From melatonin to probiotics, more parents are turning to herbs and supplements to support their children’s health. But are these remedies effective? Are they safe? And how can pediatricians help families make informed choices?
In this episode, Dr. Cora Collette Breuner of Seattle Children’s discusses the growing use of natural remedies in pediatrics. She shares what families are using, how they’re deciding, and why it’s essential that providers ask the right questions and build trust with both patients and parents.
Guest:
Cora Collette Breuner, MD, MPH, Pediatric and Adolescent Medicine Specialist, Seattle Children’s
Host/Producer: Carol Vassar
TRANSCRIPT
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Carol Vassar, podcast host/producer:
More and more it seems, parents are turning to herbs and supplements to support their children’s health, seeking natural solutions for everything from sleep to anxiety to immunity, but with so many products on the market and so little regulation, how do families know what’s safe and what works, and how should pediatricians respond when parents bring these options into the exam room?
In this episode, we sit down with Dr. Cora Collette Breuner, a nationally recognized adolescent medicine specialist from Seattle Children’s to unpack the growing interest in herbs and supplements for kids’ health. Dr. Breuner shares what parents are using, where they’re getting their information, and what healthcare providers need to share about drug interactions, safety, and cultural humility when navigating these conversations. What are the benefits and risks of incorporating over-the-counter herbs and supplements into a child’s diet? Here’s Dr. Cora Collette Breuner.
Dr. Cora Collette Breuner, Pediatric/Adolescent Medicine Specialist, Seattle Children’s
These are excellent questions, and these are ones that I ask every day because I teach at the medical school in Seattle, and I also teach the residents and fellows at Seattle Children’s Hospital. What I like to ask them to ask their families is what herbs and supplements, or what other interventions, are you using for your child when they’re doing their well visits or just coming in for an emergency room visit?
Because parents are using these herbs and supplements in their kids and healthcare providers don’t necessarily ask about it, so they don’t know. Because there are some definite benefits from some of these herbs and supplements, and there are also some problems, especially when they are interfering with the medications that we actually prescribe. We do know from studies that between 24% and 70% of people use holistic integrative therapies in children and adolescents and in themselves, and we know that kids who are more likely to have complex diseases or behavioral health issues are more likely to have their families use herbs and supplements to help change their behavior. We know this. But what we don’t know is whether what they’re using for these kids is safe, nor do we know if it works. These are really important issues for the pediatrician and for those who care for kids.
Carol Vassar, podcast host/producer:
What are some of the popular herbs and supplements that parents are using and giving to their children?
Dr. Cora Collette Breuner, Pediatric/Adolescent Medicine Specialist, Seattle Children’s
One of the most popular herbs and supplements parents are using in their children are melatonin, probiotics, sleep aids such as chamomile, anxiety agents. There’s also a number of other types of vitamins that people use, including vitamin D, vitamin C, and other things like fish oil, which all of which have some evidence but don’t have a lot of data in terms of safety, especially when people are just buying it on the internet.
Carol Vassar, podcast host/producer:
Are there studies going on to talk about and look into the efficacy of some of the supplements you just talked about?
Dr. Cora Collette Breuner, Pediatric/Adolescent Medicine Specialist, Seattle Children’s
Excellent question. Yes and no, in answer to your question. It’s expensive to do these studies because the gold standard of these studies requires that the patient be on a placebo or not a placebo. Many of these herbs and supplements are blends. You would combine, let’s say, chamomile and St. John’s wort or arnica and another salve with some kind of CBD in it. It’s always hard to tease out which one of those is being studied, and then you compare it to a placebo. At any rate, it’s very hard to do. It’s possible to do, but it is hard to actually accomplish what you’re looking for, which is, does this work better than a placebo? That’s what you’re looking for.
Carol Vassar, podcast host/producer:
The FDA is not involved in the oversight of herbs and supplements, are they?
Dr. Cora Collette Breuner, Pediatric/Adolescent Medicine Specialist, Seattle Children’s
No. Another fantastic question. In 1994, the government passed a law called the Dietary Supplement and Health Education Act, which has been in place obviously for now 30 years, and it’s not going anywhere. This is a law that says that it’s okay to bring products to the people, to the public without determining whether it works or not, and without clear guarantees that what you’re buying has what is supposed to have in it lacking contamination and consistently batched so that every single bottle contains the exact same amount.
There is no guarantee to people who are purchasing this that what they’re buying has that scrutiny. Now, the FDA does want to know if there are adverse effects, so the FDA does keep a list of adverse effects that are occurring in kids who might take this. There’s a number of studies that have been published about creatine, for example, where creatine might contain a mercury compound or other toxic components from the way it was put together, that our youth don’t even realize they’re taking.
