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Children’s Health

Last Updated on May 19, 2021 by MyFormulary

Related Terms

  • Anaphylactic shock, anaphylaxis, anti-diarrheals, B. pertussis, Bordetella pertussis contagious, chicken pox, chickenpox, conjunctivitis, cough, croup, dehydration, diarrhea, diphtheria, ear infection, ectoparasites, electrolyte imbalance, encephalitis, fever, food allergy, herpes, immune system, immunity, infections, lice, middle ear infection, otitis media, pediculosis, pertussis, pink eye, pinkeye, tetanus, upper respiratory infection, vaccination, vaccine, Varicella, whopping cough.

Background

  • Children are vulnerable to certain illnesses and infections for several reasons. First, children do not have fully developed immune systems until they are about 7-8 years old. Because the immune system helps the body fight against diseases and infections, children have an increased risk of developing conditions, such as whooping cough, diarrhea, ear infections, chickenpox, croup, and food allergies, compared to adults.
  • Another reason children may develop illnesses is because they are frequently exposed to germs. Young children are not as aware or diligent about proper hygiene as adults. Children may wipe their noses with their hands and then play with toys shared with other children. When children are at daycare or school, they are exposed to an exceptionally wide range of germs, and it is easy to spread infections among friends or classmates.
  • Research suggests that babies who are breastfed are less likely to develop infections (especially lung infections, ear infections, and diarrhea) during their first year of life compared to babies who are fed formulas. This is because the mother’s breast milk contains important antibodies, enzymes, fats, and proteins that help boost the baby’s immune system.
    Although baby formulas contain all of the important vitamins and nutrients a growing baby needs, manufacturers have not been able to replicate all of the components in breast milk. Formulas lack the antibodies found in breast milk, and they are more difficult for newborns to digest.
  • Many other factors, such as inherited disorders (such as immune system deficiencies) and the home environment, may contribute to childhood illnesses. For instance, children who are exposed to cigarette smoke in the home have an increased risk of developing infections.
  • Because diseases and infections are often more severe in children than adults, it is important that children be taken to their doctors when symptoms develop.
  • Treatment for childhood illnesses varies depending on the specific child. Because children are smaller than adults and their bodies are still developing, they do not usually receive the same treatments. They may require different doses or different types of medicines. It is important that parents and caregivers carefully read the labels of medications to make sure they are safe before giving them to their children. For instance, aspirin is safe in adults, but it should not be given to children because it may cause serious side effects, including Reye’s syndrome, a life-threatening condition that causes brain inflammation and vomiting.
  • When a child is sick, parents are encouraged to have the child stay at home instead rather than attend school or daycare. This helps prevent the sick child from spreading his/her illness to other children. Although individual facilities each have their own rules, most require children to stay at home if they have a fever that is higher than 100 degrees Fahrenheit, are vomiting, or have diarrhea. Some facilities also require children with bacterial infections, such as pinkeye or strep throat, to stay at home for the first 24 hours of antibiotic therapy. Once medicine has been started, the infections are less likely to be contagious.
  • Many steps can be taken to decrease the risk of childhood illnesses. For instance, children should regularly wash their hands with soap and warm water. This is especially important after using the bathroom, before eating food, and after touching objects that may contain disease-causing germs. Avoiding close contact with people who have contagious illnesses may also help reduce the risk of contacting infections. Parents or caregivers are also encouraged to talk with their children’s pediatricians about recommended immunizations, such as the flu shot.

Integrative Therapies

Note
: Most integrative therapies have not been well-studied in children. Safety in children has not been proven for most of the therapies listed below. Therefore, parents and caregivers should talk to their children’s pediatricians before trying integrative therapies.

A

Strong scientific evidence

  • Saccharomyces boulardii

    : There is good evidence that concurrent use of Saccharomyces boulardii with antibiotic therapy reduces the incidence of developing antibiotic-associated diarrhea (AAD) (Clostridium difficile and other). In general, positive results occur only when Saccharomyces boulardii is continued for several days to several weeks after the course of antibiotics is stopped. Duplication of these results should be attempted to confirm these findings.

  • Avoid if allergic or hypersensitive to yeast, Saccharomyces boulardii, Saccharomyces cerevisiae, or other species in the Saccharomycetaceae family. Use cautiously in immunocompromised or critically ill patients. Use cautiously with indwelling central venous catheters, colitis, cancer, or constipation. Use cautiously in the elderly, in individuals undergoing chemotherapy, and in infants. Use cautiously if taking antidiarrheal agents. Avoid with a yeast infection. Avoid if pregnant or breastfeeding.
  • Zinc
    : Multiple studies in developing countries found that zinc supplementation may reduce the severity and duration of diarrhea in children, especially those that are malnourished and with low zinc levels.

  • Zinc is generally considered safe when taken at the recommended dosages. Avoid zinc chloride since studies have not been done on its safety or effectiveness. Avoid with kidney disease. Use cautiously if pregnant or breastfeeding.

B

Good scientific evidence

  • Iodine
    :
    Povidone-iodine solutions appear to have broad-spectrum activity against bacteria and have been used in the management of childhood bacterial conjunctivitis. Povidone-iodine solutions may also be used for ophthalmia neonatorum, a type of bacterial conjunctivitis with eye discharge that occurs during the first month of life, and may be as effective as other anti-bacterial solutions such as neomycin-polymyxin B-gramicidin. Medical supervision is recommended and povidone-iodine solutions are not an effective treatment for viral conjunctivitis.

