Integrative Medicine for CYSHCN

Introduction

Integrative medicine includes practices that are supportive and complementary of allopathic medicine. In 2012, more than 1:10 children used complementary therapy in the preceding year. [McClafferty: 2017] In children, especially those with special health care needs, the most common complementary practice is using non-vitamin, non-mineral natural supplements. [Levy: 2015] The prevalence of non-allopathic approaches demonstrates the importance of the medical home team to provide information to families who seek an integrative approach.
Primary care clinicians should ask specifically about the use of supplements and other complementary or alternative medicine practices. They can provide guidance on the potential for drug interactions, known side effects, potential exposure to toxins, or overdose. They can also provide a perspective on cost vs. benefit, point families toward evidence-based approaches that are considered safe and effective, and give referrals to practitioners who are licensed and boarded.
The American Academy of Pediatrics (AAP) offers a clinical guideline on pediatric integrative medicine (below). The guideline provides clinicians with up-to-date information and resources about complementary practices while recognizing that new therapies will outpace research and it can be challenging for busy clinicians to offer good advice and prevent harm.
  • McClafferty H, Vohra S, Bailey M, Brown M, Esparham A, Gerstbacher D, Golianu B, Niemi AK, Sibinga E, Weydert J, Yeh AM.
    Pediatric Integrative Medicine.
    Pediatrics. 2017;140(3). PubMed abstract
    Reviews common types of complementary therapies, the education required for practitioners, and communication strategies for discussing integrative medicine with families.

Other Names & Coding

  • Complementary and alternative medicine (CAM)
  • Holistic treatments
  • Mind-body therapies
  • Traditional medicine practices
Appropriately trained primary care clinicians may provide these services; however, they should be associated with diagnosis codes for covered services.
Procedure CPT Codes (if a physician performs the service)
Acupuncture 9781x
Biofeedback training, any modality 90901
Hypnotherapy 90880
Osteopathic manipulation 98925-9
Chiropractic manipulation 98940-3
Diagnosis (in ICD-10-CM) Diagnosis Codes
Other specified counseling (such as for health advice or counseling) Z71.89

Speaking with Families about Integrative Medicine

The National Center for Complementary and Integrative Health offers the acronym ARMED (Ask, Respect, Monitor, Educate, and Distribute) to help clinicians talk with families about integrative and complementary health practices.
Other recommended practices:
  • Ensure families have access to standard services and are actively involved in all treatment decisions.
  • Attempt to determine an etiologic of the child’s condition. Explain current biologic understanding of the child's condition.
  • Discuss controversial as well as complementary therapies as part of the initial management plan and whenever asked.
  • Be knowledgeable about the standard and nonstandard treatments, or refer for consultation. Since it is difficult to keep current on all the alternative therapies, the medical home may ask the family to schedule a follow-up appointment to allow the provider time for literature review and time to discuss the proposed therapy in depth.
  • Schedule ample time for the discussion, making certain your comments are not taken as an endorsement. Discuss the placebo effect and the importance of controlled research trials. Be ready to explain the difference between a case report and a controlled trial.
  • Provide information about the specific treatment, discuss decision making, and emphasize the red flags, such as the claim of an unrealistic cure or that every child will benefit.
  • Identify any confounding factors, e.g., opinions of relatives.
  • Be willing to support a trial of therapy in select situations; require clear treatment objectives and pre/post evaluation of symptoms.
  • Remain actively involved even if you do not agree with the parents' decision. If you can't do this and maintain an open therapeutic relationship, consider a referral to a medical home where the parents and the provider may more closely share the same philosophy.
  • If you feel that the alternative therapy and/or the declining of traditional therapeutic approaches for the alternative therapy is too risky, suggest that the family establish a new medical home that feels more comfortable with the family's choice.
Further details about how to speak with families about integrative medicine can be found at [McClafferty: 2017] and [Nickel: 2003].