We also know that there’s a lot of other supplements that might contain banned substances, like a protein powder might contain prednisone or another product for arthritis, curcumin, or turmeric might contain ibuprofen. There’s no guarantee of that. Now I have to push back against myself and say, “But there are a number of companies, Cora, that really do due diligence to make sure that what is available to the public is safe, is consistently batched, lacking contamination.” So those companies are there, but there are also other companies where they don’t have that scrutiny on their product.
Carol Vassar, podcast host/producer:
As parents are considering herbs or supplements for their children, do you know where they’re getting the information that pushes them toward a particular herb or a particular supplement?
Dr. Cora Collette Breuner, Pediatric/Adolescent Medicine Specialist, Seattle Children’s
Well, gee, I just love this interview because you’re hitting all the points for me. We know exactly where it’s coming from, and it’s from the internet, it’s from TikTok, it’s from other sources, it’s from family and friends. Culturally, it’s important to recognize it in specific cultures. There are healers that aren’t necessarily part of our traditional healthcare establishment that would be giving advice about different products that they might pick from the ground or are mixed together in their food. I don’t want to deny that people are using this in terms of healing for their children because of centuries of information regarding this, but we don’t have a real, solid, evidence-based format or platform on which to support that, although we know that it occurs.
Carol Vassar, podcast host/producer:
You have a background in looking into how other cultures handle healthcare and supplements in particular. How can we help parents respect that tradition and ensure their children’s safety?
Dr. Cora Collette Breuner, Pediatric/Adolescent Medicine Specialist, Seattle Children’s
That’s important. I was trained in the military. I did my residency in San Diego, and then I spent a number of years in Japan and Korea, Iwakuni, and the Philippines, and spent quite a bit of time working with different cultures and different traditional healing properties that families used that had been passed down through generations. I also spent a year in Pakistan taking care of Afghan refugees. Again, a completely different culture where there wasn’t necessarily even the ability to access healthcare because it would be miles and miles and miles to walk to some healthcare provider, whereas they had a neighborhood healer in their community.
I do respect that, and I understand that’s important to acknowledge and partner with our families, but it’s also important to recognize that we are in the business of keeping our kids healthy, so we make sure that the hot water temperature is 120 degrees. We make sure that these kids are buckled in their seat belts, wearing helmets. If we’re going to be doing that much surveillance and advocacy for our kids’ safety, we also need to do the exact same thing or things we put into their body where there isn’t a lot of evidence or data for support.
Carol Vassar, podcast host/producer:
Let’s talk about some of the risks. I’m thinking more in the long term of using herbs or supplements in children at different stages in their lives. Are there different effects that these herbs and supplements have on children who are 3 versus 13 versus when they’re adults and they’re 23?
Dr. Cora Collette Breuner, Pediatric/Adolescent Medicine Specialist, Seattle Children’s
Yes. Excellent question. This has to do with the developing brain, the developing body. I go back to melatonin because it is one that frequently comes up when I give talks about this in my office, in my clinic, or even with my friends. Melatonin is a hormone. It is not an herb like Echinacea, Kava, or even St. John’s wort. It’s a hormone that’s secreted by a part of our hypothalamic-pituitary axis called our pineal gland, where it’s secreted when it’s dark out or when you’re getting ready for bed.
If we’re giving something called melatonin to someone, it can actually stop your own brain from producing melatonin. Then your body isn’t doing what it’s supposed to do. Then it needs more. So people keep giving more of it. That’s one piece that’s worrisome. The second piece that’s worrisome, as we know, it’s a hormone. We do not know the long-term effects of giving a child pre-pubertal around 10, 11, 12, or even as young as three. We have no idea what the long-term effects are in these kids in terms of how they grow through how tall they’re going to be, or any other puberty changes when they’re on this particular supplement for years and years.
Carol Vassar, podcast host/producer:
It sounds like there’s a lot we don’t know about herbs and supplements. Is there research going on, or is that difficult because you don’t have the same dosage or the same formula with each and every different supplement that comes along?
Dr. Cora Collette Breuner, Pediatric/Adolescent Medicine Specialist, Seattle Children’s
Yes, there are really good studies using something called fish oil or omega-3 oils. We do have really solid studies with this particular supplement, which is also found in food. But we do know that if you use a dose-dependent based on age and size of fish oil on a daily basis, that kids have less depression and less anxiety if they get this every single day. We also know that kids who are on fish oil and may have less of a need for some of the medications that we prescribe because they have both together. So it wouldn’t mean completely stopping and anxiolytic or antidepressant medication.
