Complementary Therapies in Medicine 2013 (Apr); 21 Suppl 1: S34–47 ~ FULL TEXT
Tycho J. Zuzak, Johanna Bonková, Domenico Careddu, Miklós Garami, Adamos Hadjipanayis, Janez Jazbec, Joyce Miller et. al.
Department of Pediatric Oncology and Hematology,
University Children's Hospital Essen,
Hufelandstr. 55, D-45147
INTRODUCTION: Few data document the use of complementary and alternative medicine (CAM) in Europe, with even fewer investigating use by children.
METHODS: A narrative, non-systematic review of CAM use in Europe was performed by combining data from published surveys with expert perspectives. Limitations created by a lack of representative studies, varying definitions of CAM use, and what qualifies as CAM in different countries was partially overcome by integrating local experts to summarise information available only in the national language and provide their perspectives about CAM availability, quality, use and popularity in their countries using a semi-structured questionnaire. Local and international published surveys were summarised, and the prevalence of CAM use was extrapolated.
RESULTS: Data from 20 European countries were available, representing 69% of the European population. Some data about CAM use by the general population were available for 90% of the examined countries, whereas peer-reviewed published surveys were available for only 60%. We extrapolated that 56% (range: 10-90%, adjusted for population size) of the European population in general had used CAM at least once in the past year. Surveys in CAM use by children were available for 55% of the investigated countries. The extrapolated prevalence of CAM use by children in Europe was 52% (range: 5-90%, adjusted for population size). Paediatric CAM experts reported an increasing awareness for and use of CAM in healthcare institutions.
CONCLUSION: This precursor for further surveys indicates that CAM appears to be popular not only among adults in Europe, but also for children. Development of a pan-European definition of CAM use and CAM therapies are required to achieve surveys comparable between European countries. Additionally, more research investigating the efficacy and potential adverse effects of CAM therapies is needed because of increasing CAM use by children in Europe.
KEYWORDS CAM; Prevalence; Europe; Child; Homeopathy; Herbal; Acupuncture; Anthroposophic
From the Full-Text Article:
Complementary and alternative medicine (CAM) includes
practices that are not an integral part of the conventional
healthcare system, but are used by many patients to supplement
their care.  Particularly patients in western industrial
nations show an increasing interest in using CAM to treat
acute and chronic diseases. [2–4] This rising interest includes
both adults and children. [1, 5–7] Professional organisations,
such as American Academy of Pediatrics and the WHO, have
begun to collect and publish information about which types
of traditional and complementary medicine are used by
certain patient groups. [8, 9] Efforts to include education and
training for CAM therapies in medical school programs and
in healthcare institutions have also become popular in some
European countries. [10, 11]
Europe covers approximately 10,180,000 km2 (3,930,000
sq. mi), consists of approximately 50 states and hosts a population
of 731 million people. Europe is distinguished by its
wide variety of languages, cultures and religions. This heterogeneity
makes assessing CAM use and CAM training across
Europe as a whole difficult. Exact numbers for the prevalence
of CAM use in Europe are not available. Europe-wide
surveys of CAM use by the public in general and not focussed
on patients with a specific disease currently do not exist.
The survey conducted by Molassiotis et al. gathered data for
CAM use by cancer patients in 16 European countries using
a descriptive investigation, and found that 36% of the cancer
patients surveyed have used some form of CAM (range
among countries: 15–73%). 
They identified a heterogeneous
group of 58 therapies being used by cancer patients.
Recent studies conducted in Europe report that CAM use by
children is less common than by adult patients, but appears
to be increasing in some European countries. [9, 13, 14] Although
there have been some recent efforts in singular European
countries to investigate paediatric CAM usage and characterise
the CAM user, an international comparative survey has
not yet been done. [15–18] The aim of this survey was to present
an overview about characteristics of CAM use in children
in different European countries and to estimate the prevalence
of CAM use by the population in general, and more
specifically by children, in Europe despite the scarcity of
peer-reviewed published surveys.
A narrative, non-systematic review was assembled by combining
expert opinions with a thorough and balanced review
of available evidence from the literature.  An unrestricted
literature search using the keywords, 'alternative',
'complementary', 'integrative', 'prevalence' and
'paediatric' or 'children' was performed by internet
search using PubMed and open accessible search engines.
All European countries with a minimum of 5 million habitants
were initially included for which any data about CAM
use in children were published in the last 10 years (29
countries), then expanded to include 2 smaller countries.
Corresponding authors from these publications were contacted
in each country, and they were asked to provide
information about paediatric CAM use in their countries.
These authors stand out because of their activities in
investigating CAM in paediatrics and were of different
professions and positions, such as physicians, scientist and
No negative selection had to be made, because
paediatric CAM experts in European countries are very rare.
We developed a semi-structured questionnaire divided
into three sections for provision of
(1) general information about CAM use,
(2) CAM use by paediatric patients, and
(3) space for an expert’s summary, conclusion, and personal comments.
We requested that each participating expert
also conduct a literature search in local and national
databases using the keywords listed above translated into
their native language. We asked the participating experts
to extrapolate the prevalence of CAM use by both children
and the population in general in their countries, estimate
changes in prevalence over time and estimate CAM awareness
of healthcare professionals and politicians in their
countries based on published investigations. If published
surveys were insufficient, we asked experts to complement
existing data with their expertise.
We obtained data from 20 (72%) of the 29 European
countries to which we made requests, and data were
provided by at least one expert in each of these 20
countries. Thus, expertise was available concerning CAM
use from countries with altogether more than 534 million
inhabitants (69% of the total European population)
and covering an area of 5,590,000 km2 (43% of Europe).
Some data about CAM use by the general population
was available from surveys for 18 of the 20 (90%)
countries, but usually only included adult respondents
Data from surveys published in international, peerreviewed
journals were available for 12/20 (60%) countries,
but these were of different quality, included different
groups within the population, utilised different definitions
for CAM use (1 per year, vs. 1 per lifetime, etc.) and/or
inquired a restricted number of CAM therapies only (Fig. 1).
This lack of a standardised approach and often also the
examination of a study population non-representative for
the entire country in published surveys prevented the calculation
of general prevalence of CAM use in each country from
published data alone. Participating local experts needed to
extrapolate the general prevalence of CAM use in their countries
from data provided in the surveys together with their
own experience and using their own definitions of what to
include as CAM therapies. We defined CAM use as using at
least one type of CAM (defined by the country expert) at
least once within the last year. The mean prevalence of CAM
use by the general population across all 20 countries was
estimated by the local experts to be 48% (range: 10–90%,
Fig. 2). The mean prevalence of CAM use in Europe adjusted
for the size of the population of each country was 56%.
