April 23, 2004 -- As more adults turn to dietary supplements, more children and teens are taking them too. Higher use of dietary supplements in kids with chronic health problems poses a serious concern as many parents often know little about their potential risks, a newly published review shows.
One study showed that more than half of all children and just under a third of adolescents in the U.S. routinely take dietary supplements. North Carolina pediatrician Kathi J. Kemper, MD, says parents often fail to tell their child's pediatrician about supplement use.
"There is a misconception that adults are the only ones using these products, and that is certainly not the case," Kemper tells WebMD. "And the population that is the most medically vulnerable -- children with existing health problems -- are the most likely to be given dietary supplements other than multivitamins."
In their review of earlier studies examining dietary supplement use among children and adolescents, Kemper and colleagues reported that the use of herbal supplements was higher among children with chronic recurrent or incurable diseases than in healthy children.
They say that dietary supplement and complementary alternative medicine use was highest in children with cancer, cystic fibrosis, attention-deficit/hyperactivity disorder (ADHD), and inflammatory bowel disease.
Parental Consent: Just as Dangerous?
In her review of various surveys she says that many parents were unaware that the products could interact with other medications. Many did not believe that herbal products could have any side effects or that the dietary supplement might be dangerous. Most parents reported that they wanted to improve the general health of their children by giving them dietary supplements.
The most notorious example for herbal supplement danger involves the stimulant ephedra, which has been linked to more than 150 deaths from heart disease or stroke and was taken off the market earlier this month. Ephedra was especially popular among teen athletes, who took it to boost physical performance, and among teenaged girls, who used it for weight loss.
Although ephedra is no longer on the shelves, the FDA has already expressed concern about the safety of products touted as alternatives to the stimulant. The active ingredient in many of these alternatives is bitter orange (Citrus aurantium), which has been shown to interact with prescription and over-the-counter drugs and has been reported to be linked to hazardous health problems such as high blood pressure, increased risk of heart arrhythmias, heart attack, and stroke.
Other alternative products may contain the lichen-derived alkaloids aristolochic acid, which have been linked to kidney failure and cancers. The FDA was concerned enough about products containing these acids to issue a warning about them late in 2001.
St. John's Wort, Tea Tree Oil
St. John's Wort, the world's most popular herbal remedy widely used for depression, has been shown to lower the effectiveness of many drugs, including birth control pills and more recently it was shown to compromise the effects of cancer fighting drugs. Kemper says it is not likely that teens taking the pill would know about this possible interaction.
She also sited tea tree oil, used topically for acne, ringworm, and other skin problems, as a little known danger to toddlers. Ingestion of as little as a teaspoon of the oil has been linked to serious toxicity, including coma.
Echinacea, commonly used to treat colds and upper respiratory infections, is among the herbals most often given to children. Although it is considered generally safe, a recent study showed that kids who took it were more likely to develop rashes.
"The bottom line is that parents should not equate 'natural' with 'safe,'" Kemper says. "Parents should seek expert guidance when considering the use of complementary and alternative medicines, and they should inform their child's pediatrician of any herb or dietary supplement use."
Augusta, Ga. neonatalogist Jatinder Bhatia, MD, says it is no surprise that parents of sick children turn to alternative medicines, even when there is little or no scientific proof that they work. Bhatia is a nutrition spokesman for the American Academy of Pediatrics.
He cites as an example of the move to give babies with Down's syndrome mega-doses of multivitamins.
But he says there are almost no data on the safety of herbal supplement use among children and adolescents, and for this reason parents should be especially careful about giving them to their kids.
"If a parent is going to give these products to a child, they need to make sure that the child's pediatrician knows about it," he says.
"Unlike drugs, herbal products have not been scrutinized by the FDA, so it is truly a case of buyer beware. Some herbs and plants may have beneficial effects as well as expected toxicities, similar to drugs. It is critical that parents research what is known about the safety and effectiveness of a supplement when considering giving it to their children", says Kemper.