But if you had someone on fish oil and these medications, you wouldn’t necessarily need more of them. Nothing’s free, though. If you take fish oil, you have to be careful because it can, if you don’t watch out, cause an irritating sensation where when you burp, it tastes like fish, which a lot of kids don’t like at all. So you have to be careful about this. There’s products that are freeze-dried fish oil, and there’s also products that don’t have fish oil. They’re just synthetically made omega-3s that don’t have that. It’s totally possible to do this. But you have to be very careful about how you do this with your children so that they’re not fighting you when you’re trying to give them something.
Carol Vassar, podcast host/producer:
You were talking about interaction between medications, I’m curious when somebody is taking an herb or a supplement, and it’s also on a prescription medication of some kind, is there a concern there has to be concern with regard to potential for interactions? Talk about that.
Dr. Cora Collette Breuner, Pediatric/Adolescent Medicine Specialist, Seattle Children’s
Yes, thank you. There’s an herb for depression called St. John’s wort. I mentioned it, and most people know about this. But it’s a lot of other herbs and supplements go through the same metabolic pathway. St. John’s wort or hypericin goes through the liver through the cytochrome P450 system, and it increases the amount of the metabolism of the P450 system. If you’re taking St. John’s wort, for example, and you’re taking birth control pills, it might ramp up the metabolism of that, making birth control pills less effective. Also, St. John’s wort in ramping up the P450 system might decrease the availability of an HIV protease inhibitor for those of our patients that need the antiretrovirals for survival, and it might decrease the availability of some of our transplant medications that we use to keep a patient from rejecting a transplant.
Are there a lot of studies showing that St. John’s wort actually causes this? No. But is it theoretical? Yes. But it is important to recognize that this particular product can interact with what you are prescribing in a negative way. Finally, St. John’s wort actually affects something called platelet aggregation, which is the clotting of the blood. Many folks in the emergency room, I need to tell them, you need to ask about a lot of herbs and supplements, because a lot of them affect platelet aggregation. So you might have a patient in your practice, or in your emergency room, or even in the OR that still has oozing or whatever when you’re trying to close a wound. The reason is because they’ve been taking this herb or supplement for something completely unrelated for depression, but they’re having some problem with wound closure. So it is one of those things that you know when you’re getting surgery, it says right on the form, “Don’t take any of these things three days before surgery.” There was a reason that it’s stated on those documents.
Carol Vassar, podcast host/producer:
When parents are considering an herb or a supplement for their child, what question should they be asking?
Dr. Cora Collette Breuner, Pediatric/Adolescent Medicine Specialist, Seattle Children’s
Excellent question. The questions they should be asking their healthcare providers, pediatricians, those who care for children and adolescents, young adults. Well, first of all, when a parent asks a healthcare provider about this, the healthcare provider should not have any judgment or criticism around a patient asking this question or a parent asking this question, because honestly, we are the experts. They’re asking us whether it’s okay. I honor that and make it really part of the equation of partnering with my families, especially in this topic. I work in the Northwest, so there’s a lot of folks who try all sorts of things, and when they come in, I just say, “Bring it. I want to see what it is you want to know, and I’ll, with due diligence, try to find out a way that I can help you learn the most you can about this and do it in a safe way.”
The first question that the parent or patient, if they’re a teen, should be asking the healthcare provider that’s seeing them is, “I am trying to think outside the box. I really don’t want to just not do anything for my child, or I don’t want to just use a medication you’re prescribed. I’d rather try something else. Are you okay with me talking to you about that?” Because if they say, no, that’s tough, and I’ve been giving lectures about this for years to my colleagues, “You need to be way more open-minded about this because people are doing this and if you don’t talk to them about it, they’re going to go online, and they’re going to go to other social media platforms and not go to you with this.”
Carol Vassar, podcast host/producer:
They might be getting poor information, misinformation.
Dr. Cora Collette Breuner, Pediatric/Adolescent Medicine Specialist, Seattle Children’s
Correct.
Carol Vassar, podcast host/producer:
A lot of states are legalizing marijuana for general use. I know that there is medical marijuana, but have you seen any increase in issues with regard to children being given this by their parents, or do you have concerns in that area?
