Getting a child to eat healthy food, comforting them when they fall over and hurt themselves, looking after them when they have a bad cold or helping them feel better while they are recovering are all part of a nanny's daily experience. More parents are turning to complementary and alternative therapies alongside or instead of conventional medicine. While nannies don't make the decisions about how a child is treated, they need to be informed about the debates surrounding these therapies.
Belief and evidence
People may choose complementary therapies because they believe they might be safer than prescription drugs; they like the emphasis on 'all things natural', and the holistic or whole-person approach; and they like feeling in control of their treatment. They also like having more time in consultations to build a good patient-therapist relationship. A recent survey found that users spent more than 15 a month on these therapies, making it a lucrative business.
But despite their appeal, they remain controversial. One problem is regulation. In the UK it is perfectly legal for anyone to practise complementary medicine without training, except in the areas of chiropractic and osteopathy, which are regulated by law. Many therapies are regulated voluntarily by organisations. But it can be confusing knowing where to go for safe treatment. In aromatherapy, for example, there are 12 professional member associations, each with different training requirements.
A great problem with using complementary therapies with children is lack of research evidence. Dr Adrian White is senior lecturer at Exeter University's department of complementary medicine and editor-in-chief of the research journal Complementary Therapies in Medicine. Dr White warns parents and carers to be very careful when taking children to therapists.
'Childhood illness is a medical speciality; doctors are trained to diagnose and treat children's diseases. But the great majority of complementary therapists have not had any special training in this area,' says Dr White.
'So parents should always visit their GP or hospital first for a proper diagnosis.
'The little evidence there is suggests that coughs and colds may be prevented or treated by the herb echinacea, that hayfever might be helped by homeopathy, headaches might respond to relaxation therapy and insomnia could be helped by treatments including relaxation and hypnotherapy - not to mention more exercise!'
One particular area to be cautious about is when children are diagnosed as 'allergic' or 'sensitive' to foods. Dr White says, 'Genuine food allergy, for example to peanuts, is one thing, and needs to be taken very seriously.
But a number of practitioners use unreliable tests that suggest a child's problem is due to an "allergy". Once the idea that a particular food causes trouble is implanted, it may be difficult to undo the anxiety associated with eating that food. It is not unknown for children to be put on diets that are so highly restrictive that their growth may be affected.'
Self-help Seekers
The ready market of people hungry for information and advice has led to an abundance of self-help resources. Susan Clark, a journalist who was health and fitness editor of the Sunday Times and a trained yoga teacher, has just published What really works for kids - the insider's guide to natural health for mums and dads (Bantam Press, 10.99). She believes strongly in parents' right to choose complementary therapies for their children if they wish. Among those she describes are herbal medicine, homeopathy, essential oils, flower remedies, traditional Chinese medicine, the Indian therapy of ayurveda and a series of hands-on treatments such as massage, reflexology and yoga.
In her introduction to the book Ms Clark says, 'Children's bodies are wonderfully responsive to natural medicine. Children know instinctively how to get better, and what they need from you is nurture, support and care to guide them through.' She says that through using her book, parents and carers can 'give nature a nudge. For example, instead of treating a cold with an over-the-counter remedy that suppresses the symptoms, why not use a herb like echinacea that can support the immune system instead?'
The book offers a relatively up-to-date, often personal, overview of the options on offer to parents and carers. It also suggests a variety of pick-me-ups and tips for adults to ease the stresses of caring for children, which nannies may be tempted to try for themselves. However, readers should note that the author acts as a consultant to several herbal companies and the Health Food Manufacturers' Association. This is important to know, as the book recommends many specific products and companies by name.
Ms Clark stresses, 'This is not an either/or approach. If you want to take your kids to the doctor - and if they have an acute condition you must take them -that's fine. What we then do is show you how to support your children's system if they are given prescription drugs, and how to "clear up" and detox a body after sickness.'
The book offers tips on healthy eating, with recipes. It explains the role of different vitamins and other nutrients and advises on how to choose from the bewildering array of potions, pills and different forms of herbal medicines, suggesting suitable doses for children of different ages.
A GP's view
Dr Imogen Bloor, a GP in London with a four-year-old daughter, prescribes a dose of 'healthy scepticism' towards complementary therapies and self-help books.
'Parents exercise close scrutiny on what conventional doctors prescribe for their children,' she says. 'Yet they will administer all sorts of complementary therapies on the assumption that it's natural, and it's better, when it's not necessarily natural or better. Read the advice with at least the same degree of scepticism as if you were going to the doctor.'
She believes complementary medicines can help minor problems. For example, the herbal cream arnica is said to soothe bumps and bruises. Cough mixtures are another example. A honey and lemon or liquorice medicine might make the child feel better without risking their health.
'If it makes parents feel they are doing something and avoids them coming to the doctor needlessly, then I don't think it's a problem,' she says. But she stresses that if carers have any doubt about a child's condition, they should seek a GP's advice. 'A persistent cough could mean asthma, for instance, which requires medical treatment.'
Dr Bloor adds, 'I do accept that there are things we don't know or understand about complementary therapies, and I would strongly encourage complementary practitioners to work alongside GPs and engage in further research so we feel more confident about prescribing and recommending them.
Intuitively it feels like a good thing, but on the basis of the available evidence, one has to exercise caution.'
Far from being harmless, some therapies, particularly herbal medicine, can be as powerful as prescription drugs. Many medicines come directly from plants or are chemical imitations of the pharmacologically active ingredients of a plant. Interactions can potentially be serious. Dr Bloor warns against mixing herbs and existing medication without medical advice.
Traditional Chinese medicine is another area for caution. Recent analysis of some creams prescribed for eczema revealed that they actually contained powerful steroids. Homeopathic therapies, on the other hand, are unlikely to cause harm. Therapists aim to treat the whole person rather than specific symptoms. In the eyes of conventional scientists there is no explanation for how it works. At the same time, the risks associated with it are small.
Like Dr Adrian White, Dr Bloor warns against against manipulating children's diets. She feels many parents waste money on vitamins and supplements. 'Up to the age of five, children do benefit from vitamin drops containing A, C and D, but other than that, if children are eating a healthy diet they don't need vitamins. When taking vitamin pills, children only absorb what they need and excrete the rest anyway.'
She says, 'We all have to be sensibly critical of imposing medicines on children unless we are sure that, first, a problem needs treating, and second, that the treatment is at best going to have benefits and at worst do no harm.'
Parents and carers should be particularly careful of giving therapies to younger children, who cannot communicate verbally.
However, one treatment that Dr Bloor advocates for well babies is baby massage. 'When my daughter was a baby I took her to massage sessions run by our local health visitors, for one hour a week for six weeks,' she says.
'It was a lovely way of bonding. Now I rub her tummy using baby massage if she has constipation. That is a good example of a holistic approach to a child's health.'
She believes conventional medicine has a lot to learn from complementary therapy's holistic approach, where consultations can last an hour or more.
'As a GP I often feel that people would benefit just from more time than we can offer in the surgery, just to hear their anxieties and reassure them.
That's where a good homeopath can come in. But they should know their limits and when to tell parents to seek medical advice.'