(70%) experts reported that CAM use was rising in their
countries, and 11 (55%) experts reported that awareness
about CAM in healthcare and politics was increasing (Fig. 3).
Data were available for CAM use in children from surveys
conducted in 11 (55%) countries, 9 (45%) of which were published
in international, peer-reviewed journals. The mean
prevalence of CAM use by children across all 20 countries
was estimated by the local experts to be 45% (range: 5–90%).
The mean prevalence in Europe adjusted for the size of the
population of each country was 52%. A qualitative analysis
of the most popular CAM therapies in Europe identified
homeopathy, herbal medicine and acupuncture, but a wide
diversity of CAM therapies were used by both children and
adults in the surveyed countries. Some CAM types were not
surveyed in some countries because no standardised list of
CAM therapies exists. Details compiled from the information
submitted by participating experts about CAM use are
described for each country (in alphabetical order) in the
Austria (population 8.2 million)
Acupuncture, osteopathy, homeopathy, neural therapy,
F.X. Mayr therapy, traditional Chinese medicine (TCM),
orthomolecular therapy, anthroposophic medicine, applied
kinesiology, and herbal medicine are CAM methods that are
recognised by the Austrian Medical Board and for which
standardised national training and qualification standards
exist. In Austria, 11% of physicians are certified by the Austrian
Medical Board for acupuncture, 6.6% for osteopathy, 2%
for homeopathy, less than 1% for the remaining recognised
Children: There are no published data about
the use of CAM by paediatric patients to date, however,
the 'CAMbrella Austria' research consortium is currently
gathering these data for publication. 
Comment: Only 6
paediatric departments in Austrian hospitals offer CAM via
outpatient clinics. Very little paediatric CAM research has
been conducted compared to the many and increasing number
of CAM research groups for adults. We estimate that 60%
of paediatric patients use CAM provided in private practices.
Bulgaria (population 7.7 million)
Bulgaria possesses a long-standing tradition in herbal
medicines. CAM was officially recognised in Bulgaria for the
first time with the changes to the health law 2001.  The Bulgarian
traditional medicine is grounded in phytopharmacy. 
The use of many Chinese and Indian medical techniques,
such as acupuncture and yoga, started after the turn to
a market-oriented economy. Homeopathy has been used
since 1990.  More recently Bulgarian authors have started
analysing the wide-spread utilisation of dietary food supplements
against minor ailments. [24–26]
Children: No published
data about CAM use by children are available.
Available studies show that interest in and usage of CAM
in Bulgaria is increasing. Studies have focussed on safety
evaluation of the widely used non-traditional herbs, such as
Ginkgo, and created a methodological approach for establishing
a national herbal drugs policy. 
Cyprus (population 1.0 million)
Popular CAM therapies in Cyprus include homeopathy, herbal
medicine, chiropractic, acupuncture, aromatherapy and
reflexology. There are ten medical doctors practicing homeopathy
on the island. One unpublished study was conducted
by the Cyprus University in 2010. From the 600 interviews
conducted in all districts of Cyprus (urban and rural), they
found that 60% of the respondents had heard of homeopathy,
17% had visited a doctor practicing homeopathy, and
20% had used homeopathic medicine. Additionally, 75% of
the respondents stated that homeopathy should be included
in the National Health System.
Children: No published data
of CAM use by children are available.
Comment: CAM use is
not popular among Cypriot patients, and no legislation exists
for CAM. A few CAM practitioners are interested in training
others, and there is no research currently being conducted
in this field in Cyprus.
Czech Republic (population 10.2 million)
No formal studies have explored CAM use in the Czech
Republic. However, interest in CAM appears to be growing
among the population. The number of CAM products available
is increasing, as are seminars and courses about CAM.
The number of healthcare professionals with CAM training is
also growing. CAM therapies broadly ranging from homeopathy,
anthroposophic medicine, TCM and Ayurveda to dietary
methods, naturopathy, manipulative methods and spiritistic
medicine are available in the Czech Republic.
published data of CAM use by children are available.
Up to the recent past, CAM was not taken seriously
by the public health authorities or ignored completely. A
change from this position is taking place very slowly and is
Denmark (population 5.3 million)
In 2005, 42% of the Danish population reported that they
had used CAM. Acupuncture (5%), reflexology (6%), and
other types of bodywork (13%) were the most popular
methods.  Half of all general practitioners offer CAM in
their practices.  The typical Danish CAM user is either a
child or a female between 25 and 64 years of age, often
well-educated and living in a big city. [28, 29]
Children: A study
conducted in 2003 by the Odense University Hospital found
that 53% of paediatric patients used CAM and that 23% had
used it during the last month.  The types of CAM used
were divided between herbal medicine (herbal drugs or
dietary supplements, used by 15%), alternative therapies
(i.e. acupuncture, used by 7%) and chiropractic (used by
2%). A positive effect of CAM treatment was experienced by
56% of patients using herbal drugs or dietary supplements,
79% using alternative therapies, and 92% using chiropractic,
and 6% of patients reported experiencing side effects
that appeared to come from the herbal treatment or change
Comment: CAM use has increased over the last 20
years, and most Danish patients now seem to prefer CAM
treatments over treatment with pharmaceutical drugs. CAM
is often used to treat children in Denmark, and its use in
paediatrics continues to increase rapidly.
France (population 60.8 million)
We estimate that fewer than 5 hospitals offer CAM treatments
experimentally. Homeopathy and auriculotherapy are
most popular. Only one survey has been published to date,
and was performed in 2005 at 3 hospitals (both public and
private) treating both adult and paediatric cancer patients
including the Centre du Lutte Contre le Cancer Paul Strauss
(CLCC), in Strasbourg.  Of the cancer patients surveyed,
28% used at least one CAM treatment. Homeopathy (60%),
special diets or dietary supplements (44%), herbal medicine
(37.5%) and mistletoe preparations (40%) were reportedly
Children: There is no survey of CAM use in general
paediatrics. Ten children with cancer were included in the
summarised survey. Half of them reported using CAM: homeopathy
(4 patients), mistletoe preparation (1), vitamin C
(5), selenium (2) and fish oil (2).
Comment: CAM is most
often suggested by general practitioners with a subspecialty
in homeopathy and sometimes by CAM therapists or discovered
by patients in the Internet. There is no recognition of
CAM by the French government.