  • Reactions can be severe and deaths have occurred with exposure to iodine. Avoid iodine-based products if allergic or hypersensitive to iodine. Do no use for more than 14 days. Avoid Lugol solution and saturated solution of potassium iodide (SSKI, PIMA) with hyperkalemia (high amounts of potassium in the blood), pulmonary edema (fluid in the lungs), bronchitis, or tuberculosis. Use cautiously when applying to the skin because it may irritate/burn tissues. Use sodium iodide cautiously with kidney failure. Avoid sodium iodide with gastrointestinal obstruction. Iodine is safe in recommended doses for pregnant or breastfeeding women. Avoid povidone-iodine for perianal preparation during delivery or postpartum antisepsis.
  • Probiotics
    : Lactobacillus GG may reduce the risk of nosocomial (originating in a healthcare setting) diarrhea in children and infants, particularly cases caused by rotavirus gastroenteritis. Probiotics may reduce the duration of diarrhea and related hospital stays in children. Fermented formula and formula supplemented with probiotics may reduce both the number and duration of episodes of diarrhea.
    There is tentative support for probiotics for diarrhea prevention in adults and children. Supplementation may benefit HIV-positive men, and yogurt containing Lactobacillus casei may help reduce incidence in healthy young adults. Children may benefit from Bifidobacterium lactis (strain Bb 12) added to their formula. Probiotics may reduce duration of symptoms in adults and children with infectious diarrhea by 17 to 30 hours. Effective forms include Lactobacillus strain GG, Lactobacillus reuteri, combination Lactobacillus rhamnosus and Lactobacillus reuteri, and combination Lactobacillus acidophilus and Lactobacillus bifidus. More studies are needed to evaluate types, dosages, duration of treatment, and relationships to specific pathogens.

  • Probiotics are generally considered safe and well-tolerated. Avoid if allergic or hypersensitive to probiotics. Use cautiously if lactose intolerant. Caution is advised when using probiotics in neonates born prematurely or with immune deficiency.
  • Psyllium
    : Psyllium, also known as ispaghula, comes from the husks of the seeds of Plantago ovata. Psyllium contains a high level of soluble dietary fiber and is the main ingredient in many commonly used laxatives, such as Metamucil® and Serutan®. Psyllium has been studied for the treatment of diarrhea, particularly in patients undergoing tube feeding. It has also been studied in addition to treatment with orlistat (a lipase inhibitor that is designed to help people lose weight) in hopes of decreasing gastrointestinal effects (diarrhea and oily discharge) of this weight loss agent. An effective stool bulking effect has generally been found in scientific studies.

  • Avoid if allergic or hypersensitive to psyllium, ispaghula, or English plantain (Plantago lanceolata). Prescription drugs should be taken one hour before or two hours after psyllium. Use cautiously if pregnant or breastfeeding because psyllium may lower blood sugar levels.
  • Saccaromyces boulardii

    : Saccharomyces boulardii is a non-pathogenic yeast strain that has been used to treat and prevent diarrhea that is caused by many different factors. Several trials suggest the efficacy of Saccharomyces boulardii in the treatment of diarrhea in children. Further studies are still required. Use of Saccharomyces boulardii may be advantageous in both the reduction of stool frequency per day and the duration of diarrhea in this age group.

  • Avoid if allergic/hypersensitive to yeast, Saccharomyces boulardii, Saccharomyces cerevisiae, or other species in the Saccharomycetaceae family. Use cautiously in immunocompromised or critically ill patients. Use cautiously with indwelling central venous catheters, colitis, cancer, or constipation. Use cautiously in the elderly, in individuals undergoing chemotherapy, and in infants. Use cautiously if taking antidiarrheal agents. Avoid with a yeast infection. Avoid if pregnant or breastfeeding.
  • Soy
    : Numerous studies report that infants and young children (ages two to 36 months) with diarrhea who are fed soy formula experience fewer bowel movements per day and fewer days of diarrhea. This research suggests soy to have benefits over other types of formula, including cow milk-based solutions. The addition of soy fiber to soy formula may increase the effectiveness. Better quality research is needed before a firm conclusion can be made on the use of soy for acute diarrhea in infants and young children.

  • Parents are advised to speak with a qualified healthcare provider if infants experience prolonged diarrhea, become dehydrated, develop signs of infection such as fever, or experience blood in the stool. A healthcare provider should be consulted for current breastfeeding recommendations, and to suggest long-term formulas with adequate nutritional value. A doctor may recommend a specially designed soy formula, but regular soy milk should not be given to infants.
  • Avoid if allergic to soy. Breathing problems and rash may occur in sensitive people. Soy, as a part of the regular diet, is traditionally considered to be safe during pregnancy and breastfeeding, but there is limited scientific data. The effects of high doses of soy or soy isoflavones in humans are not clear, and therefore are not recommended. There has been a case report of vitamin D deficiency rickets in an infant nursed with soybean milk (not specifically designed for infants). People who experience intestinal irritation (colitis) from cow’s milk may experience intestinal damage or diarrhea from soy. It is not known if soy or soy isoflavones share the same side effects as estrogens, such as increased risk of blood clots. The use of soy is often discouraged in patients with hormone-sensitive cancers, such as breast, ovarian, or uterine cancer. Other hormone-sensitive conditions such as endometriosis may also be worsened. Patients taking blood-thinning drugs like warfarin should check with their doctors and/or pharmacists before taking soy supplements.

C

Unclear or conflicting scientific evidence

  • Acupuncture
    : Acupuncture plus point-injection has been found beneficial for the treatment of hives, although more research is needed to confirm these findings.

