When it comes to helping kids lead healthy, productive lives, Dr. Cora Collette Breuner, MD, MPH, believes in the power of integrative medicine, accessible to all. Just as important, she believes in the potential for healing by partnering with parents and caregivers to ensure they have the research-driven information they need to make informed choices about their child’s health care.
Dr. Breuner is a pediatrician, an expert on adolescent medicine and a professor of pediatrics, orthopedics, and sports medicine at the University of Washington School of Medicine. In her clinics at Seattle Children’s Hospital, Dr. Breuner focuses on the use of holistic, mindful, and integrative approaches such as biofeedback, yoga, massage to manage eating disorders, sports, and trauma-related injuries, headaches, abdominal pain, and chronic musculoskeletal pain. She serves on the Executive Committee in the Section on Integrative Medicine with the American Academy of Pediatrics.
We asked for her thoughts on the melding of integrative treatments in pediatrics and adolescent medicine and what all parents and caregivers can do to ensure their kids have access to all options.
Seattle’s Child (SC): I understand the term ‘alternative health care’ is out. What do the terms holistic, integrative and complementary care mean?
Dr. Breuner: Parents and caregivers today want to know about other non-pharmacological types of interventions they might consider to help their child or teenager. We know that there are evidence-based holistic interventions like acupuncture and massage that are supported by quality research that parents can consider for their kids, along with other interventions that a pediatrician or other healthcare provider might recommend. It isn’t about doing these holistic modalities “instead of” medical intervention but doing them with contemporary medical approaches.
SC: What sorts of holistic and integrative interventions with quality research are parents and caregivers interested in?
Dr. Breuner: There are many holistic interventions parents and caregivers may want to know about. For example, they ask about chiropractic for their kid with back pain or acupuncture for their child with a headache. They have questions about St. John’s wort for their child with depression or osteopathic manipulation in their teen whose neck hurts. They want to know about massage therapy in their child with endometriosis, or yoga as a supportive intervention for their adolescent with an eating disorder.
And finally, they want to know about other holistic integrative therapies such as music therapy or art therapy for their child with cancer and dog or animal therapy for their teen with autism. All of these are interventions with evidence-based data for many health issues. They are part of a holistic and integrative approach to caring for a child or teenager.
SC: You work with both allopathic and naturopathic medical students. Do you encourage them to work together in addressing kids’ health concerns?
Dr. Breuner: Yes. There is an elective I orchestrated for medical students, pediatric and family medicine residents from University of Washington School of Medicine where the trainees travel to Bastyr University to learn and work with naturopathic students. If we as healthcare providers don’t know all the different interventions that can be done to help a child or adolescent, a parent or caregiver may seek information online and initiate interventions without talking to their healthcare providers. That may not be the correct approach and may even delay appropriate and data-driven care. Healthcare providers need to work with parents and caregivers and not be judgmental. We must have back-and-forth open communication for the ultimate positive health outcomes for all children and adolescents.
SC: How can I be assured that my child’s healthcare provider is knowledgeable about holistic interventions?
Dr. Breuner: Pediatric healthcare providers are knowledgeable about holistic approaches. When asked ‘I want to treat my kid for their anxiety with acupuncture. Is that OK?’ We need to respond with open communication such as ‘Let’s explore this intervention together. From research review, there aren’t current studies that prove acupuncture is an effective intervention. However, other modalities like cognitive behavioral therapy do have good evidence-based research. Let’s talk about this further.’
SC: Why is it important that pediatricians be up to speed on holistic care options?
Dr. Breuner: We know that there are 6.75 million health-related searches in Google every day. Many of these are queries about children and teens. Parents and caregivers are searching for treatments to help their kids when the interventions we offer in the allopathic arena are not quickly effective, have side effects, are expensive, or may not align with what parents or caregivers want for their kids. Healthcare providers need to know where to search for evidence-based efficacy data on interventions our patients, families and caregivers are exploring so they can help them make informed decisions about the health care of their child and/or teen.
SC: Tell me about the biofeedback program you lead at Seattle Children’s Hospital.
Dr. Breuner: I am so proud of this program! It’s an intervention, implemented in 1983 at Seattle Children’s Hospital, where children and adolescents are taught, in six sessions, how to modulate their body’s physiologic responses. Wires are placed on the forehead, neck, and shoulders providing feedback on muscle tension in parts of the body. The other wires measure heart rate, temperature and breath. Kids learn how to relax in response to triggers through feedback by working with a trained biofeedback therapist.
SC: Why are so many people looking at holistic and integrative care for their kids? Is there equitable access to integrative care?
Dr. Breuner: We don’t have all the answers. What we prescribe is not always effective. Everyone wants the best for their child and people should have access to all interventions that are safe and effective. However, equity is an issue when it comes to integrative and holistic care. Some state insurance plans don’t cover integrative interventions even though they have been proven to work.
The more research that shows integrative interventions are effective in children and adolescents, the more likely insurance companies will pay for it, and the more likely there will be equitable distribution for all. Families in under-resourced communities may spend money on products advertised as natural and safe but which have no rigorous efficacy testing and are not covered by insurance. I worry that many families are going this route instead of getting on waiting lists for treatments we know work.
There is research that shows that integrative therapy is effective for certain diagnoses and can be covered by some insurance companies
SC: Can you give a few specific examples of holistic interventions that work according to evidence-based research?
Dr. Breuner: Acupuncture is efficacious for decreasing chemotherapy-associated nausea. There is data on sports massage for keeping athletes healthy, although not a lot of robust data that it helps kids with menstrual cramps. A study several years ago showed that kids with eating disorders got better and gained weight faster if they got a 10-minute massage each day. Chiropractic manipulation can help young adults with spine pain. Still under review is manual therapy in the treatment of a number of musculoskeletal and chronic medical conditions.
SC: So, which aspects under the holistic umbrella are big red flags for you?
Dr. Breuner: My biggest concern and worry is the safety of herbs and dietary supplements. The industry isn’t always well-regulated, meaning consumers and healthcare providers may not be aware of how to look for consistency of dosing and lack of contamination in a product. For example, I get asked about melatonin for sleep. Is it safe? What do I think about its long-term use? I do not know what’s in any bottle picked up in the natural food section of a store. I don’t know the effects of long-term use in children and adolescents.
SC: Do parents withhold information about natural products or approaches they try with kids? If so, why?
Dr. Breuner: If a parent or caregiver feels judged about telling or even asking their health care provider about an integrative intervention, they may not be forthcoming in discussing this. This can be dangerous, especially when there may be an interaction between what the healthcare provider is prescribing and what modality is being implemented. We need to have trust that we all want what is best for the child and adolescent.
SC: How does that trust get built?
Dr. Breuner: By being open and vulnerable both as healthcare providers and as patients, families, and caregivers. If you want to go with a natural approach to your child’s health, there’s nothing wrong with that. You aren’t asking a favor when you ask a healthcare provider, ‘Can you work with me?’ It’s your right as a parent or caregiver to ask that whoever is providing care for your child or teen is willing to work with you.
If healthcare providers don’t know about an intervention that a patient, parent, or caregiver is asking about they can say, ‘I don’t know, but I will get back to you with information soon.’ Healthcare providers have had countless hours and years of training in reviewing the rigor of scientific data and are quite adept at reviewing interactions and efficacy.
All children, adolescents, families, and caregivers deserve nothing less than holistic and integrative health care. Healthcare providers are in a perfect collaborative position to support this.