Germany (population 82.5 million)
Approximately 70% of German people declared they use
some form of CAM.  Popular CAM therapies are homeopathy,
chiropractic, herbal medicine, TCM and anthroposophic
medicine. About 30% (60,000) of German physicians have at
least one CAM certification, and these are most commonly
in homeopathy, naturopathy, acupuncture, chiropractic or
Children: A study performed at
an outpatient clinic for general paediatrics in 2005 revealed
that 59% of the parents of children with chronic illnesses
and 53% of the parents of children with acute illnesses gave
their children some form of CAM.  Homeopathy, herbal and
anthroposophic remedies were used most often. A study performed
in patients with diabetes mellitus reported that 18%
used CAM therapies that included homeopathy, vitamins and
minerals and special diets,  and 35% of paediatric cancer
patients reported using CAM (most frequently, homeopathy,
nutritional supplements and anthroposophic medicine)
in a survey conducted in 2004. 
Comment: CAM has a long
tradition in Germany and is frequently used, but surveys
of CAM use by paediatric patients have only recently been
initiated. In general, professionals working in paediatrics
in Germany are more open towards CAM therapies. The
number of publications about CAM in specialist medical
resources is increasing, as are the number of research publications
and presentations at scientific meetings in the field
Greece (population 11.2 million)
A study published in 1996 indicates that 31% of the
inhabitants of Attica (Athens’ district) had visited a CAM
practitioner at least once.  This figure is estimated to
be much higher now, based on sales of CAM medicines
by pharmacies. According to a recently published study,
Greek physicians display little interest in CAM, but are most
familiar with homeopathy (59%), special diets (58%), antioxidants
including vitamin C (56%) and acupuncture (48%). 
Homeopathy, acupuncture, herbal medicine, reflexology and
aromatherapy are most popular in Greece.
Children: No published
data for CAM use by children are available. Only 7
paediatricians are known to practice homeopathy throughout
Comment: The perceived proportion of patients
using CAM is low. CAM is not officially recognised in Greece,
although manufacture and circulation of CAM medicines
are officially regulated by Greek legislation. Insurers cover
homeopathy and acupuncture treatments from physicians
only. Interest of Greek patients in CAM increases yearly, but
Greek physicians display little interest in CAM.
Hungary (population 10.0 million)
Approximately 50–60% of Hungarian people use some
form of CAM,  with homeopathy and herbal medicine
being most popular. Although, allopathic physicians are the
most common providers of CAM, non-allopathic physicians
and non-medical practitioners may provide specific CAM
Children: Of paediatric cancer patients, 60%
report using some kind of CAM.  Natural products, dietary
supplements, herbal medicines and special diets are most
Comment: CAM use has been increasing in Hungary
since the fall of the Iron Curtain in 1989. [38, 39]
Italy (population 58.6 million)
A survey by the National Institute of Statistics in 2005
showed that 14% of the population had used CAM,  and
that homeopathy, manual treatments, herbal medicine and
acupuncture were most common.
Children: The 2005 survey
reported that 10% of children between 0 and 14
years of age had used CAM, and that 8% of these children
used homeopathy, 2% used herbal medicine (2%)
and <1% used manual treatments or acupuncture. Other
CAM therapies were not surveyed. In a study conducted
in 1999, 46% of respondents reported using CAM
to treat health problems of their children,  including
homeopathy (72%), herbal medicine (17%), acupuncture
(5%), anthroposophic medicine (2%), chiropractic (2%),
osteopathy (1%) and oriental medicine (1%).
The National Federation of the Orders of Physicians
and Dentists drew up a document in 2002 identifying
disciplines that are recognised as non-conventional
medicine and can only be practiced by medical doctors.
These include acupuncture, herbal medicine, homeopathy,
homotoxicology, anthroposophic medicine, Ayurveda and
Netherlands (population 16.3 million)
Between 9 and 10% of Dutch people visit a CAM practitioner
at least once yearly.  Homeopathy, acupuncture, naturopathic
medicine and paranormal healers are most popular.
Children: A study published in 1998 reported that 31% of
a group of Dutch paediatric cancer patients used CAM.  A
survey conducted in 2006 reported that almost one third
of patients visiting a general paediatrician had used CAM
in the past year.  Most frequently used were homeopathy
(48%), herbal medicine (45%), nutritional supplements
(28%) and manual therapies (28%). A third study revealed
that almost 40% of parents of paediatric gastroenterology
patients were turning to CAM for their child. 
CAM is frequently used by Dutch paediatric patients, and
a change in thinking regarding CAM has been observed
during the last 5 years. Paediatricians are more open to
CAM, but not very knowledgeable about it.  Recently, an
incidental but fatal adverse reaction was reported in the
Netherlands for a 3–month old baby receiving craniosacral
therapy. This incident has heightened awareness about the
risks of CAM and the necessity of giving evidence-based
advice to parents. 
Norway (population 4.5 million)
Studies of the prevalence of CAM use in Norway have
focussed on visits to CAM practitioners. The latest study
reported that 49% of Norwegians were treated by CAM
practitioners during the previous 12 months.  Massage,
acupuncture, homeopathy and reflexology were most commonly
used. Norway has an indigenous population, the Sami,
which have their own folk medicine.
Children: No data is
available specifically about the prevalence of CAM use in
paediatrics in Norway, although some studies did include
children. The proportion of children under 10 years of age
that visited homeopaths increased from 10% in 1985 to 26% in
1998.  Another study reported an increase in the proportion
of children under 16 years of age who visited homeopaths,
compared to others CAM providers, increased from 25% in
1995 to 36% in 2004. 
Comment: The Norwegian government
has actively supported CAM research, treatment and
legislative regulation. Research funding was provided in the
1990ies, and a national research centre and national information
centre established in 2000 and 2007, respectively. A
law regulating CAM practitioners was passed in 2004, and a
school for acupuncture was officially accredited in 2009.
Poland (population 38.6 million)
Approximately 58% of Polish patients use some form of CAM,
including 35–94% of cancer patients, [50, 51] 68–70% of sclerosis
multiplex patients, [52–54] 38% of patients with cardiac
problems51 and 47–50% of patients with discopathy. The
most popular CAM therapies were reported to be herbal
medicine and bioenergotherapy, which were used by 42–83%
patients.  A survey of oncological wards reported that 42%
of the physicians treated their patients with at least one CAM
Children: The only study referring to children was
conducted on paediatric cancer patients, and reported that
43% used CAM.  The types of CAM included spiritualism (47%
of CAM users), herbal medicine (42%), bioenergotherapy
(37%) and special diets (2%).