  • Needles must be sterile in order to avoid disease transmission. Avoid with valvular heart disease, infections, bleeding disorders, or with agents that increase the risk of bleeding (anticoagulants), medical conditions of unknown origin, and neurological disorders. Avoid on areas that have received radiation therapy and during pregnancy. Use cautiously with pulmonary diseases (like asthma or emphysema). Use cautiously in elderly or medically compromised patients, diabetics, or with history of seizures. Avoid electroacupuncture with arrhythmia (irregular heartbeat) or in patients with pacemakers.
  • American pawpaw
    : American pawpaw (Asimina triloba) is a fruiting tree native to North America. However, the tree is also cultivated in Asia, Australia, and Europe. Pawpaw extract in combination with thymol (thyme oil) and tea tree oil in a shampoo formulation may effectively treat lice. Better-quality studies using pawpaw alone are needed before a firm recommendation can be made.

  • Well-designed studies on the long-term effects of pawpaw extracts have not been conducted. The constituents in pawpaw extract are cytotoxic (poisonous to cells). Therefore, oral use of pawpaw extract is not recommended without the supervision of a physician. Avoid if allergic to Asimina triloba or any other members of the Annonaceae plant family (including other species of Asimina and those in the genera Annona, Deeringothamnus, Disepalum, Goniothalanus, Rollinia, Uvaria, or Xylopia). Use cautiously with gastrointestinal problems or with a history of dermatological reactions.
  • Applied kinesiology
    : Applied kinesiology (AK) is commonly used for food allergy diagnosis. However, evidence is mixed as to whether AK can aid in this type of assessment.

  • Applied kinesiology techniques in themselves are considered harmless. However, medical conditions should not be treated with AK alone, and AK should not delay appropriate medical treatment.
  • Arnica
    : Arnica has not been well studied for its effects on diarrhea, but early study suggests that homeopathic arnica may decrease the duration of acute diarrhea in children. Further study is needed to make a strong recommendation.

  • Avoid if allergic or hypersensitive to arnica or any member of the Asteraceae or Compositae families (sunflowers, marigolds or any related plants like daisies, ragweed or asters). Use cautiously with blood thinners, protein-bound drugs, cholesterol or heart medications, or diabetes drugs. Use cautiously with a history of stroke. Avoid contact with open wounds or near the eyes and mouth. Avoid if pregnant or breastfeeding.
  • Arrowroot
    : Arrowroot refers to any plant of the genus Maranta, but the term is most commonly used to describe the easily digestible starch obtained from the rhizomes of Maranta arundinacea. Arrowroot is an edible starch with proposed demulcent (soothing) effects and is a well-known traditional remedy for diarrhea. Early research suggests it may have a beneficial effect in the treatment of diarrhea in irritable bowel syndrome (IBS) patients. Additional study is needed in this area.

  • Avoid if allergic or hypersensitive to arrowroot (Marantana arundinacea), its constituents, or members of the Marantaceae family. Use cautiously with a history of constipation. Although arrowroot has been used traditionally in infants, pregnant and breastfeeding women should avoid this herb due to a lack of scientific safety evidence.
  • Art therapy
    : It is not clear if play with modeling clay is an effective therapeutic intervention in children with constipation and encopresis (fecal incontinence associated with psychiatric disorders). In one study, play with modeling clay was associated with improvement in five of six children, but was limited by lack of a control group.

  • Art therapy may evoke distressing thoughts or feelings. Use under the guidance of a qualified art therapist or other mental health professional. Some forms of art therapy use potentially harmful materials. Only materials known to be safe should be used. Related clean-up materials (like turpentine or mineral spirits) that release potentially toxic fumes should only be used with good ventilation.
  • Belladonna
    : Belladonna (Atropa belladonna) is an herb that has been used for centuries for a variety of indications. Belladonna is used as a homeopathic drug regulated by the U.S. Food and Drug Administration (FDA). Homeopathic drugs use very dilute amounts of a plant or mineral, such as belladonna. Reports of side effects associated with homeopathic medicines are lacking in the available literature. In clinical study, individuals taking a 30X dilution of belladonna were reported to experience significantly fewer recurrences of otitis media (29.3 vs. 43.5%), shorter treatment duration, and a shorter duration of symptoms than subjects treated with antibiotics.

  • Avoid if allergic to belladonna or plants of the Solanaceae
    (nightshade) family (such as bell peppers, potatoes, or eggplants). Avoid with a history of heart disease, high blood pressure, heart attack, abnormal heartbeat, congestive heart failure, stomach ulcer, constipation, stomach acid reflux, hiatal hernia, gastrointestinal disease, ileostomy, colostomy, fever, bowel obstruction, benign prostatic hypertrophy (enlarged prostate), urinary retention, glaucoma (narrow angle), psychotic illness, Sjögren’s syndrome, dry mouth, neuromuscular disorders (such as myasthenia gravis), or Down’s syndrome. Avoid if pregnant or breastfeeding.
  • Berberine
    : Berberine is a bitter-tasting, yellow, plant alkaloid with a long history of medicinal use in Chinese and Ayurvedic medicine. Berberine has been evaluated as a treatment for infectious diarrhea, including choleric diarrhea, although the data is conflicting. Therefore, there is currently insufficient evidence regarding the efficacy of berberine in the management of infectious diarrhea.

