Natural health product use and management in pediatrics: An integrative review

Introduction: Pediatric use of natural health products (NHPs) is common, although conventional health care providers frequently do not attempt to manage them due to limited knowledge and lack of confidence. The aim of this review is to synthesize available guidance given to pediatric health care providers on how to manage NHPs in clinical practice. Methods: An integrative review of the literature was conducted. Key search terms were NHPs, dietary supplements, herbal medicines, CAM, pediatrics, decision-making, guides, management, safety, parents, and medical providers. Expert organizations and databases including CINAHL, PubMed, Embase, and the Cochrane Collaboration were searched. Fifty-two articles were chosen for inclusion based on appraisal using the Johns Hopkins Nursing Evidence-Based practice tool for research and non-research. Themes for NHP management were identified through integrating repeated expert guidance. Results: Three themes emerged from the literature regarding clinical management of NHPs: product regulation and its impact on safety, communication deficits, and limited provider knowledge. Despite guidance on NHP management from well-known organizations such as the American Academy of Pediatrics and the NIH National Center for Complementary and Alternative Medicine, considerable heterogeneity was discovered in management guidelines. Discussion: This is the first known review to synthesize NHP clinical management guidance. Identified themes led to development of six key principles to help guide clinician NHP management. More research is needed to evaluate if this guidance is effective in promoting clinician confidence and competency with NHP management. (C) 2013 Elsevier GmbH. All rights reserved.