Downloaded from http://adc.bmj.com/ on January 30, 2015 - Published by group.bmj.com
PostScript
LETTER
Toxicity of remedies for infantile colic
advise their patients’ families responsibly, directing them to reliable sources of information on the subject, and educating them on the potential risks associated. Health authorities should regulate these products more strictly, giving them similar treatment as the rest of medical products throughout the whole process, from production to the patient, as the uncontrolled use in children may represent serious health risks.
Moisés Rodríguez-González,1 Isabel Benavente Fernández,2 Pamela Zafra Rodríguez,2 Alfonso M Lechuga-Sancho,3 Simón Lubián López2 1
Pediatric Cardiology Section, Hospital Universitario Puerta del Mar, Cádiz, Spain Neonatology Section, Hospital Universitario Puerta del Mar, Cádiz, Spain 3 Pediatric Endocrinology Section, Hospital Universitario Puerta del Mar, Cádiz, Spain 2
Correspondence to Dr Moisés Rodríguez González, Pediatric Cardiology Section, Hospital Universitario Puerta del Mar, C/Isaac Peral 13, San Fernando, Cádiz 11100, Spain; [email protected] Collaborators Javier González Durio. Competing interests None. Patient consent Obtained. Provenance and peer review Not commissioned; internally peer reviewed.
Figure 1 ECG shows a narrow QRS tachycardia at 300 bpm, with retrograde P waves to QRS and a short RP interval. Arch Dis Child December 2014 Vol 99 No 12
1147
Drug therapy
Carminatives are substances that prevent the formation and/or promote elimination of intestinal gas by an antispasmodic effect on the gastrointestinal smooth muscle. They are frequently used to treat infant colic, and are usually easily obtained over-the-counter in pharmacies and other health-related stores. They are seemingly not identified as drugs by the caregiver, which increases their sense of security, plus there is a lack of control in the presentation and marketing of these products. In addition, some carminatives include belladonna alkaloids and/or star anise, substances that could have serious side effects. All this is cause for concern, as there are many factors that together may increase the risk for toxicity in this context. We report a 23-day-old, previously healthy boy suffering from infantile colic who received higher doses than recommended of an over-the-counter carminative containing belladonna. He was admitted to our neonatal intensive care unit due to anticholinergic syndrome with supraventricular tachycardia possibly triggered off by belladonna intoxication (figure 1). Following cardioversion to sinus rhythm, a Wolff– Parkinson–White syndrome was revealed (figure 2).
The use of complementary/alternative medicine (CAM), including homeopathy, is growing. Approximately 12% of children receive some so-called ‘natural’ remedy, and infantile colic represents 4.5% of conditions treated in this way.1 2 Parents are prone to selecting CAM for their children themselves, reflecting a lack of awareness of the fact that these are drugs.1 Up to 10% of general practitioners often prescribe these despite the lack of evidence regarding their effectiveness and safety in any paediatric field and the reported life-threatening side effects.3 4 Many CAMs are not subject to the same strict regulations by authorities as other drugs. They are widely available and may be easily found marketed as over-the-counter (even online) medicines. Furthermore, caregivers are likely to be exposed to unreliable and potentially dangerous information from family, friends, the internet and other media sources.1 2 There are many misconceptions of homeopathic products such as carminatives, and so they are believed to be free of toxic or side effects because of supposedly low concentrations of active ingredients, and are incorrectly considered as ‘natural or herbal safe medicine’.2 Therefore, paediatricians should reconsider the use of carminatives for treating infant colic since in our opinion, the possibility of serious side effects outweighs their benefits in infants. Health providers should ask about them in the clinic and should be sufficiently knowledgeable in this area to
Downloaded from http://adc.bmj.com/ on January 30, 2015 - Published by group.bmj.com
PostScript
Drug therapy
Figure 2 ECG following cardioversion which revealed a short PR interval with δ-wave, more prominent on leads II, III and V4, consistent with Wolff–Parkinson–White syndrome. To cite Rodríguez-González M, Benavente Fernández I, Zafra Rodríguez P, et al. Arch Dis Child 2014;99:1147–1148. Received 2 June 2014 Revised 7 August 2014 Accepted 8 August 2014 Published Online First 28 August 2014 Arch Dis Child 2014;99:1147–1148. doi:10.1136/archdischild-2014-306885
1148
REFERENCES 1
2
Posadzki P, Watson L, Alotaibi A, et al. Prevalence of complementary and alternative medicine (CAM)-use in UK paediatric patients: a systematic review of surveys. Complement Ther Med 2013;21:224–31. Thompson EA, Bishop JL, Northstone K. The use of homeopathic products in childhood: data generated over 8.5 years from the Avon Longitudinal Study of Parents and Children (ALSPAC). J Altern Complement
3
4
Med 2010;16:69–79. http://online.liebertpub.com/doi/ abs/10.1089/acm.2009.0007 Meyer S, Gortner L, Larsen A, et al. Complementary and alternative medicine in paediatrics: a systematic overview/synthesis of Cochrane Collaboration reviews. Swiss Med Wkly 2013;143:w13794. Aviner S, Berkovitch M, Dalkian H, et al. Use of a homeopathic preparation for “Infantile Colic” and an apparent life-threatening event. Pediatrics 2010;125: e318–23.