  • Avoid if allergic or hypersensitive to berberine, to plants that contain berberine (Hydrastis canadensis (goldenseal), Coptis chinensis (coptis or goldenthread), Berberis aquifolium (Oregon grape), Berberis vulgaris (barberry), and Berberis aristata (tree turmeric), or to members of the Berberidaceae family. Avoid in newborns due to the potential for an increase in free bilirubin, jaundice, and development of kernicterus. Use cautiously with cardiovascular disease, gastrointestinal disorders, hematologic disorders, leukopenia, kidney disease, liver disease, respiratory disorders, cancer, hypertyraminemia, diabetes, or low blood pressure. Use cautiously in children due to a lack of safety information. Use cautiously in individuals with high exposure to sunlight or artificial light. Use cautiously for longer than eight weeks due to theoretical changes in bacterial gut flora. Use cautiously if taking anticoagulants, antihypertensives, sedatives, anti-inflammatories, medications metabolized by CYP P450 3A4 including cyclosporin, or any prescription medications. Avoid if pregnant or breastfeeding.
  • Bilberry
    : Bilberry is an herb made from the wrinkled, black berries of a small deciduous shrub. The use of bilberry fruit in traditional European medicine dates back to the 12th Century. A close relative of blueberry, bilberry is commonly used to make jams, pies, cobblers, syrups, and alcoholic/non-alcoholic beverages. Bilberry is used traditionally to treat diarrhea, but reliable research in this area is currently lacking.

  • Long-term side effects and safety of bilberry remain unknown. Avoid if allergic to bilberry, anthocyanosides (a component of bilberry), or other plants in the Ericaceae family. Do not consume bilberry leaves. Use cautiously with bleeding disorders or diabetes. Use cautiously if taking anticoagulant/anti-platelet medications or drugs that alter blood sugar levels. Stop use before surgeries or dental or diagnostic procedures that have bleeding risks. Use cautiously in doses higher than recommended. Avoid if pregnant or breastfeeding, due to a lack of safety evidence.
  • Bovine colostrum
    : Bovine colostrum is the pre-milk fluid produced from cow mammary glands during the first two to four days after birth. Bovine colostrum confers growth, nutrient, and immune factors to the offspring. Bovine colostrum may be effective for improving gastrointestinal health. Preliminary evidence suggests that colostrum inhibits the adhesion or activity of certain bacteria to intestinal cells, which may help in the treatment of diarrhea. Additional study is needed in this area.

  • Avoid if allergic to dairy products. Use bovine colostrum cautiously because toxic compounds, such as polychlorinated biphenyls (PCBs), dichlorodiphenyltrichloroethane (DDT), and dichlordiphenyldichloroethylene (DDE), have been found in human colostrum and breast milk. Thus, it is possible that these agents may be found in bovine colostrum. Avoid with, or if at risk of, cancer. Use cautiously with immune system disorders or atherosclerosis (hardening of the arteries). Use cautiously if taking medications, such as anti-diarrheal agents (e.g. Imodium®), insulin, or CNS agents (such as amphetamines, caffeine). Avoid if pregnant or breastfeeding.
  • Bupleurum
    : Chinese studies have suggested that bupleurum may be helpful for reducing fever. However, additional study is needed to draw a firm conclusion about safety and effectiveness. In traditional Chinese medicine, bupleurum is often used in combination with other herbs.

  • Avoid if allergic or hypersensitive to bupleurum, Apiaceae or Umbelliferae (carrot) families, snakeroot, cow parsnip, or poison hemlock. Use cautiously if operating motor vehicles or hazardous machinery. Use cautiously with low blood pressure, diabetes, or edema. Use cautiously with a history of bleeding, hemostatic disorders, or drug-related hemostatic disorders. Use cautiously if taking blood thinners. Avoid if pregnant or breastfeeding.
  • Calendula
    : Calendula, also known as marigold, has been widely used on the skin to treat minor wounds, skin infections, burns, bee stings, sunburn, warts, and cancer. Calendula has been studied for reducing pain caused by otitis media. Some human studies suggest that calendula may possess mild anesthetic (pain-relieving) properties equal to those of similar non-herbal eardrop preparations. Further studies are needed before a conclusion can be made.

  • Use cautiously if allergic to plants in the Aster/Compositae family (such as ragweed, chrysanthemums, marigolds, or daisies). Use cautiously while driving or operating machinery. Avoid if pregnant or breastfeeding.
  • Carob
    : Carob (Ceratonia siliqua) is a leguminous evergreen tree of the family Leguminosae (pulse family). Traditionally, carob has been used for the treatment of gastrointestinal conditions, especially diarrhea. Preliminary study used different types of carob products as an adjunct to oral rehydrating solution for diarrhea in children and showed promising results. Additional study is needed in this area.

  • Avoid if allergic/hypersensitive to carob (Ceratonia siliqua), its constituents, or any plants in the Fabaceae family, including tamarind. Avoid with metabolic disorders, with a chromium, cobalt, copper, iron, or zinc disorder or deficiency, kidney disorders, or acute diarrhea. Avoid in underweight infants. Use cautiously in patients with anemia, known allergy to peanuts and other nuts, complications with powdered, bulk forming laxative drinks, diabetes, or hyperlipidemia (high cholesterol). Use cautiously if taking oral herbs or drugs. Use cautiously in hypouricemic patients. Avoid if pregnant or breastfeeding.
  • Carrot
    : A carrot-rice based rehydration solution decreased the duration of acute diarrhea when compared to two conventional rehydration solutions. However, more research is needed.

