September 9, 2015

Going on the Offensive for Childhood Wellness: Profiles of 3 Initiatives

From integrative med to school-based care, inventive approaches promise progress

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Threats to children’s well-being are proliferating— from sedentary lifestyles to unhealthful diets to mounting childhood stresses. Isn’t it time pediatric providers responded in kind, with a multifront offensive to promote child wellness in new and diverse ways?

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That’s the tack Cleveland Clinic Children’s is increasingly taking to wellness, and the past year has seen new efforts on multiple fronts. A few examples are detailed below.

Newly launched Center for Pediatric Integrative Medicine

Among the biggest recent wellness-related initiatives is the 2014 launch of the Center for Pediatric Integrative Medicine, one of the nation’s few integrative medicine centers expressly for children.

While Cleveland Clinic Children’s has offered many integrative and complementary therapies for years, this formal center has brought them under a single roof in a handsomely renovated space at Cleveland Clinic Children’s Hospital for Rehabilitation, where many complex cases are managed. The result is a more coordinated, collaborative and multidisciplinary approach to delivering these therapies than ever before.

The center is staffed by a multidisciplinary team of pediatric specialists in disciplines ranging from behavioral medicine to pain management to physical medicine and rehabilitation. Team members are certified in a host of therapeutic techniques, including:

  • Acupuncture/acupressure/laser acupuncture
  • Biofeedback
  • Guided imagery and hypnosis
  • Integrative dry needling
  • Frequency-specific microcurrent therapy
  • Craniosacral therapy
  • Myofascial release and osteopathic manipulation
  • Reiki and (for infants) therapeutic touch
  • Relaxation/breathing strategies and yoga

Staff tailor these modalities to the needs of young patients with difficult-to-manage chronic conditions ranging from chronic pain to concussions, pulmonary conditions, anxiety/depression and more.

“Going beyond a child’s physical needs to address lifestyle and emotional needs can reduce the frequency of disease episodes, decrease stress from chronic illness and improve quality of life,” says Benjamin Katholi, MD, a pediatric physiatrist who directs the new center. “The center’s treatments are intended as a complement to, not a replacement for, traditional medical therapies.”

One of the new center’s objectives is enhanced and coordinated research efforts to better define the evidence for and utility of integrative therapies for children. Staff are beginning or planning research on interventions from acupuncture to reiki to frequency-specific microcurrent therapy.

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Studying the promise of a plant-based diet for kids

Few studies have evaluated wholly plant-based diets in any pediatric populations. To help fill that gap, Cleveland Clinic Children’s researchers conducted one of the first randomized trials of a vegan diet in obese children with hypercholesterolemia.

The study, published in Journal of Pediatrics earlier this year, randomized 30 children ages 9 to 18 to a four-week intervention with either a plant-based, no-added-fat diet or the American Heart Association (AHA) diet, which is similar but allows non-whole grains, low-fat dairy, some plant oils and moderate amounts of lean meat and fish.

All children were obese (BMI > 95th percentile) and had a total cholesterol level over 169 mg/dL. At least one parent undertook the assigned diet with each child.

After four weeks, children in the plant-based diet group had statistically significant mean improvements from baseline in nine of 15 anthropometric measures or biomarkers of cardiovascular risk or inflammation, whereas children in the AHA diet group had improvements in just four of the 15 measures.

Difficulty shopping for food for the plant-based diet was the only statistically significant acceptability barrier reported by the children’s families.

“These findings are suggestive of an added benefit in terms of weight loss and cardiovascular health with a stricter vegan diet compared with the AHA diet, which is considered a standard of care,” says lead author and general pediatrician Michael Macknin, MD.

Despite the study’s limitations — including its small size, short duration and restriction to mostly middle-class patients — it suggests that the documented benefits of a plant-based diet in adults will extend to children as well.

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“These results argue for larger and longer studies of plant-based, no-added-fat diets as a tool for preventing cardiovascular disease and other health problems in obese children and adolescents,” Dr. Macknin concludes.

Going mobile to care for underserved communities

Children in underserved communities typically have the greatest healthcare needs, including preventive and primary care as well as management of chronic conditions. Recognizing that, Cleveland Clinic Children’s has launched a School-Based Health Care (SBHC) program to serve students from kindergarten through 12th grade in the place they go every weekday: school.

The full-service pediatric office on wheels makes regular visits to participating public schools in some of Cleveland’s inner-ring suburbs to offer preventive screening, physical exams, immunization, first aid, diagnosis and treatment of acute conditions, and care of some chronic conditions of childhood.

The SBHC mobile unit (photo at top of this post) is staffed by a pediatrician or pediatric advanced practice nurse who will work with a student’s existing healthcare provider if the child has one — or who may become the child’s pediatric provider if needed.

“We find we can help children with underlying conditions whose treatment may not be optimized, such as kids who are missing a lot of school due to uncontrolled asthma,” says Deb Lonzer, MD, Chair of the Department of Community Pediatrics. “Parents are thrilled about the SBHC program, as their children can get needed care or checkups without parents needing to take off work or worry about transportation.”

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