Comment: CAM is frequently
used by patients in Poland, but published data for CAM use is
limited, especially for paediatric patients. Existing data suggest
large numbers of self-medicating adult and paediatric
Portugal (population 10.5 million)
Two published articles mentioned that CAM use in Portugal
has increased over the last few years. [57, 58] No data exist
on the prevalence of CAM use in the general population.
A qualitative study mentions that approximately 25% of
people contacted that lived in urban areas and 75% that
lived in rural areas stated they visit some type of CAM
therapists, which included acupuncturists, chiropractors,
several specific types of local healers and herbal medicine
practitioners.  A wide variety of ethnopharmacological
studies on primarily wild plants used as herbal remedies
in some regions of Portugal have been conducted, [60–64] suggesting
that herbal medicine constitutes a major component
of traditional medicine.
Children: No data are available for
CAM use by children.
Comment: CAM is only practiced in
private clinics. Very little CAM research has been conducted
in Portugal other than ethno-pharmacological investigations
of plants used in traditional medicine. The appearance of
several private CAM clinics and a look at books available in
public libraries suggest that popular interest in CAM is rising.
Slovenia (population 2.0 million)
No studies have explored the prevalence of CAM use in the
general population or any specific group in Slovenia.
Unpublished results of a survey among parents of
paediatric cancer patients showed that between 60% and
80% used some form of CAM to treat their children. The range
of methods was wide, and included dietary interventions,
homeopathy, TCM, Ayurveda and other biological, manipulative
and energetic methods.
Spain (population 43.3 million)
Published data indicate that 24% of the population have
used some type of CAM.  Most popular were yoga, acupuncture
and chiropractic. A larger percentage of patients with
chronic illnesses reported using CAM: 37% of patients with
hepatitis,  26% of patients with intestinal inflammatory
illnesses  and 48% of patients with fibromyalgia. 
No published data about CAM use by children are available.
Comment: CAM is offered by physicians and therapists without
Sweden (population 9.0 million)
Use of CAM has increased over the past 20 years in Sweden.
An investigation in 1987 showed that 22% of the population
of Stockholm had experience with CAM use,  and a study
in 2001 reported that 50% of people living in Stockholm had
used CAM at least once.  The most common CAM therapies
were massage, natural products, chiropractic, acupuncture
and naprapathy. Zone therapy, homeopathy, healing, anthroposophic
medicine, rosen therapy, kinesiology and crystal
therapy are less common but also practiced in Sweden. 
Children: Swedish law prohibits practicing CAM on children
under 8 years of age, reducing the published data
available for CAM use in paediatrics in Sweden. One article
has been published concerning communication therapy
via expressive art  and another concerning pain experience
and management by non-pharmacological strategies,
thermal regulation and distraction. 
Comment: As EU regulations
for CAM become available, it is expected that Sweden
will raise the ban against CAM and follow EU directives.
Switzerland (population 7.5 million)
Approximately 57% of Swiss people declared they use
some form of CAM.  Popular CAM therapies are homeopathy,
herbal medicine, TCM and anthroposophic medicine.
Acupuncture, anthroposophic medicine, homeopathy, TCM,
neural therapy and herbal medicine were an integral part
of primary care in Switzerland between 1999 and 2005, and
will be reintegrated between 2012 and 2017 to gather more
scientific evidence about its pros and cons. 
study performed at an intensive care unit in 1997 revealed
that 18% of the parents of critically ill paediatric patients
used some form of CAM.  In a current survey performed
at the emergency department of the same hospital, 58%
of all respondents stated that their children were using or
had used some form of CAM therapies, 25% during the presenting
illness.  Homeopathy was the most frequently used
form of CAM (77% of all CAM users), followed by herbal
medicine (64%), anthroposophic medicine (24%), TCM (13%)
and Ayurveda (5%). 
Comment: CAM has a long tradition
in Switzerland and is frequently used, but surveys of CAM
use by paediatric patients have only recently been initiated.
These efforts report high numbers of self-medicating
paediatric patients and an exclusion of the physician from
the decision-making process. Furthermore, some adverse
effects and intoxications have been reported with remedies
from CAM. 
Turkey (population 73.7 million)
Most published data about CAM users in Turkey concern cancer
patients.  The prevalence of CAM use among patients
with cancer varied between 36%  and 87%.  Some studies
are also available about CAM use by healthy people, and
most of these concern herbal preparations. 
of CAM use ranged from 46% to 77% for children. [89–94]
Ozturk and Karayagiz concluded in 2008 that a majority
of parents (57%) used CAM therapies for their children,
with herbal therapy being most popular (77%).  Hizel-Bulbul
et al. reported in 2008 that 27% of parents, who used natural/
herbal products for their children within 1 year, used
them without a doctor’s recommendation. Commonly known
alternative treatment methods were thermal water (83%),
herbal tea (21%), acupuncture (15%), massage (6%), and
bioenergy (2%).  A study performed in endocrinology centres
for diabetes management in 2006 revealed that 52%
of the parents of diabetic paediatric patients applied some
form of CAM.  Herbal medicine (60% of all CAM users) was
most popular. Most (69%) families did not report their CAM
use to any healthcare professional. Three studies on CAM
usage by paediatric oncology patients have been conducted
in Turkey. The incidence of CAM usage for children with
cancer varied between 49 and 77%, and herbal products
were most commonly used. [79, 93, 94]
Comment: Despite the
high prevalence of CAM use in Turkey, a gap exists between
CAM users and healthcare professionals. Healthcare professions
neither ask about CAM use nor inform their patients
about CAM therapies, and also patients or their parents do
not inform their physicians about CAM use during conventional
UK (population 61.7 million)
CAM usage has increased in both adult and paediatric populations
in the last decade. A 2010 survey of both adults and
children documented that 60% had used CAM at least once
in their lives and 35% had done so in the last year,  compared
with surveys in 2000 and 2001 reporting CAM usage
by adults to be between 20 and 28%. [96, 97]
Children: In an
systematic review of 2,781 children in the UK covering the
years 1975–2005, CAM use ranged between 6 and 91%.  A
UK-based cross-sectional survey from 2001 reported that 18%
of children used some form of CAM at least once.  In 2008,
a cross-sectional survey of all paediatric outpatients over
a 3-month period at a major paediatric hospital reported
that 37% of their patients used CAM.  CAM use was not
reported to the responsible clinician in over half the cases.