  • Avoid if allergic or hypersensitive to carrot, its constituents, or members of the Apiaceae family. Use cautiously with hypoglycemia (low blood sugar) or diabetes, or if taking hypoglycemics. Use cautiously with bowel obstruction, if taking oral drugs, herbs, or supplements, with hormone-sensitive conditions, and in children. Use cautiously with known allergy/hypersensitivity to carrot or birch pollen-related allergens, as cross-sensitivity has been documented. Use cautiously and only in food amounts in pregnant and breastfeeding women.
  • Chamomile
    : Chamomile is an herb that has an apple-like smell and taste. It is commonly taken as a tea. Preliminary study reports that chamomile with apple pectin may reduce the length of time that children experience diarrhea. There is a lack of research on this use in adults. Further research is needed before a recommendation can be made for diarrhea in children.

  • Avoid if allergic to chamomile or any related plants, such as aster, chrysanthemum, mugwort, ragweed, or ragwort. Avoid with heart disease, breathing disorders, hormone-sensitive conditions, or central nervous system disorders. Avoid if taking cardiac depressive agents, central nervous system depressants, respiratory depressive agents, or anticoagulants. Use cautiously if taking benzodiazepine, anti-arrhythmic medications, calcium channel blockers, alcohol, sedative agents, anxiolytic medications, spasmolytic drugs, oral medications, or agents that are broken down by the liver. Use cautiously if driving or operating machinery. Avoid if pregnant or breastfeeding.
  • Chiropractic
    : Chiropractic is a healthcare discipline that focuses on the relationship between musculoskeletal structure (primarily the spine) and body function (as coordinated by the nervous system), and how this relationship affects the preservation and restoration of health. Although ear infections are treated with chiropractic manipulation with some success, well-designed clinical trials have not yet been conducted. Presently, there is insufficient evidence to support the use of chiropractic manipulation for the treatment of otitis media in children.

  • Avoid with vertebrobasilar vascular insufficiency, aneurysms, arteritis, or unstable spondylolisthesis. Avoid use on post-surgical areas of para-spinal tissue. Use cautiously with acute arthritis, brittle bone disease, conditions that cause decreased bone mineralization, bleeding disorders, migraines, or if at risk for tumors or metastasis of the spine. Use extra caution during cervical adjustments. Avoid if pregnant or breastfeeding due to a lack of scientific data.
  • Clay
    : It is not clear if play with modeling clay is an effective therapeutic intervention in children with constipation and encopresis (fecal incontinence associated with psychiatric disorders). In one study, play with modeling clay was associated with improvement in five of six children, but was limited by lack of a control group.

  • There is a lack of reports of allergy to clay in the available scientific literature. However, in theory, allergy/hypersensitivity to clay, clay products, or constituents of clay may occur. Avoid if pregnant or breastfeeding.
  • Chlorophyll
    : Taking chlorophyll by mouth as a liquid was reported to be an effective treatment for chickenpox. More research is needed before a firm conclusion can be made.

  • Avoid if allergic or hypersensitive to chlorophyll or any of its metabolites. Use cautiously with photosensitivity, compromised liver function, diabetes, or gastrointestinal conditions or obstructions. Use cautiously if taking immunosuppressant agents or agents used to treat diabetes. Avoid if pregnant or breastfeeding.
  • Clove
    : Clove is commonly used as a fragrant or flavoring agent. There is a risk of blindness if it comes in contact with the eyes. Clove oil (eugenol) has been used for its analgesic (pain-relieving), local anesthetic, anti-inflammatory, and antibacterial effects. Early studies suggest that clove may lower fever, but reliable human studies are currently unavailable.

  • Avoid if allergic to clove, eugenol, or some licorice products or tobacco (clove cigarette) products. Use cautiously if allergic to Balsam of Peru. Avoid with a history of seizures, stroke, or liver damage. Use cautiously if taking medications that treat diabetes. Use cautiously with diabetes, low blood sugar levels, bleeding problems, or impotence. Stop use two weeks before and immediately after surgery/dental/diagnostic procedures with bleeding risks. Use cautiously if driving or operating machinery. Avoid if pregnant or breastfeeding.
  • Colon therapy/colonic irrigation
    : Preliminary study shows possible benefits of regular irrigation of the lower part of the colon in the treatment of fecal incontinence. Further study is needed before a conclusion can be made.

  • Excessive treatments may allow the body to absorb too much water, which causes electrolyte imbalances, nausea, vomiting, heart failure, fluid in the lungs, abnormal heart rhythms or coma. Infections have been reported, possibly due to contaminated equipment or as a result of clearing out normal colon bacteria that destroys infectious bacteria. There is a risk of the bowel wall breaking, which is a serious complication that can lead to septic shock and death. Avoid with diverticulitis, ulcerative colitis, Crohn’s disease, severe or internal hemorrhoids, rectal/colon tumors, or recovering from bowel surgery. Avoid frequent treatments with heart or kidney disease. Colonic equipment must be sterile. Colonic irrigation should not be used as the only treatment for serious conditions. Avoid if pregnant or breastfeeding due to lack of scientific data.
  • DMSO
    : Dimethyl sulfoxide (DMSO) is a sulfur-containing organic compound that may help treat herpes zoster. This treatment may work even better when used with the drug idoxuridine. Further research is necessary before a conclusion can be made.

  • Avoid if allergic or hypersensitive to DMSO. Use caution with urinary tract cancer or liver and kidney dysfunction. Avoid if pregnant or breastfeeding.
  • Eyebright
    : Eyebright has been used in eye solutions for centuries to manage multiple eye conditions. Currently, there is insufficient scientific evidence to recommend for or against the use of eyebright in the treatment of conjunctivitis.