Arch Dis Child December 2014 Vol 99 No 12
Downloaded from http://adc.bmj.com/ on January 30, 2015 - Published by group.bmj.com
Toxicity of remedies for infantile colic Moisés Rodríguez-González, Isabel Benavente Fernández, Pamela Zafra Rodríguez, Alfonso M Lechuga-Sancho and Simón Lubián López Arch Dis Child 2014 99: 1147-1148 originally published online August 28, 2014
doi: 10.1136/archdischild-2014-306885 Updated information and services can be found at: http://adc.bmj.com/content/99/12/1147
These include:
References Email alerting service
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This article cites 4 articles, 1 of which you can access for free at: http://adc.bmj.com/content/99/12/1147#BIBL Receive free email alerts when new articles cite this article. Sign up in the box at the top right corner of the online article.
Articles on similar topics can be found in the following collections ADC Drug Therapy (99) Child health (3363) Infant health (737) Drugs: cardiovascular system (443) Pain (neurology) (514) Arrhythmias (69) Neonatal and paediatric intensive care (329) Neonatal health (584) Competing interests (ethics) (143) Journalology (193)
Notes
To request permissions go to: http://group.bmj.com/group/rights-licensing/permissions To order reprints go to: http://journals.bmj.com/cgi/reprintform To subscribe to BMJ go to: http://group.bmj.com/subscribe/
PostScript
LETTER
Toxicity of remedies for infantile colic
advise their patients’ families responsibly, directing them to reliable sources of information on the subject, and educating them on the potential risks associated. Health authorities should regulate these products more strictly, giving them similar treatment as the rest of medical products throughout the whole process, from production to the patient, as the uncontrolled use in children may represent serious health risks.
Moisés Rodríguez-González,1 Isabel Benavente Fernández,2 Pamela Zafra Rodríguez,2 Alfonso M Lechuga-Sancho,3 Simón Lubián López2 1
Pediatric Cardiology Section, Hospital Universitario Puerta del Mar, Cádiz, Spain Neonatology Section, Hospital Universitario Puerta del Mar, Cádiz, Spain 3 Pediatric Endocrinology Section, Hospital Universitario Puerta del Mar, Cádiz, Spain 2
Correspondence to Dr Moisés Rodríguez González, Pediatric Cardiology Section, Hospital Universitario Puerta del Mar, C/Isaac Peral 13, San Fernando, Cádiz 11100, Spain; [email protected] Collaborators Javier González Durio. Competing interests None. Patient consent Obtained. Provenance and peer review Not commissioned; internally peer reviewed.
Figure 1 ECG shows a narrow QRS tachycardia at 300 bpm, with retrograde P waves to QRS and a short RP interval. Arch Dis Child December 2014 Vol 99 No 12
1147
Drug therapy
Carminatives are substances that prevent the formation and/or promote elimination of intestinal gas by an antispasmodic effect on the gastrointestinal smooth muscle. They are frequently used to treat infant colic, and are usually easily obtained over-the-counter in pharmacies and other health-related stores. They are seemingly not identified as drugs by the caregiver, which increases their sense of security, plus there is a lack of control in the presentation and marketing of these products. In addition, some carminatives include belladonna alkaloids and/or star anise, substances that could have serious side effects. All this is cause for concern, as there are many factors that together may increase the risk for toxicity in this context. We report a 23-day-old, previously healthy boy suffering from infantile colic who received higher doses than recommended of an over-the-counter carminative containing belladonna. He was admitted to our neonatal intensive care unit due to anticholinergic syndrome with supraventricular tachycardia possibly triggered off by belladonna intoxication (figure 1). Following cardioversion to sinus rhythm, a Wolff– Parkinson–White syndrome was revealed (figure 2).