Pearls & Alerts

Collaboration
Consider collaborating with integrative medicine specialists to help patients struggling with pain, anxiety, depression, headaches, digestive disorders like constipation, menstrual problems, chronic fatigue, and arthritis. Recognize that these providers usually treat the whole person and do not focus on just “the headache” or “the pain.” While some modalities have eclectic certification programs, primary care providers should try and steer families toward trained and certified integrative medicine practitioners.
Avoid having the child’s neck manipulated
For families who choose to obtain chiropractic or osteopathic manipulation for their child, advise them to avoid having the child’s neck manipulated aggressively. Take special precautions with patients with increased risk of vascular dissection, instability issues (like atlanto-axial instability that can occur with Down syndrome), and hypermobility concerns (that can occur with Ehlers-Danlos syndrome).
Acupuncture vs. needling
Not all acupuncture is the same. A licensed acupuncturist’s training is close to 3,000 hours; whereas, physical therapists who perform needling often get 40-200 hours of training. Dry needling (with or without electrical stimulation) done by physical therapists is controversial and illegal in multiple states. Advise precaution if having needles placed around the pleural cavity as pneumothoraces can occur.
Herbalists training varies greatly
The American Herbalists Guild recommends a program of at least 1600 hours of study at a school of herbal medicine, including a 400-hour clinical requirement to become a practicing herbalist. Practitioners who have a Doctorate in Naturopathic Medicine or Masters in Oriental Medicine have fulfilled this requirement of study. A licensed acupuncturist and a licensed chiropractor will not have the same level of training.
Essential oils could have deleterious effects on children’s bodies
Although high-quality research is lacking, several case studies link lavender and tea tree oil to prepubertal gynecomastia in boys and possible premature thelarche in girls; these have been dubbed potential “endocrine disruptors.” Encourage families interested in using essential oils to work with a certified professional. The National Association for Holistic Aromatherapy (NAHA), an organization promoting standards for certification in aromatherapy, offers a database of providers.

Types of Integrative Medicine

In the United States, many people consider allopathic or Western medicine (e.g., performed by a medical doctor, osteopathic doctor, nurse practitioner, or physician’s assistant) to be “mainstream” or “conventional.” However, this framework depends on what system the family is most familiar with; a newly immigrated family may not consider Western medical practices to be “conventional.” Practices that can be combined with Western or allopathic medicine are considered complementary; those practices used instead of allopathic medicine are often considered “alternative.” Integrative health brings together mainstream and complementary practices for a holistic approach to health. This section briefly summarizes some well-known complementary practices. The National Center for Complementary and Integrative Health (NIH) is a good source of information for clinicians and families.

Medical Systems

Traditional Chinese Medicine / Oriental Medicine

Traditional Chinese Medicine (TCM) / Oriental Medicine (OM) is a whole system of medicine characterized by the combination and individualized use of herbal medicine, acupuncture, tui na (manipulative therapies), tai chi chuan, and diet. TCM is widely accepted as mainstream practice in many Eastern countries, such as China, Japan, and Korea, whereas an estimated 20% of people in the United States use TCM. There is increasing interest in studying how OM may be used to augment or replace pharmacologic treatment of many pediatric conditions. Caution should be observed due to the potential for some imported herbal products to be contaminated with toxic compounds, heavy metals, pesticides, and microorganisms, or to have faulty manufacturing practices, such as when one herb is mistakenly replaced with another.
In the United States, obtaining a Master’s degree in OM and acupuncture (AOM) requires 3-4 years (at least 2700 hours of training); a Doctorate of AOM requires 1200 more hours in addition to the Master’s degree. See Academic Collaborative for Integrative Health (ACIH) and National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) for more information and a provider database; Let's Talk About... Traditional Chinese Medicine (Spanish & English) offers an example of printable patient education.

Ayurvedic Medicine

Ayurveda is a system of medicine that originated in India and evolved over many centuries. It combines the use of products derived from vegetable, animal, metal, mineral, and gem sources with diet, exercise, and lifestyle recommendations. Many products and practices used in Ayurvedic medicine are also used on their own as complementary approaches—for example, herbs, massage, and specialized diets. Not much scientific study has been given to comparing the effectiveness of Ayurveda to allopathic treatments. Observe caution due to the potential for toxins to be found in imported products. See the National Ayurvedic Medical Association (NAMA) for more information and a searchable database of providers.

