Are they safe?
June 26, 2000 -- Ever since Linda White's daughter reached puberty, the family's consumption of catnip has gone way up.
But it's not that the family cat is getting blissed-out; it's White's 13-year-old daughter who's been taking the herb. White, a writer based in Denver, believes that catnip (mixed with a tincture of cramp bark) makes an ideal remedy for her daughter's menstrual cramps.
The girl happily accepts the concoction, just as she and her brother slurped astragalus soup when they were little kids with sniffles. Ever since they were toddlers, their mother has given them echinacea to ward off colds and peppermint tea to calm their stomachs. Now that they're older, they also take various herbs for acne and muscle strains.
When it comes to medicine, it may seem like White's family is miles from the mainstream. But White, co-author of the book Kids, Herbs, and Health, still believes in doctors. As well she should: Her formal title is Linda White, MD.
White graduated from medical school and trained in pediatrics before she took up writing. With her background, she knows that herbs can't cure everything. She also knows that most herbs have never been scientifically tested on adults, let alone children.
"People ask, 'How can you be experimenting with your kids?' " White says. "But these herbs have been used for thousands of years, which is like a clinical trial on a huge scale. I just use what seems to work best."
Judging from the bottles filling the shelves of health food stores and supermarkets, many parents think the way White does. Supplement manufacturers have recently tapped into a major new market with products such as "E-Kid-Nacea Plus," an echinacea supplement that promises to "support a healthy immune system"; "Calm Child," a combination of hawthorn berry, catnip leaf, and other herbs that "support a focused calmness"; and Herbs for Kids brand "St. John's Wort Blend," a product that "nourishes the nervous system and promotes a positive outlook."
The list goes on: herbal cough elixirs, cold remedies, fever reducers. Whether it's asthma or attention deficit disorder, practically every childhood malady now has a corresponding herbal remedy. Americans are expected to spend nearly $16 billion on herbals this year; clearly, much of that windfall will come from the pockets of concerned parents. But do herbs deliver?
Unfortunately, many parents end up paying for empty promises instead of reliable remedies, says Kathi Kemper, MD, director of the Center for Holistic Pediatric Education and Research at Children's Hospital in Boston and author of The Holistic Pediatrician.
As a pediatrician who practices therapeutic touch and sees some potential value in homeopathy -- two alternative therapies scorned by most traditional doctors -- Kemper could be expected to have an especially open mind about herbs.
But she has strong advice for parents considering the capsules, powders, and potions crowding store shelves: Save your money. Such products are unregulated and unproven, and they're unlikely to live up to their claims, she says. In fact, she says, some may even be harmful.
"I used to be much more pro-herb," Kemper says. "But I found they were not as potent [as manufacturers claim them to be] or as effective as [prescription] medications. I became aware that people were not getting what they were paying for."
Without doubt, the plant world is a bountiful source of medicines and remedies. But a plant in a meadow or forest may bear little resemblance to one that's been stuffed into a capsule, Kemper says.
Such herbal products are only minimally regulated by the Food and Drug Administration, and a given dose may contain anywhere from a megadose of an active ingredient to no active ingredient at all, Kemper says. Herbs can also be contaminated with toxic heavy metals such as lead or mercury, or, in the case of many herbs imported from China, intentionally laced with steroids and other dangerous medications, she says.
Furthermore, only a few herbs, including echinacea and St. John's wort, have ever been tested for safety and effectiveness. And in almost every study, the subjects were either lab rats or adults, not kids, Kemper says. As she writes in her book, "Children are not sophisticated rodents or small adults." Because young bodies process drugs differently, kids may be especially vulnerable to side effects, she says.
The risks are real. In 1998, the American Association of Poison Control Centers (AAPCC) received four reports of children under 6 developing life-threatening complications after taking dietary supplements (not including vitamins and minerals). Another 192 youngsters had less serious reactions. (The association didn't track the particular supplements involved, nor the dosages.) While these cases represent a tiny fraction of all the children who take herbs, there were probably many more incidents that were never reported to a poison control center, says RoseAnn Soloway, associate director of the AAPCC.
Herbs can also indirectly harm children if parents use them in place of prescription medications. "When a child has a serious condition, you don't want to take away proven remedies in favor of untested alternatives," Kemper says.
Kemper only recommends easy-to-recognize herbs of time-tested value. For instance, a child with an upset stomach might feel better after a cup of chamomile and peppermint tea or some juice with a quarter-teaspoon of ginger grated into it. Then again, she says, a little Pepto-Bismol would help, too, but only if the child doesn't have a fever: Pepto-Bismol isn't recommended if kids have fevers because of the risk of Reye's syndrome. If parents still want to take a chance on questionable herbal treatments, capsules, powders, and potions, Kemper suggests sticking with brands manufactured in developed countries -- especially the United States and Germany -- to reduce the risk of contamination.
Clearly, many parents are willing to take a risk on herbal remedies, and many are glad they did. Sunny Mavor, founder of Herbs for Kids and co-author with White of Kids, Herbs, and Health, says she has a huge stack of "love letters" from satisfied clients, and she's never received a complaint about unwanted side effects.
Skeptics and herbalists do agree, however, that parents should use caution with herbs, which means keeping all herbal products out of children's reach and never giving more than the recommended dose. (In general, the dose for a child should be one-third to one-fourth of an adult dose, according to the Herb Research Foundation in Boulder, Colo.) Most important, parents should tell their pediatrician about every herb their child takes.
All sides also agree that scientists aren't likely to settle the questions and uncertainties about herbs any time soon. If parents waited for scientific trials to prove herbs worked for kids, Mavor says, "it would keep herbs out of the mouths of children forever."
Of course, not everyone would say that's a bad thing.
Chris Woolston is a freelance health and medical writer living in Billings, Mont. He writes for WebMD, Consumer Health Interactive, and Time Inc. Health.
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