In two other cross-sectional surveys of 339 and 337 parents
of paediatric patients, 54% and 51% had not told their paediatrician
or GP about their CAM usage, respectively.  A large
Scottish study of 161 general practices treating 167,865 children
reported that 5% of practices provided homeopathy and
herbal remedies, with most prescribed being for the treatment
of infant colic (85%), musculoskeletal bruises (52%) and
teething (49%).  Adverse effects either as a direct result
of homeopathy or herbal remedies, or as a result of interactions
between CAM and conventional medicines have been
reported. [103, 104]
Comment: Healthcare professionals who do not supply
CAM in their own clinics often refer or offer advice to
patients about CAM.  Many healthcare professionals consider
themselves not well informed enough about CAM to
recommend it to their patients, but would like to see CAM
more commonly included in NHS services. [102, 105–110] Parents
in the UK commonly choose CAM therapies for their children,
and 61% stated they are satisfied with the result, with 65%
stating they would recommend it to others.  These trends
appear to be driving diversification of the types of CAM therapies
offered to and used by paediatric patients in the UK
Little is known about CAM use by children. This is especially
true for Europe, since the bulk of the literature is derived
from children living in the USA. Comprehensive European
analyses of CAM use in paediatrics are scare, which may
partly be due to the diversity of languages, alphabets, religions,
biodiversity and the historical background of Europe.
Here we present a pan-European review about CAM in paediatrics,
realised by combining data published in international
journals, data from local or national surveys in original language
conveyed by local experts, and expert perspectives
about CAM availability, quality, use and popularity in their
countries. Thus, a control mechanism was integrated by
expert experience that increased the amount and quality
of information about CAM use in Europe to provide the best
comparative picture possible.
Published studies were of different quality and based on
various definitions of CAM or CAM use. For instance, some
studies asked only about specific therapies, some included
all types of CAM and surveys qualified CAM use either as in
a certain period of time or over the entire lifetime. In fact,
the absence of a uniform definition of CAM for European
countries also creates different country-based perspectives
about what is included when all types of CAM are surveyed.
Surveys about the use of CAM in European countries published
in international, peer-reviewed journals were rare
and did not contain data from a representative group of
the population, preventing accurate extrapolation of mean
CAM use in Europe. Although surveys of some kind had been
conducted in 90% of 20 European countries included in our
review, only 60% of these were published in peer-reviewed
journals. All of these points of variability prevent the unified
questioning in different countries that is required as
the base for a systematic review. Our approach extended
the data that could be included to those also published in
the national language and attempted to bridge the lack of
unified questioning with expert perspectives.
CAM therapies appear to be popular not only with adults,
but also for children, in Europe. This was demonstrated
both in the available surveys and in the opinions of the participating
local CAM experts from the 20 larger European
countries in our review. Our review incorporated data that
can be extrapolated to represent 68% of European population,
making it the most comprehensive effort to date. Our
results suggest that more than 430 million citizens in Europe
may use CAM, and that CAM use has a similar prevalence
among European children. This widespread use of CAM and
the anecdotal reports of adverse side effects either directly
from CAM therapies, as a result of interactions between CAM
and conventional therapies used in combination or because
of insufficient training by healthcare providers strongly support
a need for more structured CAM research. Investigations
of how CAM treatments are conducted are needed to raise
the quality of CAM treatment, and in cases where CAM is
used in combination with conventional treatment, would
also optimise the combined success of treatment.
Our use of local expert perspectives in this review to
compensate for deficiencies in published surveys may have
resulted in an overestimation of CAM use because of personal
experiences and preferences of these experts. Despite
its potential limitations, this survey can serve as a base for
further efforts to investigate European CAM use in children.
Several local experts described an increased awareness
about CAM in healthcare and politics in combination with
some type of wait-and-see strategy of their country regarding
the regulation or training for CAM treatment. However, it
appears that most countries will wait and adapt regulations
for CAM use and training decided by the EU.
This is especially
important for Sweden, where it is currently prohibited by
law to treat children less than 8 years of age with CAM therapies.
Evidence-based research necessary for pan-European
harmonisation of paediatric CAM use and training are currently
limited by lack of Europe wide funding and consortia
for cooperative investigations in several European countries.
The CAMbrella project has been initiated to assess CAM use
in the general population.  A collaborative effort similar
to CAMbrella is necessary for paediatrics to generate the
evidence-based data necessary to inform EU legislation for
CAM use and training specifically for children. The European
Paediatric CAM Initiative was launched 2010 with paediatric
CAM specialists from four European countries and is in the
process of recruiting more.  This initiative may have the
power to provide the basis for such a consortium to investigate
CAM use in paediatrics.
Our survey implies further steps to reach the next pan-
European goals for CAM use in paediatrics. Establishment
of a European definition for CAM and CAM use would allow
initiation of pan-European systematic reviews. Creating this
definition requires standardisation of CAM use, designation
of specific therapies as CAM and definition of a homogeneous
study population. A validated unifying questionnaire should
also be created that is adapted for specific European characteristics.
These efforts would lay the groundwork to support
extensive systematic investigations in European countries on
CAM use in paediatrics.
Conflict of interest statement
The author has no conflicts of interest.
We thank K. Astrahantseff for helpful discussions about the
paper and editing, and S. Freund for preparation of the figures.
Eisenberg DM, Davis RB, Ettner SL, Appel S, Wilkey S, Van Rompay M, Kessler RC.
Trends in Alternative Medicine Use in the United States, 1990 to 1997:
Results of a Follow-up National Survey
JAMA 1998 (Nov 11); 280 (18): 1569–1575
Cohen MH, Kemper KJ, Stevens L, Hashimoto D, Gilmour J.
Pediatric use of complementary therapies: ethical and policy choices.
McCann LJ, Newell SJ.
Survey of paediatric complementary and alternative medicine use in health and chronic illness.
Arch Dis Child 2006;91:173–4.
Lee FH, Raja SN.
Complementary and alternative medicine in chronic pain.
Prevalence of use of complementary/alternative medicine: a systematic review.
Bull World Health Organ 2000;78:252–7.
Davis MP, Darden PM.
Use of complementary and alternative medicine by children in the United States.
Arch Pediatr Adolesc
Prevalence of complementary/alternative medicine for children: a systematic review.
Eur J Pediatr
World Health Organization:
Legal Status of Traditional Medicine and Complementary/Alternative Medicine:
A Worldwide Review
Cohen MH, Kemper KJ.
Complementary therapies in pediatrics: a legal perspective.
Brinkhaus B, Witt CM, Jena S, Bockelbrink A, Ortiz M, Willich SN.
Integration of complementary and alternative medicine into medical schools in Austria,
Germany and Switzerland: results of a cross-sectional study.