  • Avoid if allergic to eyebright, any of its constituents or members of the Scrophulariaceae family. Use cautiously as an eye treatment, particularly homemade preparations, due to the risk of infection if it is not sterile. Use cautiously with diabetes and drugs that are broken down by the liver. Avoid if pregnant or breastfeeding.
  • Goldenseal
    : Goldenseal is one of the five top-selling herbal products in the United States. Berberine, a constituent from goldenseal, has been used as a treatment for diarrhea caused by bacterial infections (including infectious diarrhea from cholera). Due to the very small amount of berberine in most goldenseal products, it is unclear whether goldenseal contains enough berberine to have the same effects. Therefore, there is currently not enough scientific evidence to make a recommendation in this area.

  • Avoid if allergic or hypersensitive to goldenseal or any of its constituents, like berberine and hydrastine. Use cautiously with bleeding disorders, diabetes, or low blood sugar. Avoid if pregnant or breastfeeding.
  • Hibiscus
    : The Hibiscus genus contains several species, many of which have been used medicinally. Currently, there is limited available evidence evaluating the effects of hibiscus for the treatment of head lice. Study participants have been treated with creams containing hibiscus tea plus henna. Additional studies involving hibiscus alone are warranted in this area.

  • Avoid if allergic or hypersensitive to hibiscus, its constituents, or members of the Malvaceae family. Use cautiously with high or low blood pressure.
  • Lactobacillus acidophilus

    : Lactobacilli are bacteria that normally live in the gastrointestinal tract, mouth, and vagina. A small amount of human research suggests that Lactobacillus acidophilus may not be effective when used to prevent diarrhea in travelers or in people taking antibiotics. Several studies report that the related species Lactobacillus GG may be helpful for diarrhea prevention in children and travelers. Additional study is needed in these areas before a firm conclusion can be drawn.

  • A small amount of research in children, using different forms of acidophilus, reports no improvement in diarrhea. Future studies should use a viable Lactobacillus acidophilus culture to assess effects on diarrhea. Lactobacillus GG, a different species, is suggested by multiple human studies to be a safe and effective treatment for diarrhea in otherwise healthy infants and children. Lactobacillus acidophilus may aid in the management of chronic or persistent diarrhea and bacterial-overgrowth related diarrhea. Further research is needed to determine what dose may be safe and effective for diarrhea treatment in children.
  • There is conflicting information from several human studies as to whether using Lactobacillus acidophilus by mouth improves digestion of lactose. More research is needed before a conclusion can be made on the use of Lactobacillus for lactose intolerance.
  • Lactobacillus acidophilus may be difficult to tolerate if allergic to dairy products containing L. acidophilus. Avoid with a history of an injury or illness of the intestinal wall, immune-disease, or heart valve surgery. Avoid if taking prescription drugs (such as corticosteroids) because of the risk of infection. Use cautiously with heart murmurs. Antibiotics or alcohol may destroy Lactobacillus acidophilus.
    Therefore, it is recommended that Lactobacillus acidophilus be taken three hours after taking antibiotics or drinking alcohol. Some individuals can use antacids to decrease the amount of acid in the stomach one hour before taking Lactobacillus acidophilus.
  • Lavender
    : Oils from lavender flowers are used in aromatherapy, baked goods, candles, cosmetics, detergents, jellies, massage oils, perfumes, powders, shampoo, soaps, and teas. Limited available clinical study used a naturopathic eardrop called NHED (containing Allium sativum, Verbascum thapsus, Calendula flores, Hypericum perfoliatum, lavender, and vitamin E in olive oil) with and without an antibiotic and topical anesthetic. It was found that the ear pain was self-limiting and resolved after a few days with or without antibiotics. This evidence is early, and further research is needed before any conclusion about this treatment can be made.

  • Avoid if allergic or hypersensitive to lavender. Avoid with a history of seizures, bleeding disorders, eating disorders (such as anorexia or bulimia), or anemia (low levels of iron). Avoid if pregnant or breastfeeding.
  • Mullein
    : Mullein (Verbascum thapsus) has been used in natural medicine for centuries and is among the oldest known medicinal plants. There are some clinical studies using mullein in combination with other herbal products as an eardrop to treat earaches caused by ear infections. It is not clear what the effects of mullein alone are on ear infections because the product studied was a combination of different herbal products. Additional study is needed before a conclusion can be made regarding use of mullein for earache associated with acute otitis media.

  • Avoid if allergic/hypersensitive to mullein (Verbascum thapsus), its constituents, or any members of the Scrophulariaceae (figwort) family. Use cautiously if taking anticoagulants (blood thinners). There are reports that mullein may contain a toxin called rotenone, which is an insecticide. Avoid if pregnant or breastfeeding.
  • Probiotics
    : Probiotics are beneficial bacteria that are sometimes called “friendly germs.” They help maintain a healthy intestine and help the body digest foods. They also help keep harmful bacteria and yeasts in the gut under control. Most probiotics come from food sources, especially cultured milk products.

