|
|
Echinacea
|
Liquid
Extracts in Pediatric Practice
by Aviva Romm (July 2005)
Pediatric herb use has risen dramatically in recent years. Surveys indicate
that greater than 50% of all young children and 30% of all adolescents
in the United States have used a dietary supplement, and herbs are amongst
the most popular of these. Herbal therapies are commonly used for chronic
or recurrent conditions such as ADHD, asthma, upper respiratory infections,
atopic dermatitis, allergic rhinitis, cancer, inflammatory bowel disease,
rheumatoid arthritis, and cystic fibrosis. Herbalists and naturopathic
doctors are regularly consulted for a wide range of both chronic and acute
pediatric health problems. Used appropriately, liquid herbal extracts—tinctures
and glycerites-- are among the most valuable and effective botanical tools
for treating pediatric complaints. This article explores pediatric herb
safety and dosing, the advantages of liquid herbal extracts for kids,
and herbal indications for several common pediatric conditions.
Herbs, Kids, and Safety
Herbal medicines have a strong historic basis for use in the pediatric
population, perhaps the most famous being chamomile, made immortal by
Beatrix Potter in her beloved Tales of Peter Rabbit. The World Health
Organization reported approximately 8000 case reports of adverse effects
related to herbs between 1968 and 1997. Of these, 100 were in children
aged 10 years and under and 100 were in adolescents. Given the extended
time period of these reports, the fact that most of the evidence is anecdotal,
and that adverse effects are frequently not caused by the supplements
themselves, but by contaminants, this data suggests a high level of herb
safety. Nonetheless, children and adolescents are under going formative
physical development, and caution should be applied to all substances
prescribed in the pediatric population. Very little is known about the
safety of combining herbs with pharmaceutical drugs in the pediatric population;
therefore, it is best to follow safety guidelines similar to those for
adults to avoid potentially harmful herb-drug interactions.
The following should be considered when determining whether botanical
medicines
are appropriate for use on an individual basis:
• Age of child and severity/nature of condition
• Practitioner’s scope of practice
• Safety and efficacy of herbs comparable to conventional therapy
• Concurrent medication/ supplement use
Pediatric Dosing
Guidelines for dosing are best determined based on a composite
of information including: traditional and historic use, contemporary practitioners’
clinical experience, clinical trials, and monograph standards. While cutting
an adult dose of an herb down to a pediatric “serving size”
does not guarantee an accurate pediatric dose, herbalists typically arrive
at a pediatric dose on an adult: child weight-dose ratio as follows:
Child’s weight x Adult dose
__________________________ = Pediatric dose
150
50 lbs x 30 drops
_________________ = 10 drops
150
Advantages of Liquid Extracts for Kids
Compliance with botanicals can be difficult, particularly with young children
for whom taste is a determining factor. Liquid extracts allow the practitioner
and parent to overcome this main obstacle — getting the herbs into
the kids! Liquid extracts are particularly suitable for use in the pediatric
population for several reasons:
1. It is easy to deliver and disguise the necessary dose
of herbs due to the concentrated nature of tinctures and glycerites,
and one avoids the difficulty of getting children to take large amounts
of tea or swallow pills or capsules
2. Dose is easy to monitor as tinctures are delivered in drops.
3. Tinctures and glycerites are highly convenient to use, require no
preparation, have a long shelf-life, and are easily transportable.
Further, for most herbs, the combination of water and alcohol
allows for the greatest extractability of the desired medicinal constituents.
This means that the medicines are not only easy to deliver, but are also
highly reliable when made from quality starting materials, as Herb Pharm
products are.
Administering Liquid Extracts to Kids
Liquid extracts are very easy to administer. Here are several tips:
• Dilute in a small amount of water for older children
and with palatable herbs even for younger children.
• Dilute in a small amount of juice to disguise the taste when
necessary.
• Stir dose into a small portion of applesauce.
• Add vegetable glycerin to equal 25% of the total tincture and
give directly as above.
• Add Elderberry glycerite to equal 25% of the total tincture
and give directly as above.
• For breastfeeding infants, the dropper tip can be placed in
the corner of the baby’s mouth while the baby is suckling.
Pediatric Conditions and Indications for Liquid
Herbal Extracts
Choosing what herbs to give for a specific condition is easier in kids
than adults, as prescribing does not need to be quite so uniquely individualized.
A one-size fits all approach is typically effective for common acute illnesses,
and kids tend to respond quickly. Practitioners and parents can purchase
individual tinctures and/or glycerites and combine these based on the
child’s individual symptoms picture, or they can give proprietary
blends that are often applicable for a number of common complaints.
Echinacea Liquid Extracts
While studies have been contradictory on the ability of Echinacea to reduce
cold symptoms once they have begun, it is clear that Echinacea reduces
the fre-quency of upper respiratory infections in children. This is significant,
as recurrent colds are the leading cause of school absenteeism, and also
a cause of lost work for parents caring for their sick children. Echinacea
provides gentle immune support, and exper-ienced herbalists will report
that in adequate dosing, does reduce the severity and duration of acute
URI and prevents recurrence. Product quality and dosing are the keys to
effective Echinacea use. Herb Pharm offers several high quality Echinacea
products including Echinacea tincture, Echinacea glyercite, and Children’s
Echinacea glyercite (orange flavored). I recommend the following pediatric
doses for these products:
For preventative care: 1 drop per every 5 pounds of the
child’s body weight, given twice daily at the onset of cold and
flu season in susceptible children.
