New study highlights the impact of pediatric integrative medicine services

A new study conducted by University Hospitals Connor Whole Health highlights the impact of pediatric integrative medicine services. This unique self-governed program, operating within UH Rainbow Babies & Children's Hospital, integrates complementary therapies – such as lifestyle interventions, supplements, herbal medicine, cognitive strategies, and bodywork therapies – alongside conventional medical practices. The study describes how this combined approach can help address gaps in care for pediatric patients with complex conditions.

The U.S. pediatric population is experiencing a rise in chronic illnesses such as obesity, diabetes, asthma, autoimmune diseases, and mental health issues – including those associated with social media. Pediatric integrative medicine is emerging as a promising solution. However, the published landscape describing how these services are implemented, and which pediatric patients are served by integrative medicine, remains limited in scope. The UH Connor Whole Health Pediatrics Program (UH CWHP) was initiated in 2020 as a physician-led service with broad service integration, addressing demands for comprehensive care. This study examined patient demographics, clinical characteristics, and treatment strategies utilized within UH CWHP.

This retrospective study reviewed 2,677 outpatient UH CWHP visits among 657 patients from March 2020 to September 2023. Among those patients, common conditions included anxiety (59.2%), fatigue (44.4%), headache (43.1%), abdominal pain (33.6%), constipation (33.0%), and long-COVID (24.7%). Frequently recommended interventions included dietary changes (61.8%), self-care (33.8%), massage (21.0%), and acupuncture (19.2%). Supplements often suggested were probiotics (49.9%), vitamin D (42.6%), multivitamins (41.9%), and fish oil (39.4%).

The study revealed that many patients with anxiety preferred non-drug treatments and were receptive to learning new coping skills such as cognitive reframing, breathing techniques, dietary modifications, and management of inner dialogs. Patients valued insights from Traditional Chinese Medicine, and about 30 percent utilized Chinese herbal treatment. Those with anxiety related to long-COVID often required additional treatments (e.g., antihistamines). For fatigue related to long-COVID and for many patients with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome, pacing and low dose naltrexone were key interventions.

Dietary interventions and nutritional management focused on realistic, family-friendly shifts toward nutrient rich, minimally processed foods. Probiotics were prescribed in subgroups of patients showing dysbiosis commonly linked to diet and antibiotics. Approximately 30 percent of patients presented with vitamin D deficiency. Also, patients exhibiting seasonal mood imbalances were prescribed light therapy as a helpful non-drug treatment.

Moreover, this study found that myofascial pain was often overlooked before UH CWHP visits. Treatment focused on teaching patients myofascial self-care techniques to manage pain and reduce reliance on medication. Gua Sha, a Traditional Chinese Medicine technique, was frequently used and taught for home pain management. In addition, sleep disruptions and insomnia were common with contributing factors including screen use before bed and inconsistent routines. Support included sleep education, referral to sleep medicine, melatonin, Chinese herbal treatments, and management of iron deficiency.

"Pediatric Integrative Medicine can fill key service gaps in existing health systems, particularly in regards to offering nonpharmacologic pain control methods and emotional regulation strategies. It can also serve complex populations such as patients with long-COVID and Myalgic Encephalomyelitis/Chronic Fatigue Syndrome who do not otherwise have a home within the medical system," said David W. Miller, MD, FAAP, L.Ac., Dipl. OM, Principal Investigator of the study, Medical Director of Pediatric Integrative Medicine, and the Françoise Adan, MD, Endowed Director in Connor Whole Health Leadership. "Patients value care that includes diet and lifestyle modification as well, and appreciate the integration of herbal medicine alongside conventional care approaches. Working with a trained physician helps patients understand what is safe and likely effective, and helps in navigating the vast information available on the internet."

The whole health model of care provides a framework to understand what matters most to our patients. This study demonstrates the variety of integrative and lifestyle strategies that can be implemented to improve the health of our pediatric patients." 

Kristi Artz, MD, MS, FACLM, CCMS, Vice President of UH Connor Whole Health, and Sara H. Connor Chair in Integrative Health

UH Connor Whole Health is currently implementing patient-reported outcome measures within its clinics to build upon these findings and better describe the effects of pediatric integrative medicine on patient outcomes. This work was supported by the Elisabeth Severance Prentiss Foundation.