  • Saccharomyces boulardii and a probiotic formula Escherichia coli Nissle 1917 (EcN) solution have been shown to moderately improve acute diarrhea in children. However, all probiotic preparations may not have the same effectiveness.
  • Supplementation of infant formulas with probiotics is a potential approach for the management of cow’s milk allergy, but there is conflicting evidence as to whether it improves digestion of lactose. More research is needed before a conclusion can be made on the use of probiotics for lactose intolerance.
  • Although some data support the use of probiotics for the treatment and prevention of antibiotic-associated diarrhea (AAD), other studies have found a lack of benefit. Although probiotics are considered a safe and reasonable approach for AAD, larger and better-designed studies are needed for definitive recommendations. There is limited evidence suggesting that probiotics may reduce recurrence of Clostridium difficile associated diarrhea and may help in the treatment of bacterial overgrowth-related chronic diarrhea. More studies are needed to provide guidelines for these uses.
  • Probiotic capsules (containing Lactobacillus rhamnosus GG and LC705, Bifidobacterium breve 99, and Propionibacterium freudenreichii JS) were not shown to protect against ear infections in children. More research is needed to confirm these findings.
  • Probiotics are generally considered safe and well-tolerated. Avoid if allergic or hypersensitive to probiotics. Use cautiously if lactose intolerant.
  • Saccaromyces boulardii

    : With the introduction of broad-spectrum antibiotics into clinical practice, Clostridium difficile infection has become a common cause of infectious diarrhea in hospitalized patients. For the treatment of Clostridium difficile associated recurrent diarrhea, Saccharomyces boulardii has been shown to decrease recurrences by about 50%, especially when combined with high-dose vancomycin.
    While only small studies have been performed, treatment with Saccharomyces boulardii may improve quality of life in chronic diarrhea in AIDS patients. As fungemia has been associated with Saccharomyces boulardii administration in patients with central lines, care should be exercised in treating these patients.
    Preliminary evidence supports the use of Saccharomyces boulardii for diarrhea prevention during tube feeding. However, the role of antibiotics in the results is unclear. Although evidence supports the use of Saccharomyces boulardii for other forms of diarrhea, little evidence exists to support standard treatment with Saccharomyces boulardii for traveler’s diarrhea. More studies need to be performed.

  • Avoid if allergic/hypersensitive to yeast, Saccharomyces boulardii, Saccharomyces cerevisiae, or other species in the Saccharomycetaceae family. Use cautiously in immunocompromised or critically ill patients. Use cautiously with indwelling central venous catheters, colitis, cancer, or constipation. Use cautiously in the elderly, in individuals undergoing chemotherapy, and in infants. Use cautiously if taking antidiarrheal agents. Avoid with a yeast infection. Avoid if pregnant or breastfeeding.
  • Sanicle
    : Sanicle has been studied as a treatment for recurrent otitis media. More evidence is needed before a conclusion can be made.

  • Avoid if allergic or sensitive to sanicle. Use cautiously with stomach problems. Use cautiously if taking blood pressure-lowering or diuretic drugs. Avoid if pregnant or breastfeeding.
  • Slippery elm
    : Traditionally, slippery elm has been used to treat diarrhea. While theoretically the tannins found in the herb may decrease water content of stool, and the mucilage may act as a soothing agent to inflamed mucous membranes, reliable scientific evidence to support the use of slippery elm for this indication is currently lacking. Systematic research is necessary in this area before a clear conclusion can be drawn.

  • Avoid if allergic or hypersensitive to slippery elm. Avoid if pregnant or breastfeeding.
  • Soy
    : Although soy has been shown to help treat acute diarrhea in children, it remains unknown if it can treat diarrhea in adults. Due to limited human study, there is not enough evidence to recommend for or against the use of soy-polysaccharide/fiber in the treatment of diarrhea in this patient population. Further research is needed before a recommendation can be made.

  • Avoid if allergic to soy. Breathing problems and rash may occur in sensitive people. Soy, as a part of the regular diet, is traditionally considered to be safe during pregnancy and breastfeeding, but there is limited scientific data. The effects of high doses of soy or soy isoflavones in humans are not clear, and therefore are not recommended. There has been a case report of vitamin D deficiency rickets in an infant nursed with soybean milk (not specifically designed for infants). People who experience intestinal irritation (colitis) from cow’s milk may experience intestinal damage or diarrhea from soy. It is not known if soy or soy isoflavones share the same side effects as estrogens, such as an increased risk of blood clots. The use of soy is often discouraged in patients with hormone-sensitive cancers, such as breast, ovarian, or uterine cancer. Other hormone-sensitive conditions such as endometriosis may also be worsened. Patients taking blood-thinning drugs like warfarin should check with a doctor and pharmacist before taking soy supplementation.
  • Tai chi
    : Tai chi is a system of movements and positions believed to have developed in 12th Century China. A small study showed that treatment with tai chi might increase immunity to the virus that causes shingles. This may suggest the use of tai chi in the prevention of chickenpox (varicella zoster), but further well-designed large studies need to be performed.

  • Avoid with severe osteoporosis or joint problems, acute back pain, sprains, or fractures. Avoid during active infections, right after a meal, or when very tired. Some believe that visualization of energy flow below the waist during menstruation may increase menstrual bleeding. Straining downwards or holding low postures should be avoided during pregnancy, and by people with inguinal hernias. Some tai chi practitioners believe that practicing for too long or using too much intention may direct the flow of chi (qi) inappropriately, possibly resulting in physical or emotional illness. Tai chi should not be used as a substitute for more proven therapies for potentially serious conditions. Advancing too quickly while studying tai chi may increase the risk of injury.
  • Tea tree oil
    : Early studies have found that tea tree alone or in combination with other agents may be effective against lice. However, large, well-designed trials are still needed before a conclusion can be made.