Dr. Cora Collette Breuner, Pediatric/Adolescent Medicine Specialist, Seattle Children’s
Another very provocative question. I’m coming in from Washington state, where it’s legal, the whole West Coast of the United States, so Washington, Oregon, California, completely, and also Canada. I don’t find that folks are doing that as much as people think they are. I mean, it’s in the same vein as giving your kid a sip of alcohol, right? It’s not okay. So I know it sounds like we are seeing this more. I’m not seeing it. What I’m seeing in some of my adolescents is they’re confused about the legal age for it because there’s this myth that it’s 18, it’s 21. There’s a feeling that it’s a really good medicine, if you will, for anxiety, which it’s not. Let me see. How can I answer this? I feel like families are concerned, and in states where it is legal, we do know that there are more adults using THC, CBD than in states where it’s not legal.
We know that. We know that in states where it’s legal, there’s a higher number of DUIs from marijuana and in some different parts of the state than alcohol in adults. We know that. But do we think that parents are actually supplying it to their kids or kids are illegally getting it? No, our data isn’t really robust in that right now through our different studies in adolescent medicine, which is where I’m putting my adolescent medicine hat on, too. I do think that families need to have a conversation with their kids about this because it does cause impairment in driving. It does cause significant abdominal pain if it’s used for long periods of time, and it can cause more paranoia and lack of motivation in folks who use it every day.
But I’m not seeing it… Now I see CBD, which is different than THC, which is the neuropsychoactive component. I do see CBD, which allegedly doesn’t contain any THC in it, and there’s not a whole lot of data to show efficacy for CBD except in babies with seizure disorders. We do see an effect for that, and there are a lot of people doing research on that. That is coming is where is the place for CBD for different chronic pain conditions, et cetera, but it’s not out there yet.
Carol Vassar, podcast host/producer:
Are there any herbs or supplements that concern you that you’d like to talk about and maybe warn parents about as we talk here?
Dr. Cora Collette Breuner, Pediatric/Adolescent Medicine Specialist, Seattle Children’s
My biggest concern is that the healthcare providers don’t know enough about this, and they don’t really know where to go for information. When a concerned family comes to us asking questions, my concern is many people are just saying, “I don’t know,” probably not a good idea. It leaves our parents feeling confused, worried, and unclear. I feel that the more knowledge I can give to people that care for children and adolescents, the better the parents feel more comfortable they’re talking to us, and the better care our children and adolescents get.
The National Institute of Health has a huge website where there’s a lot of information for healthcare providers free through the CDC site. There’s also databases that folks who work at hospitals that have hospital libraries or E-portals where they get information for their education. These are portals where a provider would go in and learn about how to treat an ear infection or how to treat a rash.
There’s a portal that you can ask providers to put on their hospital library or even in their clinic library where they can look up-to-the-minute data on efficacy and safety for things that their parents are coming in and asking about. I think the greatest fear I have is people turning away from this as opposed to leaning into it, because I do think it’s a place of really important research and an important way we can partner with our families. I do feel that food contains many, many of the supplement ingredients because they have not fed their child in a more holistic and organic or healthful way that they turn to supplements and vitamins just because really busy, and they do this because they don’t recognize that they can cook in the food, the stuff they’re buying, which is expensive.
My other final push is about equity because I feel the supplement industry is a multi-billion-dollar industry, and this is expensive. I don’t know if you’ve gone to your local drugstore or pharmacy trying to price out these natural supplements. It’s anywhere from $30 to $60 a month for certain products. I feel like for a family of four, which has not a great robust income, and they spend money on this, versus spending money on making sure their kid gets enough sleep and that they have proper nutrition because it’s natural. That’s what worries me too.
Carol Vassar, podcast host/producer:
Dr. Cora Collette Breuner is an adolescent medicine specialist with Seattle Children’s.
MUSIC:
Well Beyond Medicine.
Carol Vassar, podcast host/producer:
Thanks to Dr. Breuner for sharing her expertise, and thanks to you for listening. From herbs and supplements to new methods of care delivery, if it affects children’s health, the Well Beyond Medicine Podcast is on it. If you have an episode idea, share it with us via email at [email protected], or head over to our website, nemourswellbeyond.org, and leave us a voicemail. There you’ll find previous episodes of the podcast and have a chance to subscribe and leave a review. That’s nemourswellbeyond.org.
Thanks to our production team for this episode, Susan Masucci, Cheryl Munn, Lauren Teta, and Steve Savino, for all of their hard work. Join us next time as we explore a new healthcare delivery system that’s bringing health services and economic opportunity to underserved areas of the world. I’m Carol Vassar. Until then, remember, we can change children’s health for good, Well Beyond Medicine.
MUSIC:
Let’s go, oh-oh.
Well beyond medicine.