Wien Med Wochenschr
We need a conceptual integration of conventional and complementary medicine.
Molassiotis A, Fernadez-Ortega P, Pud D, Ozden G, Scott JA, Panteli V, et al.
Use of complementary and alternative medicine in cancer patients: a European survey.
Ann Oncol 2005;16:655–63.
Reznik M, Ozuah PO, Franco K, Cohen R, Motlow F.
Use of complementary therapy by adolescents with asthma.
Arch Pediatr Adolesc Med 2002;156:1042–4.
Harris P, Rees R.
The prevalence of complementary and alternative medicine use among the general population:
a systematic review of the literature.
Complement Ther Med
Zuzak TJ, Zuzak-Siegrist I, Simoes-Wust AP, Rist L, Staubli G.
Use of complementary and alternative medicine by patients presenting to a Paediatric Emergency Department.
Eur J Pediatr 2009;168:431–7.
Laengler A, Spix C, Seifert G, Gottschling S, Graf N, Kaatsch P.
Complementary and alternative treatment methods in children with cancer: a population-based retrospective
survey on the prevalence of use in Germany.
Eur J Cancer 2008;44:
Vlieger AM, Blink M, Tromp E, Benninga MA.
Use of complementary and alternative medicine by pediatric patients with functional and organic
gastrointestinal diseases: results from a multicenter survey.
Ozturk C, Karayagiz G.
Exploration of the use of complementary and alternative medicine among Turkish children.
J Clin Nurs 2008;17:2558–64.
JGIM. J Gen Intern Med;
European research network for complementary and alternative medicine,
Pharmacy in medieval Bulgaria.
Bulgarian traditional medicine: a source of ideas for phytopharmacological investigations.
J Ethnopharmacol 1986;15:121–32.
Bordet MF, Colas A, Marijnen P, Masson J, Trichard M.
Treating hot flushes in menopausal women with homeopathic treatment: results of an observational study.
Ribarova F, Stoimenova A, Popova K.
Antioxidant supplements in management of Parkinson’s disease.
Arch Balkan Med Union 2009;44(2):142–5.
Stoimenova A, Ribarova F.
Food supplements for pregnant and lactating women.
Acta Med Bulg 2009;2:24–33
Food supplements in Central and Eastern European countries.
Acta Med Bulg 2010;1:71–7.
Getov IN, Tzenova AT, Ristoff MS, Todorov TV, Petrova GI.
Safety assessment of newly marketed herbal medicines: methodological approach
(Ginkgo biloba example in Bulgaria).
J Herb Pharmacother 2007;7:239–57.
Videns- og Forskningscenter for Alternativ Behandling;
Madsen H, Andersen S, Nielsen RG, Dolmer BS, Host A, Damkier A.
Use of complementary/alternative medicine among paediatric patients.
Eur J Pediatr 2003;162:334–41.
Simon L, Prebay D, Beretz A, Bagot JL, Lobstein A, Rubinstein
I, et al.
Complementary and alternative medicines taken by cancer patients.
Bull Cancer 2007;94:483–8.
Naturheilmittel 2010 Ergebnisse einer bevölkerungsrepräsentativen Befragung;
Gottschling S, Gronwald B, Shmitt S, Schmitt C, Laengler A,
Use of complementary and alternative medicine in healthy children and children with
chronic medical conditions in Germany.
Complement Ther Med 2011, in press.
Dannemann K, Hecker W, Haberland H, Herbst A, Galler
A, Schafer T, et al.
Use of complementary and alternative medicine in children with type 1 diabetes mellitus:
prevalence, patterns of use, and costs.
Pediatr Diabetes 2008;9: 228–35.
Kivellos S, Papatriantafyllou J, Papilas K, Vithoulkas G,
Observational prospective study of homeopathic treatment in patients with migraine.
Cephalalgia July–September 2006;13(3).
Theodoropoulos I, Manolopoulos K, Von Georgi R, Bohlmann
M, Munstedt K.
Physicians and complementary and alternative medicine cancer therapies in Greece: a survey.
J Altern Complement Med 2005;11:703–8.
Buda L, Lampek K, Tahin T, Ikeda Y.
Demographic Background and Health Status of Users of Alternative Medicine: A Hungarian Example.
In: Helle Johannessen, Imre Lázár, editors.
Multiple Medical Realities: Patients and Healers in Biomedical, Alternative and Traditional Medicine Part I:
Body, Self and Sociality, Chapter 2. 2006. p. 21–34. James G. Carrier (General Editor):
European Association of Social-Anthropologists (EASA),
Volume 4, EASA Series I, EASA, USA.
Szirmai H, Földesi E, Zsámbor C, Hauser P, Jakab Z, Müller J,
Alternative therapy in childhood cancer.
Orvosi Hetilap 2006;147(40):1945–9 [Article in Hungarian].
Lázár I. Táltos Healers, Neoshamans and Multiple Medical
Realities in Postsocialist Hungary. Helle Johannessen,
Imre Lázár, editors. Multiple Medical Realities: Patients and
Healers in Biomedical, Alternative and Traditional Medicine.
Part I: Body, Self and Sociality, Chapter 3, p. 35–53. In
James G Carrier (General Editor): European Association of
Social-Anthropologists (EASA), Volume 4, EASA Series ISBN 978-
1-84545-026-7, EASA, USA; 2006.
Lázár I, Johannessen H.
Epilogue: Multiple Medical Realities: Reflections from Medical Anthropology.
In Helle Johannessen, Imre Lázár, editors. Multiple Medical Realities:
Patients and Healers in Biomedical, Alternative and Traditional Medicine, Part II:
Body, Self and the Experience of Healing, Chapter 12, p. 183–98.
In James G Carrier (General Editor): European Association of Social-Anthropologists (EASA) Volume 4,
EASA Series, ISBN 978-1-84545-026-7, EASA, USA. 2006.
Le terapie non convenzionali in Italia (Indagine multiscopo sulle condizioni di salute e ricorso
ai servizi sanitari 2005).
Istituto Nazionale di statistica ISTAT Roma 2007.
Menniti Ippolito F, De Mei B.
Caratteristiche d’uso e livelli di diffusione della Medicina Non Convenzionale.
Ann Ist Super Sanità 1999;35(4):489–97.
Centraal bureau voor de statistiek.
http://statline.cbs.nl/statweb/, [accessed 17.10.10].
Grootenhuis M, Last B, de Graaf-Nijkerk J.
Use of alternative treatment in pediatric oncology.