  • Avoid allergic or hypersensitive to tea tree oil (Melaleuca alternifolia), any of its constituents, balsam of Peru, benzoin, colophony (rosin) tinctures, eucalyptol, or other members of the Myrtle (Myrtaceae) family. Avoid taking tea tree oil by mouth. Avoid if taking antineoplastic agents. Use tea tree oil applied to the skin cautiously in patients with previous tea tree oil use. Avoid if pregnant or breastfeeding.
  • Vitamin A
    : Vitamin A is an essential fat-soluble vitamin. Vitamin A may reduce the severity and duration of diarrheal episodes in malnourished children but not in well-nourished children. Since diarrhea is a major cause of morbidity and mortality in developing countries, vitamin A supplementation may be considered in undernourished children with diarrhea.

  • Avoid if allergic or hypersensitive to vitamin A. Vitamin A toxicity can occur if taken at high dosages. Use cautiously with liver disease or alcoholism. Smokers who consume alcohol and beta-carotene may be at an increased risk for lung cancer or heart disease. Vitamin A appears safe in pregnant women if taken at recommended doses. Use cautiously if breastfeeding because the benefits or dangers to nursing infants are not clearly established.

D

Fair negative scientific evidence

  • Ayurveda
    : Limited available study compared the three Ayurvedic preparations bel (Aegle marmelos), thankuni (Hydrocotyle asiatica), and gandhavadulia (Paederia foetida) with ampicillin in dysentery (shigellosis), and found them to have no effect.

  • Ayurvedic herbs should be used cautiously because they are potent and some constituents can be potentially toxic if taken in large amounts or for a long time. Some herbs imported from India have been reported to contain high levels of toxic metals. Ayurvedic herbs can interact with other herbs, foods and drugs. A qualified healthcare professional should be consulted before taking. Avoid Ayurveda with traumatic injuries, acute pain, advanced disease stages and medical conditions that require surgery.
  • Probiotics
    : Fair evidence suggests that probiotics may not be helpful in treating HIV-associated diarrhea. Probiotic therapy appears to be well tolerated for diarrhea in HIV patients on antiretroviral therapy, but may not be helpful for gastrointestinal symptoms.

  • Probiotics are generally considered safe and well-tolerated. Avoid if allergic or hypersensitive to probiotics. Use cautiously if lactose intolerant.
  • Reflexology
    : Limited available study suggests that treatment given by a reflexologist is less effective (in terms of number of ear disorders, number of antibiotic treatments, number of sickness days, and duration of ear disorders) than treatment given by a general practitioner for ear infections.

  • Avoid with recent or healing foot fractures, unhealed wounds, or active gout flares affecting the foot. Use cautiously and seek prior medical consultation with osteoarthritis affecting the foot or ankle, or severe vascular disease of the legs or feet. Use cautiously with diabetes, heart disease, or the presence of a pacemaker, unstable blood pressure, cancer, active infections, past episodes of fainting (syncope), mental illness, gallstones, or kidney stones. Use cautiously if pregnant or breastfeeding. Reflexology should not delay diagnosis or treatment with more proven techniques or therapies.
  • Strong negative scientific evidence
    :

  • Bael fruit
    : Indian bael, an indigenous plant of India, has spread over wide areas of Southeast Asia. Indian bael has traditionally been used as a treatment for diarrhea. However, capsules of dried powder of the unripe fruit were not effective in treating diarrhea in patients with dysentery (shigellosis). Additional study investigating different preparations of bael fruit would help confirm this finding.

  • Avoid if allergic or hypersensitive to Indian bael or any of its constituents. Avoid dosages that exceed those of use in traditional medicine. Indian bael in large quantities theoretically may result in digestive complaints and constipation, given that tannins are constituents. Use cautiously if taking hypoglycemic agents or thyroid hormone, herbs for thyroid disorders, or herbs that may exacerbate or induce hyperthyroidism. Avoid if pregnant or breastfeeding as Indian bael leaves have been traditionally used to induce abortion and to sterilize women (theoretical).

Author Information

  • This information has been edited and peer-reviewed by contributors to the Natural Standard Research Collaboration ().

References

Natural Standard developed the above evidence-based information based on a thorough systematic review of the available scientific articles. For comprehensive information about alternative and complementary therapies on the professional level, go to www.naturalstandard.com. Selected references are listed below.

  1. Abraham B, Sellin JH. Drug-induced Diarrhea. Curr Gastroenterol Rep. 2007 Oct;9(5):365-72.
    View Abstract
  2. American Academy of Pediatrics (AAP). . Accessed March 12, 2009.
  3. Blakley BW, Blakley JE. Smoking and middle ear disease: are they related? A review article. Otolaryngol Head Neck Surg. 1995 Mar;112(3):441-6.
    View Abstract
  4. Centers for Disease Control and Prevention (CDC). . Accessed March 12, 2009.
  5. Eigenmann PA. The spectrum of cow’s milk allergy. Pediatr Allergy Immunol. 2007 May;18(3):265-71.
    View Abstract
  6. Ilicali OC, Keles N, Deqer K, et al. Relationship of passive cigarette smoking to otitis media. Arch Otolaryngol Head Neck Surg. 1999 Jul;125(7):758-62.
    View Abstract
  7. National Institute of Allergy and Infectious Diseases (NIAID). . Accessed March 12, 2009.
  8. National Institute on Deafness and Other Communication Disorders (NIDCD). . Accessed March 12, 2009.
  9. Natural Standard: The Authority on Integrative Medicine. . Copyright © 2009. Accessed March 12, 2009.
  10. Olifer VV, Roslavtseva SA. Current problems and ways of their solution in the prevention of scabies and pediculosis. Article in Russian. Gig Sanit. 2006 Mar-Apr;(2):25-9.
    View Abstract
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