The use of complementary/alternative medicine (CAM), including homeopathy, is growing. Approximately 12% of children receive some so-called ‘natural’ remedy, and infantile colic represents 4.5% of conditions treated in this way.1 2 Parents are prone to selecting CAM for their children themselves, reflecting a lack of awareness of the fact that these are drugs.1 Up to 10% of general practitioners often prescribe these despite the lack of evidence regarding their effectiveness and safety in any paediatric field and the reported life-threatening side effects.3 4 Many CAMs are not subject to the same strict regulations by authorities as other drugs. They are widely available and may be easily found marketed as over-the-counter (even online) medicines. Furthermore, caregivers are likely to be exposed to unreliable and potentially dangerous information from family, friends, the internet and other media sources.1 2 There are many misconceptions of homeopathic products such as carminatives, and so they are believed to be free of toxic or side effects because of supposedly low concentrations of active ingredients, and are incorrectly considered as ‘natural or herbal safe medicine’.2 Therefore, paediatricians should reconsider the use of carminatives for treating infant colic since in our opinion, the possibility of serious side effects outweighs their benefits in infants. Health providers should ask about them in the clinic and should be sufficiently knowledgeable in this area to
Downloaded from http://adc.bmj.com/ on January 30, 2015 - Published by group.bmj.com
PostScript
Drug therapy
Figure 2 ECG following cardioversion which revealed a short PR interval with δ-wave, more prominent on leads II, III and V4, consistent with Wolff–Parkinson–White syndrome. To cite Rodríguez-González M, Benavente Fernández I, Zafra Rodríguez P, et al. Arch Dis Child 2014;99:1147–1148. Received 2 June 2014 Revised 7 August 2014 Accepted 8 August 2014 Published Online First 28 August 2014 Arch Dis Child 2014;99:1147–1148. doi:10.1136/archdischild-2014-306885
1148
REFERENCES 1
2
Posadzki P, Watson L, Alotaibi A, et al. Prevalence of complementary and alternative medicine (CAM)-use in UK paediatric patients: a systematic review of surveys. Complement Ther Med 2013;21:224–31. Thompson EA, Bishop JL, Northstone K. The use of homeopathic products in childhood: data generated over 8.5 years from the Avon Longitudinal Study of Parents and Children (ALSPAC). J Altern Complement
3
4
Med 2010;16:69–79. http://online.liebertpub.com/doi/ abs/10.1089/acm.2009.0007 Meyer S, Gortner L, Larsen A, et al. Complementary and alternative medicine in paediatrics: a systematic overview/synthesis of Cochrane Collaboration reviews. Swiss Med Wkly 2013;143:w13794. Aviner S, Berkovitch M, Dalkian H, et al. Use of a homeopathic preparation for “Infantile Colic” and an apparent life-threatening event. Pediatrics 2010;125: e318–23.
Arch Dis Child December 2014 Vol 99 No 12
Downloaded from http://adc.bmj.com/ on January 30, 2015 - Published by group.bmj.com
Toxicity of remedies for infantile colic Moisés Rodríguez-González, Isabel Benavente Fernández, Pamela Zafra Rodríguez, Alfonso M Lechuga-Sancho and Simón Lubián López Arch Dis Child 2014 99: 1147-1148 originally published online August 28, 2014
doi: 10.1136/archdischild-2014-306885 Updated information and services can be found at: http://adc.bmj.com/content/99/12/1147
These include:
References Email alerting service
Topic Collections
This article cites 4 articles, 1 of which you can access for free at: http://adc.bmj.com/content/99/12/1147#BIBL Receive free email alerts when new articles cite this article. Sign up in the box at the top right corner of the online article.
Articles on similar topics can be found in the following collections ADC Drug Therapy (99) Child health (3363) Infant health (737) Drugs: cardiovascular system (443) Pain (neurology) (514) Arrhythmias (69) Neonatal and paediatric intensive care (329) Neonatal health (584) Competing interests (ethics) (143) Journalology (193)
Notes
To request permissions go to: http://group.bmj.com/group/rights-licensing/permissions To order reprints go to: http://journals.bmj.com/cgi/reprintform To subscribe to BMJ go to: http://group.bmj.com/subscribe/