Homeopathy

Homeopathy originated more than 200 years ago in Germany. The basic principles include “like cures like” and “law of minimum dose.” According to the NCCIH and the Australian government’s National Health and Medical Research Council, no sound scientific evidence supports the use of homeopathy to treat any conditions. Homeopathic products are frequently diluted to include little or no molecules of the original substance, but they may contain a number of other active compounds. In the United States, most people who use homeopathic treatments do not seek advice from a trained homeopath; instead, they buy what looks appropriate at the store or online. The FDA has been working to increase regulations on homeopathic products. See American Institute of Homeopathy (AIH) for more information and a provider database.

Naturopathy

Naturopathic medicine is based on European traditions. The elements of naturopathic medicine include lifestyle modifications, exercise, diet, herbs and supplements, detoxification, manipulative therapies, therapy and counseling, and stress reduction. In the United States, naturopathic physicians complete a 4-year graduate program accredited by the Council on Naturopathic Medical Education, which is accredited by the U.S. Department of Education. They then take a licensing exam and have continuing medical education, similar to MDs and DOs. Different states and territories have varying licensing requirements. Traditional naturopaths have different, non-U.S. Department of Education-accredited training programs and requirements, and as a result, many traditional naturopaths practice without licensing. See American Association of Naturopathic Physicians (AANP) for more information and a searchable clinician database.

Functional Medicine

This system of medicine seeks the underlying causes of disease and promotes wellness by using an individualized approach that investigates genetics, lifestyle, and environmental factors. Health practitioners who possess an active license and have obtained at least a Master’s degree (or equivalent level) in medical training can become certified in functional medicine after completing a training course and passing an exam. See Institute for Functional Medicine (IFM) for more information, training, and a searchable database of providers.

Mind-Body Therapies

Acupuncture or Acupressure

To promote wellness and healing, an acupuncturist inserts thin needles into the skin (with or without the use of electrical stimulation) to help stimulate the flow of Qi (chi) / energy. Usually, this is safe for children if performed by a qualified practitioner. Evidence Based Acupuncture: Pediatric Acupuncture Evidence Summary provides a summary and discussion on the efficacy of treatments used for common pediatric conditions and appraises the validity, relevance, and applicability of these studies. A Masters of Acupuncture requires 3 years (1900 hours) of training; more training is required if the practitioner also is licensed in OM. See National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) for more information and a searchable database of licensed providers. Acupressure (PDF Document 580 KB) and Let's Talk About... Acupuncture (Spanish & English) are examples of printable patient education.

Biofeedback

Biofeedback involves gaining more awareness of body processes to improve control of one’s health and reduce stress. There have been many recent studies of biofeedback to help children with nausea and vomiting, headaches, pain, and procedural anxiety, and bowel and bladder dysfunction. Some medical home providers use simple, relatively low-tech methods and smart-phone apps to perform biofeedback with patients. See the Association for Applied Psychophysiology and Biofeedback (AAPB) for more information and a searchable database of providers.

Hypnotherapy/Hypnosis

Guided relaxation and focused attention are used to achieve a state of internal awareness or “trance” while working towards a goal while blocking out background distractions. There have been many recent studies of hypnotherapy to help children with nausea and vomiting, pain and procedural anxiety, bowel and bladder disorders, and insomnia. It has also been used to help manage anxiety, depression, stress, trauma, and grief, and to quit smoking. Contrary to popular belief, patients undergoing hypnosis are not able to be manipulated into doing something they do not want to do. Some trained pediatric providers perform hypnosis with patients in the medical home. Self-hypnosis is a technique to train oneself to enter the “trance” state to relax and work towards a health goal. See National Pediatric Hypnosis Training Institute (NPHTI) for more information and training, and American Society of Clinical Hypnosis (ASCH) Member Referral Service for a searchable database of providers.

Osteopathy

An osteopathic physician, or DO, is a board-certified physician who also has training that focusses on a holistic understanding of body processes and how to use the hands to diagnose illness or injury and perform manipulative treatments. See the American Osteopathic Association for more information and a searchable provider databases.

