Adverse events associated with pediatric complementary and alternative medicine in the Netherlands: a national surveillance study

Eur J Pediatr. 2021 Jul;180(7):2165-2171. doi: 10.1007/s00431-020-03899-8. Epub 2021 Mar 1.


Pediatric use of complementary and alternative medicine (CAM) in the Netherlands is highly prevalent. The risks of pediatric CAM use are, however, largely unknown. Therefore, a 3-year survey was carried out at the Dutch Pediatric Surveillance Unit. Pediatricians were asked to register cases of adverse events associated with pediatric CAM usage. In 3 years, 32 unique adverse events were registered. Twenty-two of these adverse events were indirect and not related to the specific CAM therapy but due to delaying, changing, or stopping of regular treatment, a deficient or very restrictive diet or an incorrect diagnosis by a CAM therapist. These events were associated with many different CAM therapies. Nine events were deemed direct adverse events like bodily harm or toxicity and one-third of them occurred in infants. Only supplements, manual therapies, and (Chinese) herbs were involved in these nine events. In one case, there was a risk of a serious adverse event but harm had not yet occurred.Conclusion: Relatively few cases of adverse events associated with pediatric CAM usage were found, mostly due to delaying or stopping conventional treatment. Nevertheless, parents, pediatricians and CAM providers should be vigilant for both direct and indirect adverse events in children using CAM, especially in infants. What's Known: • The use of complementary and alternative medicine (CAM) in children is common. • Previous surveillance studies in other countries showed severe adverse events may occur after pediatric CAM usage. What is New: • In the Netherlands CAM-related adverse events are rare but can occur, with variable etiology and severity (from mild to potentially life-threatening) • Most CAM-related adverse events are not directly the result of CAM toxicities but rather are associated with withdrawal from appropriate therapies or with providers unable to recognize health-relevant states and delaying important diagnoses.

Keywords: Adverse events; CAM; Complementary and alternative medicine; Surveillance study.

MeSH terms

  • Child
  • Complementary Therapies*
  • Dietary Supplements / adverse effects
  • Humans
  • Infant
  • Netherlands
  • Parents
  • Surveys and Questionnaires