Epidemiological Data

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A number of international surveys indicate that herbal use in children is on the rise, but the majority of the available data is related to complementary/alternative medicines (CAM) in general [58, 60], and so it is difficult to extrapolate detailed information on herb consumption in children. In every case, these studies reported prevalence rates of 11 to 41% for CAM use, with the most frequently reported therapies being herbal or homeopathic medicines.

From a population-based telephone survey, 5% of the respondents reported giving their children herbal medicines in the past year [61]. In a national online survey, 41% of 520 adolescents reported to have used herbal remedies in the previous 6 months, mainly ginseng, ginger, Ginkgo biloba, valerian and St. John's wort [62]. The results of another study conducted in four primary paediatric care practices in Washington showed that 8% of children had been treated with herbal therapies in the prior year [58]. Other authors [63] verified herbal use among 2562 families in Kansas and Wisconsin through questionnaires: child herbal use was indicated in 35.8% of the surveys. The herbs most commonly taken by children were chamomile, Aloe vera, peppermint, garlic and lavender.

In other cases, information is focused on groups of patients with specific diagnoses or problems.

Some authors [64] explored the use of herbs in children with attention-deficit-hyperactivity disorder or depression: the prevalence of herbal therapy among 117 patients was 20% and, interestingly, the children's psychiatrists and paediatricians were not aware of such use. Ginkgo biloba, Echinacea and St John's wort were the herbs most frequently given. A survey performed in three paediatric gastroenterological centres reported that 14% of 208 children with inflammatory bowel disease used herbal medicines to treat this condition, in addition to conventional therapies [65]. In Australia, 29% of 174 asthmatic children on therapy with bronchodilators and disodium cromoglycate or inhaled steroids had used herbal preparations to ease their symptoms [66].

The results of a survey conducted in a Pittsburgh paediatric emergency department showed that approx. 6% of the parents had ever given their children herbs [67]. In another survey of 142 families in an emergency department, 45% of caregivers reported giving their child an herbal product, mostly aloe, Echinacea and sweet oil:

the most commonly reported reasons for use were colds, burns, immune stimulation and relaxation [68].

Use of herbal medicines in preoperative patients has sparked great interest because of the possibility that such therapies may alter immune response, retard wound healing or interfere with drugs or coagulation parameters: relatively little is known about the incidence of herbal use specifically in the paediatric surgical population.

Among 1021 paediatric patients surveyed through questionnaires during a preoperative visit, 12.8% used herbal remedies before the surgery: the herbs most commonly taken were echinacea, aloe and cranberry [69]. Two other surveys confirmed the use of herbal medicines also preoperatively in children. In the first study [70], among 601 children 6.4% reported to be currently taking an herbal preparation: Echinacea and arnica were the commonest used herbal remedies, but most importantly a significant number had taken herbs interacting with anaesthesia and surgery. In the other survey [71], 3.5% of 894 paediatric surgical patients had been taking herbal medications in the 2 weeks prior to surgery, mostly Echinacea. Thirty-six parents (4%) of 914 paediatric surgical patients undergoing surgical procedures at an urban children's hospital reported their child to have taken an herbal product: 15 of these children were undergoing major surgery and 13 were at risk for potential drug or anaesthetic interactions. Echinacea, chamomile and aloe were the most frequently used herbal medicines [72].

Despite the potential interference of herbal products with antitumoural chemotherapy [73], different surveys report herbal use among children with cancer as an adjunct to conventional or supportive therapy, especially to reduce the side effects of chemotherapy. An analysis of such surveys showed that the prevalence of herbal use is as high as 20% and a large proportion of users communicate this use to their physician.

Fernandez et al. [74] surveyed 583 paediatric patients diagnosed with cancer in British Columbia between 1989 and 1995. Among the 366 respondents, 42% used complementary therapies, mostly herbal agents. Among 75 children treated for cancer at the Babies and Children's Hospital of New York and interviewed on the use of unconventional therapies, 20 (27%) reported having taken at least one herbal agent, and this use was not related to the severity of chemotherapy- or radiotherapy-induced side effects, but rather to improve the general health of the child. Green tea and cat's claw were the herbs most commonly used [75]. One hundred and one paediatric cancer patients in Washington State were identified and telephone interviews were conducted: 34.7% used herbal preparations for both primary and secondary prevention, mostly to maintain good health and to avoid non-cancer illnesses: these treatments were higher in children over 5 years of age and among patients with neurological tumours [76]. Other researchers [77] interviewed by telephone parents of children with cancer in the province of Saskatchewan (Canada) to estimate the prevalence of unconventional therapies. Among families responding to the survey, 36% reported using herbal products for their child. A survey [78] was conducted among parents of children treated at the oncologic clinic of Sainte Justine Hospital in Montreal: 18 of 92 parents who completed the questionnaire (20%) reported that their child used at least one herbal product. During a 6-month period,

110 consecutive paediatric patients with cancer attending a tertiary care hospital in western Mexico were interviewed on the use of unconventional treatments: 53 patients (69%) reported to have taken herbal or plant extracts, mostly to limit the side effects of conventional therapies [79]. A detailed questionnaire was completed by 95 patients attending the Paediatric Oncology Unit of Gazi in Turkey: 25 out of 95 (26.3 %) used at least one herbal product, mostly stinging nettle. The most frequently cited reason for using an herbal product was the belief that it could help cure the cancer [80].

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