Chiropractic

Chiropractic therapy typically involves manual therapy, often including spinal manipulation. Other forms of treatment, such as exercise and nutritional counseling, may be used as well. Chiropractors undergo 4-5 years of training in their discipline after completing at least 3 years of undergraduate education. While a 2019 systematic review and meta-analysis concluded that low-velocity spinal mobilizations appear to be safe for infants, children, and adolescents, there is a lack of high-quality evidence about the use of spinal manipulation in children, and there is potential for rare but serious adverse effects. [Driehuis: 2019] While manipulation techniques may reduce crying time in infants with colic, they were not found effective for treating colic. [Dobson: 2012] See the American Chiropractic Association for more information and a searchable provider databases.

Massage Therapy

Massage therapists manipulate soft tissue to treat injury, promote healing, and alleviate stress. There are a variety of techniques. An entry-level massage therapy license requires at least 600 hours of training. See Academic Collaborative for Integrative Health (ACIH) and National Certification Board for Therapeutic Massage and Bodywork (NCBTMB) for more information; Let's Talk About... Massage Therapy: Before, During, and After (Spanish & English) offers an example of printable patient education.

Meditation

Meditation is focused on “letting go” of thoughts, judgments, or feelings by calming the body and mind through breathing. According to the NCCIH, there is evidence that meditation may help treat: pain, high blood pressure, irritable bowel syndrome, Crohn’s disease flares, anxiety, depression, insomnia, and pain (see National Center for Complementary and Integrative Health (NIH)). Little of this research has been done in children.

Mindfulness

Mindfulness is a process of being actively aware of the present, including your internal processes and how you affect others. Many schools use mindfulness to improve student outcomes, attention, emotions, calmness, and compassion for others. See Research on Mindfulness (Mindful Schools) for more information.

Relaxation techniques

While all mind-body practices achieve some degree of relaxation, other relaxation techniques include guided imagery, deep breathing, progressive muscle relaxation, and many more). Let's Talk About... Breathing Techniques (Spanish & English), Let's Talk About... Essential Oils and Deep Breathing (Spanish & English), and Let's Talk About... Progressive Muscle Relaxation are examples of printable patient education.

Yoga

Yoga combines physical practices, such as postures (asanas) with breathing (pranayama), with relaxation or meditation. There are multiple types of yoga; some focus more on exercise, some more on the breathing and centering aspects.

Tai Chi

Similar to yoga, these mindful movement practices combine moving through different postures with mental focus and breathing techniques. Tai Chi (or Tai-Chi-Chuan) is also sometimes used in self-defense. Tai Chi has been studied as a way to improve lung function in children with asthma, reduce stress, and help with balance in children with congenital hearing loss. Tai Chi has been trialed in pediatric palliative care. [Parry: 2018]

Natural Medicine/Natural Products/Dietary Supplements

Aromatherapy and Essential Oils

Aromatherapy includes both the inhalation and topical application of essential oils from aromatic plants for health and wellness benefits. Encourage families interested in using essential oils to work with a certified professional. The National Association for Holistic Aromatherapy (NAHA) and the Alliance of International Aromatherapists (AIA) provide information on professional standards and education for certification in aromatherapy as well as a searchable provider databases. The Tisserand Institute offers safety guidelines specific to children. Let's Talk About... Aromatherapy with Essential Oils (Spanish & English) and Let's Talk About... Essential Oils and Deep Breathing (Spanish & English) provide examples of printable PDF patient education.

Herbal Medicine or Phytotherapy

Many herbs are promoted as having health benefits; however, they are not regulated by the FDA. Herbs may have contaminants, side effects, and harmful interactions. Use a database such as:

Vitamins and Minerals

While food provides more benefits than vitamin and mineral supplements, supplements can help treat dietary deficiencies. The Portal's page about Calcium and Vitamin D the role of these in bone health for children with special health care needs. There is less evidence regarding routine use of a multi-vitamin/mineral supplement for people with well-rounded diets than those with dietary deficiencies.
Supplements are not regulated by the FDA and may have contaminants or may not contain what they say they do. Drugs, Herbs, & Supplements (MedlinePlus) links to free info on a wide selection of supplements. The Natural Medicines Database (TRC Healthcare) database may be helpful to identify the side effects and benefits of supplements (requires a subscription).

