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Healthy Child, Whole ChildChapter OneRead This First:What You Need to Know to Get the
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Before we can talk about "integrative pediatrics" we need to explain the underlying concept of integrative medicine. "Integrative medicine" is a term popularized by the founder of the Program in Integrative Medicine at the University of Arizona, Harvard-trained physician and author Dr. Andrew Weil. It describes a model of healing that focuses on health rather than on disease, in which doctor and patient work in partnership, employing both conventional and less-established therapies to support the natural capacity for healing we all possess. Ideally, integrative medical care promotes well-being by addressing the mind, body, and spirit in a way that is effective, reasonably priced, and free of adverse side effects. Here aretwo examples from our practices to give you an idea of how these highminded phrases translate into medical care in the real world.

Ten-month-old Michael (patient names have been changed throughout the book) came to Dr. Stu after his seventh ear infection. The previous infections had all been treated by antibiotics, but Michael's mom was concerned about the long-term effects of this treatment, which didn't seem to be very helpful, anyway. A purely conventional approach would have been to put the boy on preventive antibiotics for several months, and to consider surgical insertion of plastic tubes in his eardrums to relieve the fluid buildup in his inner ear if the condition did not resolve. But Dr. Stu thought he would see better results if he could uncover and address the reason the fluid was backing up in Michael'sears instead of just treating the boy's symptoms. Allergy or a case of gastroesophageal reflux (where the acidic stomach contents back up into the esophagus) can cause recurrent ear infections, so as an integrative pediatrician, Dr. Stu suggested dietary, lifestyle, and pharmaceutical approaches to address these possibilities. He eliminated cow's milk products from Michael's diet, changed his feeding positions, and tried a short course of acid-reducing medication. Within six weeks the fluids were gone from his middle ear, and Michael has not needed antibiotics for an ear infection since.

Dr. Russ integrated conventional and alternative therapies in a similar way when he treated Selena, a five-year-old liver-transplant recipient who was also diagnosed with a form of cancer. Since Selena's specialists were not confident she could be cured, her parents wanted Dr. Russ to do what he could to make her feel better. Dr. Russ worked in partnership with Selena's more conventional doctors to help her safely discontinue some of her medications. Among the interventions recommended were mind/body therapies and osteopathic manipulation to help ease her pain, and the herbal remedy milk thistle to help protect her transplanted liver. Selena's doctors voiced concern about her attending school because she could more easily pick up an infection, but her mom knew how important it was for her little girl "to be like every other kid," and allowed her to return to the classroom. Dr. Russ saw her a year later, and Selena looked great. Her cancer had not spread detectably, and she had not developed any infections. Although she had not been cured, her quality of life had been improved significantly.

Integrative medicine is often confused with, alternative medicine or complementary medicine, so we want to take a moment to explain the differences, with thanks to David Eisenberg M.D., who helped definethese concepts. Conventional, or allopathic, medicine is the mainstream medicine taught in most American medical schools and practiced in most American hospitals. Its "don't just stand there, do something" attitude makes it excellent for medical and surgical emergencies, but it may be less useful for chronic conditions and unnecessarily aggressive in situations where time or a more gentle approach may be equally effective.

Alternative medicine includes therapies or philosophies not generally taught in American medical schools or offered in hospitals in this country and is used separately from or instead of conventional care. Some, such as Chinese medicine or ayurvedic (Indian) medicine, may be considered alternative here, but conventional in other countries. Alternative therapies run the gamut from the well researched to the hare-brained. Therapies considered alternative may, after further study or a change in perspective, eventually be incorporated to some degree into conventional medicine. This is what is happening now with herbal therapy.

Complementary medicine refers to therapies added to conventional treatment but not clinically integrated, so that practitioners may not even be aware of each other's involvement with a patient. An example of complementary medicine would be the use of herbal or nutritional therapies to alleviate the side effects of chemotherapy for cancer without the participation of the primary physician.

How does integrative medicine differ? Unlike conventional medicine, integrative medicine is not focused on fighting disease or suppressing symptoms, but on supporting the body's own natural healing processes. This principle is especially important in treating children, who have the potential to heal so much faster than adults. As most parents have witnessed, a child can bounce back from a fever or heal a cut virtually overnight.

With its emphasis on prevention, self-care, and the importance of trying gentle noninvasive therapies first, integrative medicine upsets the whole American paradigm of medicine as a war between doctors and invading diseases. Integrative practitioners work with the whole person — not just a collection of unconnected body parts — enlisting the patient's mind, body, and spirit in healing. They look for the underlying causes of health problems instead of only addressing the symptoms. An integrative practitioner offers a wider range of therapeutic options. We look at possible therapies — conventional and otherwise — with a cautious, scientific attitude, choosing those that are most likely to offer safe and effective treatment for a particular individual. This thoughtful integration of various modalities is in large part what distinguishes integrative medicine from alternative or complementary medicine...