses do incorporate therapies into care, they must be rigorous in their understanding of each chosen therapy in order to ensure safe integration of therapies and not fragment existing care (Avis 2003). Choosing the right training and education is vital in order for the nurse to be able to perform it and be accountable for their competence and proficiency in providing that therapy. Nurses should be rigorous and analytical of the quality of their work and also the literature they may use to argue the benefits of their chosen therapies. They should ensure that a mechanism for supervision and support by specialists in the field of complementary medicine is established (Tavares 2003).

• Improve the quality of a child’s experience, communication and continuity of care

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