Prebiotics

Prebiotics are compounds that are selectively utilized by host microbiota to confer a health benefit to the host. A well-recognized example is the use of fructans (e.g., fructooligosaccharides and inulin) and galactans (galactooligosaccharides) to augment the benefits of probiotics like Bifidobacterium and Lactobacillus species). Although prebiotics traditionally have been defined as carbohydrates that act in the gut’s microbiome, expert consensus has expanded the definition to include non-carbohydrate compounds and extraintestinal sites (National Center for Complementary and Integrative Health (NIH)). The AAP offers a practice guideline about Probiotics and Prebiotics in Pediatrics (AAP) [Dan: 2010].

Probiotics

Live microorganisms found in the human gut (aka “friendly bacteria”) have been studied in a variety of conditions including colic in infants, digestive problems including irritable bowel syndrome, antibiotic-associated diarrhea, allergic disorders, and common colds (National Center for Complementary and Integrative Health (NIH)). There is evidence for their use in preventing pediatric antibiotic-associated diarrhea (L. rhamnosus or S. boulardi at 5-40 billion CFUs/day). [Goldenberg: 2015] There is no clear evidence that probiotics prevent infant colic; however, daily crying time may be reduced. [Ong: 2019] The AAP offers a practice guideline about Probiotics and Prebiotics in Pediatrics (AAP) [Dan: 2010].

Nasal Saline Irrigation

Instilling saline into one nostril and draining it out of the other is sometimes used to help with allergy symptoms. Nasal saline irrigation is safe as long as the irrigation device (Neti pot) is thoroughly cleaned.

Honey

Honey is often recommended to help with cough in children ≥1 year old. There is no solid evidence for its use to treat allergies.

Melatonin

Melatonin is used for sleep-onset difficulties and phase-shift disordered sleep. See Sleep Medications for more discussion.

Finding Evidence-Based Recommendations

The National Institute of Health developed the National Center for Complementary and Integrative Health (NIH), which has clinical guidelines, information on use and side effects of various herbs, continuing medical education opportunities to learn more about integrative medicine, clinical trials, and grant opportunities. It also provides an overview of the current evidence behind the use of the most common natural products, including melatonin, omega-3 fatty acids (fish oil), probiotics, cranberry, echinacea, garlic supplements, and ginseng (see ).
The Office of Dietary Supplements provides clinical resources about dietary supplements and offers a free app, Herb List App, to provide rapid access information about herbal supplements – this can be shared with families so they can look up the latest evidence and safety concerns while they are shopping.
Many of the professional organizations listed with the specific types of practice (above) provide more information on research and evidence for use of their modality.

Resources

Information & Support

For Professionals

National Center for Complementary and Integrative Health (NIH)
A wealth of information, research, and training for patients and clinicians on the use and safety of complementary and alternative medicines; National Institutes of Health.

Natural Medicines Database (TRC Healthcare)
Safety, effectiveness, and interactions of many dietary supplements, herbal medicines, and integrative therapies. Continuing Education courses offered; requires a subscription.

American Association of Naturopathic Physicians (AANP)
A national professional society that helps build successful medical practices, has a searchable provider database, and expands the body of naturopathic medicine research.

Institute for Functional Medicine (IFM)
Education, training, licensed provider database, and research related to functional medicine.

Association for Applied Psychophysiology and Biofeedback (AAPB)
Lists the results of formal studies about the efficacy of AAPB when used with specific disorders, outlines recommended treatment, and hosts a searchable database of biofeedback practitioners.

National Association for Holistic Aromatherapy (NAHA)
Scientific, empirical, and current information about aromatherapy and essential oils. Promotes practice standards for the profession and has a searchable database of aromatherapists.