Cancer Nurs 1998 August;21(4):282–8.
Vlieger A, van de Putte E, Hoeksma H.
The use of complementary and alternative medicine in children at a general paediatric clinic and parental reasons for use.
Ned Tijdschr Geneeskd 2006 March;150(11):625–30 [Article in Dutch].
Vlieger AM, van Vliet M, Jong MC.
Attitudes toward complementary and alternative medicine: a national survey among paediatricians in the Netherlands.
Eur J Pediatr 2010.
Holla M, IJland M, van der Vliet A, Edwards M, Verlaat C.
Diseased infant after ‘craniosacral’ manipulation of the neck and spine.
Ned Tijdschr Geneeskd 2009;153:828–31 [Article in Dutch].
Fonnebo V, Launso L.
High use of complementary and alternative medicine inside and outside of the government-funded health care system in Norway.
J Altern Complement Med 2009;15:1061–6.
Steinsbekk A, Fonnebo V. Users of homeopaths in Norway in
1998, compared to previous users and GP patients. Homeopathy
Viksveen P, Steinsbekk A. Changes in patients visiting a homeopathic
clinic in Norway from 1994 to 2004. Homeopathy
Pawlicki M, Michalczyk A. Studies of the causes of treatment
delay of cancer patients. Wspolcz Onkol 2005;9(5):191–5
[Article in Polish].
Swiatoniowski G, Klaniewski T, Sosnik K, Pokryszko A, Rychlik
M, Warszylewicz-Szymanek M, et al. The estimation of the
prevalence of alternative treatment methods used by patients
with prognostically similar oncological and cardiological entities.
Onkol Pol 2002;5(2):81–6 [Article in Polish].
Fryze W, Mirowska-Guzel D, Wiszniewska M, Darda-Ledzion L,
Czlonkowski A, Czlonkowska A. Alternative methods of treatment
used by multiple sclerosis patients in Poland. Neurol
Neurochir Pol 2006;40(5):386–90.
Mirowska-Guzel D, Gluszkiewicz M, Czlonkowski A,
Czlonkowska A. Alternative methods used in multiple sclerosis
patients. Farmakoter Psychiatr Neurol 2005;21(1):43–50
[Article in Polish].
Potemkowski A, Golab M, Szubra B. Problem of alternative
medicine in the treatment of multiple sclerosis. Zdr Publ
2001;111(2):101–4 [Article in Polish].
Duleba K, Wysocki M, Styczynski J. Physicians attitudes
towards complementary and alternative medicine in patients
with cancer: preliminary report from pediatric and oncology
centers. Med Wieku Rozwoj 2008;12:1148–54.
Duleba K, Wysocki M, Styczynski J. Complementary and alternative
medicine treatment in children with cancer Preliminary
report. Med Wieku Rozwoj 2008;12:1155–60.
Mendes E, Herdeiro MT, Pimentel F. The use of herbal
medicine therapies by cancer patients. Acta Med Port 2010;23:
Gouveia LO, Castanho P, Ferreira JJ, Guedes MM, Falcao F, e
Melo TP. Chiropractic manipulation: reasons for concern? Clin
Neurol Neurosurg 2007;109:922–5.
Nunes B, Esteves MJ. Therapeutic itineraries in rural and urban
areas: a Portuguese study. Rural Remote Health 2006;6:394.
Neves JM, Matos C, Moutinho C, Queiroz G, Gomes LR.
Ethnopharmacological notes about ancient uses of medicinal
plants in Tras-os-Montes (northern of Portugal). J Ethnopharmacol
Novais MH, Santos I, Mendes S, Pinto-Gomes C. Studies on pharmaceutical
ethnobotany in Arrabida Natural Park (Portugal). J
Camejo-Rodrigues J, Ascensao L, Bonet MA, Valles J. An
ethnobotanical study of medicinal and aromatic plants in
the Natural Park of 'Serra de Sao Mamede' (Portugal). J
Rivera D, Obon C. The ethnopharmacology of Madeira
and Porto Santo Islands, a review. J Ethnopharmacol
Tavares AC, Goncalves MJ, Cruz MT, Cavaleiro C, Lopes
MC, Canhoto J, et al. Essential oils from Distichoselinum
tenuifolium: chemical composition, cytotoxicity, antifungal
and anti-inflammatory properties. J Ethnopharmacol
Cabral RM. Presentación del primer estudio sobre uso y hábitos
de consumo de las terapias naturales en Espa˜na; Mayo 2008.
Bruguera M, Barrera JM, Ampurdanés S, Forns X, Sánchez-
Tapias JM. Utilización de las medicinas alternativas y
complementarias por los pacientes con hepatitis C crónica.
Med Clín 2004;122:334–5.
García-Planella E, Marín L, Domènech E, Bernal I, Ma˜nosa M,
Zabana Y, et al. Utilización de medicinas alternativas y consumo
de drogas por pacientes con enfermedad inflamatoria
intestinal. Med Clín 2007;128:45–8.
Junyent-Priu M, Camp-Herrero J, Fernández-Solá J. Utilización
de la medicina alternativa y complementaria en la fibromialgia.
Med Clín 2005;124:397.
Unknown. Rapport from the Parlamentariska alternativmedicinska
komitten. Stockholm Allmänna förlaget;
Jensen I, Lekander M, Nord C, Rane A, Ekenryd C. Complementary
and alternative medicine (CAM)––a systematic review of
intervention research in Sweden. Swedish Council for Working
Life and Social Research; 2007.
Eklöf M. Perspective on complementary medicine. Lund,
Sweden: Studentlitteratur; 2004 [Article in swedish].
Wikstrom BM. Communicating via expressive arts: the natural
medium of self-expression for hospitalized children. Pediatr
Idvall E, Holm C, Runeson I. Pain experiences and nonpharmacological
strategies for pain management after
tonsillectomy: a qualitative interview study of children and
parents. J Child Health Care 2005;9:196–207.
Wolf U, Maxion-Bergemann S, Bornhoft G, Matthiessen PF, Wolf
M. Use of complementary medicine in Switzerland. Forsch
Komplementmed 2006;13(Suppl. 2):4–6.
Rist L, Schwabl H. Complementary medicine as political process.
Swiss public opinion on the 'Future with Complementary
Medicine'. Forsch Komplementmed 2009;16:76–8.
Moenkhoff M, Baenziger O, Fischer J, Fanconi S. Parental attitude
towards alternative medicine in the paediatric intensive
care unit. Eur J Pediatr 1999;158:12–7.
