Herbs in Pediatric and Adolescent Medicine

Increasing numbers of children and adolescents turn to complementary and alternative medical therapies to promote health, prevent illness, and treat acute and chronic conditions. Herbs are among the most commonly used of these therapies. In 1998, herbs and other dietary supplements were a $3.5 billion dollar industry in the United States. Among teenagers who use complementary and alternative therapies,nearly 75% use herbs.Herbs and medications share a common history. Many of our most well-known medications—from aspirin and atropine to vinca alkaloids—were derived from herbs. Although many physicians would say that they are unfamiliar with herbal remedies,the vast majority rely on at least one herbal import every day: coffee. Some of the same reasons that lead physicians to choose coffee over caffeine-containing medications lead patients and families to choose herbal remedies over more standardized pharmaceutical counterparts, that is,social and cultural values and practices. Further, although many physicians lack a detailed knowledge of the hazards of natural herbal remedies,most regularly counsel their teen patients on the most widely marketed herb of all—tobacco.Tobacco illustrates three key principles of herbal toxins:1) Although some herbs have been used for thousands of years, even for religious or medicinal purposes,historical use is not a guarantee of safety; 2) The toxicity of an herb may not be apparent with single or occasional use, but short-term safety is no guarantee that chronic exposure is free of danger; 3) Beyond the potential toxicity of the herb itself are the pesticides, herbicides,and other substances with which it may be laced, which may contribute substantially to both acute and long-term health hazards.Because many herbal products are marketed as pills, capsules, or tinctures, consumers may assume that they are safe and have passed the type of rigorous standards set for pharmaceutical products. However,according to federal legislation enacted in 1994, herbs and other dietary supplements can be marketed without testing for safety or effectiveness, broad and vague“structure/function” claims are allowed, and the United States Food and Drug Administration does not have to approve packaging or marketing information before a product reaches the market. Thus, consumers have essentially no protection against misleading or fraudulent claims made by herbal manufacturers. Products vary substantially, with some(especially those containing the more expensive herbs such as ginseng)containing no active ingredients and up to 30% of herbal patent remedies imported from China having been laced with potent pharmaceuticals such as phenacetin and steroids.The purposes of this article are to familiarize pediatricians with: 1) the herbs used most commonly by children and adolescents, 2) the terms used to describe herbal products,3) common chemical constituents in herbs, and 4) herbs that are known to be toxic on either an acute or chronic basis. Further, it is designed to provide a referral source for additional information about herbal medicines from books, periodicals, and Web sites.A full list of references employed for this article can be obtained from the online version of this article. Please see: www.pedsinreview.org.Table 1Table 2Table 3Table 4Table 5Table 6Table 7