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Phytotherapy Essentials: Healthy Children, Optimising Children’s Health with Herbs

Phytotherapy Essentials: Healthy Children, Optimising Children’s Health with Herbs by Kerry Bone and Rob Santich. Warwick, Queensland: Phytotherapy Press; 2008. Paperback; 218 pages. ISBN 9780646486161. $217.74.

Author and clinical herbalist Kerry Bone is back, once again leading the way in evidence-based clinical phytotherapy publications. This time he has teamed up with Australian medical herbalist and a father himself, Rob Santich, in writing a textbook and reference guide on the use of botanical medicine in children’s health and wellness. Phytotherapy Essentials: Healthy Children, Optimising Children’s Health with Herbs addresses the major issues involved with using botanical medicine in the pediatric population. This is a clinical textbook focused on bringing together evidence-based botanical information applicable to children’s healthcare. The authors thread in personal clinical experiences with children and herbal medicine to round the edges and make it more personal.

In the opening chapter, “Basic Principles,” the authors bring forth specific issues and topics addressing the general use, efficacy, and safety of botanical medicine in the pediatric population. They discuss issues of particular importance to this population such as dosage, compliance, taste, and alcoholic versus non-alcoholic preparations.

As a naturopathic physician with a pediatric clinical practice, I was pleased to see that the topic of bioavailability of herbal medicines in children was also included. This brings to the reader’s attention the fact that a child’s physiology operates differently from that of an adult and highlights the need to incorporate this thinking when administrating herbal medicines to children. This section looks at factors affecting route of administration, including digestive maturity, gastric emptying, breastfeeding position, hepatic function, body composition, and intestinal microbiota.

The authors include a separate chapter on common disorders and health issues seen in newborns. The need for clear guidelines in the application of herbal medicine in this population is of great importance. The authors remind readers of the fact that a human infant has a developing immune system with less developed defense responses, which increases the susceptibility of neonates to certain viral, fungal, and bacterial infections. Included here are the most common health complaints that arise for an infant with practical herbal recommendations. The authors also include evidence-based studies to confirm existing traditional herbal remedies used for such conditions. Examples include chamomile (Matricaria recutita, Asteraceae) and calendula (Calendula officinalis, Asteraceae) cream for diaper rash, and the gripe water formula of lemon balm (Melissa officinalis, Lamiaceae), fennel (Foeniculum vulgare, Apiaceae), and chamomile for colicky infants.

The book also includes 2 charts. One lists the tablet/capsulated formulas mentioned in the book, which are manufactured by the Australian herb manufacturer Medi-Herb® (founded by the book's primary author), and the second provides specific herbal safety information for children. I find this chart to be confusing, inconsistent in the use of terminology, and misleading. As far as being a helpful guide, I would have to say that it is not.

The remainder of the textbook focuses on the major childhood disorders. Organized by body system, these sections include relevant information about pathophysiology, etiology, epidemiology, microbiology, pathogenesis, immunology, risk factors, and clinical manifestations for each. The holistic, multi-faceted approach of looking at pathogenesis, etiology, and risk factors is supported by evidence-based research and clinical observations. This approach is refreshing to see, and guides the reader to look at the bigger picture in designing treatment strategies.

Completing each section on childhood disorders is a general discussion on strategies for herbal treatments, treatment rationales, examples of herbal liquid formulas for treating the condition, hints for creating a comprehensive herbal protocol, and a pertinent case history from the authors’ clinical experience (when available). The majority of herbs included in the treatment formulas and protocols are not necessarily based on the traditional child’s herbal materia medica. Rather, they are included due to the availability of evidence-based research or tablet/capsule formulas, which are manufactured by Medi-Herb.

While the benefits of evidence-based knowledge are many, it is important to recognize the drawbacks that this may present in clinical herbal medicine. In this case, there are many traditional children’s herbs being seen through evidence-based research and many that will not be included for various reasons. Remembering to include vital information that has been gained through observation and experience is also an essential part of good herbal education.

There is a brief section on the route of delivering herbal medicine to a breastfeeding baby. The authors cite one study that showed insufficient transfer of a plant’s active constituent to a baby through breast milk. This low level of transfer resulted in a lack of significant therapeutic effects. Based on this study the authors write, “It is recommended that herbal doses intended for a breastfed child are always directly administered to the child.” Many mothers, herbalists, midwives, grandmothers, and doctors would not agree with this being consistent with what they have witnessed in real-life experiences. This serves as a reminder that facts and observation, like experience, are all avenues of gathering information.

A second issue worth discussing is the authors’ tendency to extract information from evidenced-based studies to support the use of herbs for similar circumstances. For example, the authors recommend the use of diluted propolis for infants in the treatment of oral Candida albicans (Saccharomycetaceae), based on research looking at the use of propolis in the treatment of chronic fungal vaginitis. I recognize that propolis is an effective anti-C. albicans agent, but is that enough to warrant the use of this substance in the infant population? Propolis is often taken from beehives or a high-resin plant (e.g. poplar buds, Populus balsamifera, Salicaceae). It can be made as a high-alcohol tincture and can be very irritating to the mucus membranes of an infant, not to mention the long-lasting foul taste it leaves in the mouth. Evidence-based research provides facts but not necessarily the realistic dynamics of applying the information in a clinical setting. Alternatively, the children’s herb licorice (Glycyrrhiza glabra, Fabaceae) provides a good tasting anti-candidal agent with growing evidence-based research on its use in children’s oral health.

There is a strong need in clinical natural medicine for reliable information on the application, safety, efficacy, and use of herbal medicine with infants and children. This book provides a good reference guide for healthcare professionals using herbal medicines with children and an educational text for students of herbal medicine. The integration of clinical experience, evidence-based research, and herbal tradition makes Healthy Children an excellent resource to add to one’s library on children’s health.

—Mary Bove, NDBattleboro Naturopathic Clinic