For mild acute URI: give the dose above, but every 3-4 hours.
For more severe URI: give 1 drop per every 2 pounds of the child’s
body weight, every 2-4 hours.
Children's Herbal Compound —
proprietary blend
For: Fever, Teething, Colds and Flu, Colic, Irritability,
“Tummy ache,” Restless Sleep, Anxiety, ADHD, IBS
Contains: chamomile, lemon balm, catnip, and fennel
Children's Herbal Compound is a classic example
of an herbal formula with a wide variety of clinical applications, making
it an essential blend to keep on hand in the home or pediatric clinic
pharmacy. Chamomile, lemon balm, and catnip are calmative herbs, as well
as helping to keep fevers in check, promote restful sleep, calm anxiety
and nervous irritability, and relax intestinal griping. Chamomile and
lemon balm are also mildly antiviral, and chamomile is a respected intestinal
and general anti-inflammatory. Fennel relaxes the intestines and relieves
gas, while also providing mild antiseptic activity and a pleasant flavor.
I have used this formula in my practice for all of the indications I have
listed above, and have used it across a wide age range from babies with
colic or who are teething to older children with behavioral problems,
stress, and anxiety or sleep difficult-ies. Compliance is very high due
to the pleasant taste of this formula.
For children with more serious sleep difficulties one can
give Relaxing Sleep Tonic™ in addition or instead.
Aunty Aviva’s Upper Respiratory “Syrup”
This is an example of how one can take individual tinctures and glycerites
and combine them in the clinic to create a specific blend for a pediatric
patient. The following combination is for a child with an acute upper
respiratory infection, or for the child with a high susceptibility to
respiratory congestion and cough.
1 part angelica
1 part elecampane
1 part Children’s Echinacea
1 part mullein
1/2 part marshmallow
1/2 part licorice root
1/2 part thyme
1/2 part anise seed
1/2 part wild cherry bark
1 part elderberry glycerite
Combine all of the tinctures in a 4-ounce amber glass bottle.
Give 1/2-1 teaspoon every 2-4 hours as needed for acute cough and congestion,
or 1/2-1 tsp twice daily to improve resistance to cough and URI.
Constipation
Here is another example of creating your own combinations using liquid
extracts. The
following preparation can be used to alleviate acute constipation in babies
and children. Discontinue use after 5 days.
1 part dandelion glycerite 1/2 part yellow dock root
1/2 part licorice root
1/2 part fennel
Mix all liquid extracts together in a 2-ounce amber glass bottle. Give
1-2 tsp in 1/2 cup warm water twice daily, depending on child’s
age.
References
• Cala S. A survey of herbal use in children with attention-deficit-hyperactivity
disorder or depression. Pharmacotherapy Feb 1, 2003; 23(2): 222-30.
• Ernst, E. Serious adverse effects of unconventional therapies
for children and adolescents: a systematic review of recent evidence.
Eur J Pediatr 2003 (162):72-80.
• Fernandez CV, Stutzer, CA, MacWilliam, L, Fryer, C. Alternative
and complementary therapy use in pediatric oncology patients in British
Columbia: prevalence and reasons for use and nonuse. J Clin Oncol.
Apr 1998;16(4): 1279-1286.
• Johnston, GA The use of complementary medicine in children with
atopic dermatitis in secondary care in Leicester. Br J Dermatol.
Sep 1, 2003; 149(3): 566-71.
• Kemper, K. et al. Consultatin for Holistic Pediatric Service for
Inpatients and Outpatients Oncology Patients at a Children’s Hospital,
Arch Pediatric Adolesc Med April 2001 (155) 449-54.
• Lanski, SL -Herbal therapy use in a pediatric emergency department
population: expect the unexpected. Pediatrics. May 1, 2003; 111(5
Pt 1): 981-5
• Matin, K. Herbal and nonherbal alternative medicine use in Northwest
Ohio. Ann Pharmacother. Dec, 2002. 36(12):1862-9,
• Ottilini, M. et al Complemen-tary and alternative medicine use
among children in the Washington, DC area. Ambul Pediatr. 2001
Mar-Apr.
1(2):122-5, Romm, A., Gardiner P. Trends in pediatric botanical medicine.
Unpublished.
• Romm, A, Gardiner, P. American Herbalists Guild pediatric botanical
medicine survey. Journal of the American Herbalists 5(1), 2004.
• Romm, A. Efficacy and Safety of Echinacea in Treating Upper Respiratory
Tract Infections (URI) in Children: A Continuing Source of Controversy.
Journal of the American Herbalists Guild. 2004.
• Romm, A. Upper Respiratory Infection (URI) in Children: The Emerging
Need for Botanical Strategies. Journal of the American Herbalists
Guild. 2004;5(1). |