Evidence Based Acupuncture: Pediatric Acupuncture Evidence Summary
Scrutinizes the evidence base of different studies using acupuncture to treat several different common pediatric conditions (e.g., cerebral palsy, asthma, chronic pain).

National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM)
Promotes national evidence-based standards of competence and credentialing and maintains a searchable database of board-certified, licensed acupuncture and oriental medicine providers.

American Society of Clinical Hypnosis (ASCH) Member Referral Service
A searchable database of hypnotists with degrees in many disciplines, including medicine, podiatry, dentistry, osteopathy, psychology, social work, counseling, marriage and family therapy, and nursing.

For Parents and Patients

Children and the Use of Complementary Health Approaches (NCCIH)
Science, side effects, and the bottom line when considering complementary health approaches; National Center for Complementary and Integrative Health.

Drugs, Herbs, & Supplements (MedlinePlus)
Searchable database with information about side effects, dosages, and precautions for prescription and over-the-counter medications; from the U.S. National Library of Medicine.

American Holistic Health Association (AHHA)
Integrative health and wellness resources (both conventional and complementary) to cope with an illness or to enhance health. Includes a database for holistic provider referrals.

Practice Guidelines

McClafferty H, Vohra S, Bailey M, Brown M, Esparham A, Gerstbacher D, Golianu B, Niemi AK, Sibinga E, Weydert J, Yeh AM.
Pediatric Integrative Medicine.
Pediatrics. 2017;140(3). PubMed abstract
Reviews common types of complementary therapies, the education required for practitioners, and communication strategies for discussing integrative medicine with families.

Patient Education

Let's Talk About... Acupuncture (Spanish & English)
Printable handout explaining the use and safety of acupuncture in children; Intermountain Healthcare.

Let's Talk About... Aromatherapy with Essential Oils (Spanish & English)
Printable handout on the use and safety of aromatherapy to treat children; Intermountain Healthcare.

Let's Talk About... Breathing Techniques (Spanish & English)
Printable information about different breathing techniques that children and adolescents can use to relax; Intermountain Healthcare.

Let's Talk About... Essential Oils and Deep Breathing (Spanish & English)
Printable information about using essential oils with deep or focused breathing to help children relax and heal; Intermountain Healthcare.

Let's Talk About... Massage Therapy: Before, During, and After (Spanish & English)
Printable handout about how to prepare your child for what to expect before, during, and after a massage; Intermountain Healthcare.

Let's Talk About... Traditional Chinese Medicine (Spanish & English)
Printable information briefly explaining traditional Chinese medicine and its various forms; Intermountain Healthcare.

Tools

My Medicine Record (U.S. Food & Drug)
Fillable form to keep track of all of prescriptions, over-the-counter medications, supplements, medical conditions, past surgeries, allergies, physician contact information, and preferred pharmacy.

Services for Patients & Families in Rhode Island (RI)

For services not listed above, browse our Services categories or search our database.

* number of provider listings may vary by how states categorize services, whether providers are listed by organization or individual, how services are organized in the state, and other factors; Nationwide (NW) providers are generally limited to web-based services, provider locator services, and organizations that serve children from across the nation.

Studies

Studies of Integrative Health in Children and Adolescents (clinicaltrial.gov)
Actively recruiting studies that you may be able to participate in and information about completed studies.

Helpful Articles

Becker DK.
Pediatric Integrative Medicine.
Prim Care. 2017;44(2):337-350. PubMed abstract
Reviews the basic principles of integrative pediatrics and summarizes data and integrative approaches to common pediatric conditions seen in the primary care setting.

Anderson BJ, Jurawanichkul S, Kligler BE, Marantz PR, Evans R.
Interdisciplinary Relationship Models for Complementary and Integrative Health: Perspectives of Chinese Medicine Practitioners in the United States.
J Altern Complement Med. 2019;25(3):288-295. PubMed abstract / Full Text
Insight into the issues associated with combining biomedicine (aka conventional medicine) and T&CM that are perceived by Chinese medicine practitioners.