Zuzak TJ, Zuzak-Siegrist I, Rist L, Staubli G, Simoes-Wust
AP. Medicinal systems of complementary and alternative
medicine: a cross-sectional survey at a pediatric emergency
department. J Altern Complement Med 2010;16:
Zuzak TJ, Rauber-Luthy C, Simoes-Wust AP. Accidental intakes
of remedies from complementary and alternative medicine in
children: analysis of data from the Swiss Toxicological Information
Centre. Eur J Pediatr 2010;169:681–8.
Gozum S, Tezel A, Koc M. Complementary alternative treatments
used by patients with cancer in eastern Turkey. Cancer
Akyuz A, Dede M, Cetinturk A, Yavan T, Yenen MC, Sarici
SU, et al. Self-application of complementary and alternative
medicine by patients with gynecologic cancer. Gynecol Obstet
Algier LA, Hanoglu Z, Ozden G, Kara F. The use of complementary
and alternative (non-conventional) medicine in cancer
patients in Turkey. Eur J Oncol Nurs 2005;9:138–46.
Aslan O, Vural H, Komurcu S, Ozet A. Use of complementary
and alternative medicine by cancer patients in Turkey: a survey.
J Altern Complement Med 2006;12:355–6.
Ceylan S, Hamzaoglu O, Komurcu S, Beyan C, Yalcin A. Survey
of the use of complementary and alternative medicine among
Turkish cancer patients. Complement Ther Med 2002;10:
Er O, Mistik S, Ozkan M, Ozturk A, Altinbas M. Factors related
to complementary/alternative medicine use among cancer
patients in central Anatolia. Tumori 2008;94:833–7.
Kav T. Use of complementary and alternative medicine: a survey
in Turkish gastroenterology patients. BMC Complement
Altern Med 2009;9:41.
? Missing from the citations
Yavuz M, Ilce A, Kaymakci S, Bildik G, Diramali A. Examination
of the complementary and alternative treatment use
with breast cancer patients. Turkiye Klinikleri J Med Sci
2007;27:680–6 [article in Turkish].
Erci B. Attitudes towards holistic complementary and alternative
medicine: a sample of healthy people in Turkey. J Clin
Babayigit A, Olmez D, Karaman O, Uzuner N. Complementary
and alternative medicine use in Turkish children with bronchial
asthma. J Altern Complement Med 2008;14:797–9.
Orhan F, Sekerel BE, Kocabas CN, Sackesen C, Adalioglu G,
Tuncer A. Complementary and alternative medicine in children
with asthma. Ann Allergy Asthma Immunol 2003;90:611–5.
Arykan D, Sivrikaya SK, Olgun N. Complementary alternative
medicine use in children with type 1 diabetes mellitus in Erzurum,
Turkey. J Clin Nurs 2009;18:2136–44.
Hizel-Bulbul S, Turgut M, Koyluoglu S. Parents’ views about
alternative practices in children. C¸ocuk Sa?gl??g? ve Hastal?klar?
Dergisi 2009;52:195–202 [Article in Turkish].
Karadeniz C, Pinarli FG, Oguz A, Gursel T, Canter B. Complementary/
alternative medicine use in a pediatric oncology unit
in Turkey. Pediatr Blood Cancer 2007;48:540–3.
Genc RE, Senol S, Turgay AS, Kantar M. Complementary and
alternative medicine used by pediatric patients with cancer in
western Turkey. Oncol Nurs Forum 2009;36:E159–64.
Shakeel M, Trinidade A, Ah-See KW. Complementary and alternative
medicine use by otolaryngology patients: a paradigm
for practitioners in all surgical specialties. Eur Arch Otorhinolaryngol
Thomas KJ, Nicholl JP, Coleman P. Use and expenditure on complementary
medicine in England: a population based survey.
Complement Ther Med 2001;9:2–11.
Ernst E, White A. The BBC survey of complementary medicine
use in the UK. Complement Ther Med 2000;8:32–6.
Bishop FL, Prescott P, Chan YK, Saville J, von Elm E, Lewith
GT. Prevalence of complementary medicine use in pediatric
cancer: a systematic review. Pediatrics 2010;125:768–76.
Simpson N, Roman K. Complementary medicine use in children:
extent and reasons. A population-based study. Br J Gen Pract
Robinson N, Blair M, Lorenc A, Gully N, Fox P, Mitchell K.
Complementary medicine use in multi-ethnic paediatric outpatients.
Complement Ther Clin Pract 2008;14:17–24.
Shakeel M, Little SA, Bruce J, Ah-See KW. Use of complementary
and alternative medicine in pediatric otolaryngology
patients attending a tertiary hospital in the UK. Int J Pediatr
Gerasimidis K, McGrogan P, Hassan K, Edwards CA. Dietary
modifications, nutritional supplements and alternative
medicine in paediatric patients with inflammatory bowel
disease. Aliment Pharmacol Ther 2008;27:155–65.
Tomassoni AJ, Simone K. Herbal medicines for children: an
illusion of safety? Curr Opin Pediatr 2001;13:162–9.
Aviner S, Berkovitch M, Dalkian H, Braunstein R, Lomnicky Y,
Schlesinger M. Use of a homeopathic preparation for 'infantile
colic' and an apparent life-threatening event. Pediatrics
van Haselen RA, Reiber U, Nickel I, Jakob A, Fisher PA. Providing
complementary and alternative medicine in primary care:
the primary care workers’ perspective. Complement Ther Med
White AR, Resch KL, Ernst E. Complementary medicine: use
and attitudes among GPs. Fam Pract 1997;14:302–6.
Ava L, Mitch B, Nicola R. Parents’ and practitioners’ differing
perspectives on traditional and complementary health
approaches (TCAs) for children. 2; 2010, 9–14.
Demographic Survey of Pediatric Patients Presenting to
a Chiropractic Teaching Clinic
Chiropractic & Osteopathy 2010 (Dec 15); 18: 33
Ross S, Simpson CR, McLay JS. Homoeopathic and herbal prescribing
in general practice in Scotland. Br J Clin Pharmacol
2006;62:647–52, discussion 5–6.
Fountain-Polley S, Kawai G, Goldstein A, Ninan T. Knowledge
and exposure to complementary and alternative medicine in
paediatric doctors: a questionnaire survey. BMC Complement
Altern Med 2007;7:38.
Winther C, von Rosenstiel I, Robinson N, Lee R, Shah P, Bukutu
C, et al. It’s a small world: paediatric CAM initiatives in the EU.
Focus Altern Complement Ther Med 2008 June;13(2):90–4.
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