Ring M, Mahadevan R.
Introduction to Integrative Medicine in the Primary Care Setting.
Prim Care. 2017;44(2):203-215. PubMed abstract
A primer for primary care professionals to engage in discussions about lifestyle change and complementary and integrative medicine options for their patients.

Authors & Reviewers

Initial publication: January 2013; last update/revision: November 2019
Current Authors and Reviewers:
Author: Jennifer Goldman-Luthy, MD, MRP, FAAP
Reviewers: Karena Luttmer, DACM, MSOM, L.Ac
Michael Green, DO
Authoring history
2013: first version: Lisa Samson-Fang, MDA; Lynne M. Kerr, MD, PhDA
AAuthor; CAContributing Author; SASenior Author; RReviewer

Page Bibliography

Dan W. Thomas, MD, Frank R. Greer, MD.
Probiotics and Prebiotics in Pediatrics.
Pediatrics. 2010;126(6). / Full Text
This clinical report reviews the currently known health benefits of probiotic and prebiotic products, including those added to commercially available infant formula and other food products for use in children.

Dobson D, Lucassen PL, Miller JJ, Vlieger AM, Prescott P, Lewith G.
Manipulative therapies for infantile colic.
Cochrane Database Syst Rev. 2012;12:CD004796. PubMed abstract
A systematic review of 6 studies that arrived at no definitive conclusion about the effectiveness of manipulative therapies for infantile colic, although the majority of the included trials appeared to indicate that the parents of infants receiving manipulative therapies reported (statistically significant) fewer hours crying per day than parents whose infants did not.

Driehuis F, Hoogeboom TJ, Nijhuis-van der Sanden MWG, de Bie RA, Staal JB.
Spinal manual therapy in infants, children and adolescents: A systematic review and meta-analysis on treatment indication, technique and outcomes.
PLoS One. 2019;14(6):e0218940. PubMed abstract / Full Text
A systematic review that found little quality evidence to guide conclusions about the effectiveness of spinal manipulation in treating pediatric patients. The authors stated that "gentle, low-velocity spinal mobilizations seem to be a safe treatment technique in infants, children and adolescents."

Goldenberg JZ, Lytvyn L, Steurich J, Parkin P, Mahant S, Johnston BC.
Probiotics for the prevention of pediatric antibiotic-associated diarrhea.
Cochrane Database Syst Rev. 2015(12):CD004827. PubMed abstract
Moderate quality evidence suggests a protective effect of a few types of probiotics in preventing AAD.

Levy SE, Hyman SL.
Complementary and alternative medicine treatments for children with autism spectrum disorders.
Child Adolesc Psychiatr Clin N Am. 2015;24(1):117-43. PubMed abstract
This review discusses factors associated with use of CAM for children with autism spectrum disorder, the empirical evidence for the most frequently used treatments, and how clinicians work with families who choose CAM treatments.

McClafferty H, Vohra S, Bailey M, Brown M, Esparham A, Gerstbacher D, Golianu B, Niemi AK, Sibinga E, Weydert J, Yeh AM.
Pediatric Integrative Medicine.
Pediatrics. 2017;140(3). PubMed abstract
Reviews common types of complementary therapies, the education required for practitioners, and communication strategies for discussing integrative medicine with families.

Nickel RE, Desch LW.
The Physician's Guide to Caring for Children with Disabilities and Chronic Conditions.
Paul H. Brookes Publishing Co; 2003.

Ong TG, Gordon M, Banks SS, Thomas MR, Akobeng AK.
Probiotics to prevent infantile colic.
Cochrane Database Syst Rev. 2019;3:CD012473. PubMed abstract / Full Text
There is no clear evidence that probiotics are more effective than placebo at preventing infantile colic; however, daily crying time appeared to reduce with probiotic use compared to placebo.

Parry SM, Staenberg B, Weaver MS.
Mindful Movement: Tai Chi, Gentle Yoga, and Qi Gong for Hospitalized Pediatric Palliative Care Patients and Family Members.
J Palliat Med. 2018;21(9):1212-1213. PubMed abstract
An exploratory study of using music and mindful movement to improve overall well-being of inpatient pediatric palliative patients and their family caregivers.