Chapter 21: Complementary & Alternative Therapies in Pediatrics

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Welcome back to The Deep Dive.

Today, we are rolling up our sleeves and tackling a massive, complex, and I think incredibly relevant stack of research.

It's a big one.

It is.

We're doing something a little different today.

We're zeroing in on a single, vital text that really shapes how nursing students and professionals understand patient care in this country.

And we're looking squarely at the intersection of modern Western medicine and everything else, and that everything else covers a lot of ground.

Exactly.

We are diving into chapter 21 of Lifer's Introduction to Maternity and Pediatric Nursing in Canada.

And if you're a nursing student, a practicing nurse, or really just someone interested in how health care actually works on the ground in Canada,

this is going to be your bread and butter.

We are not just skimming the surface here.

No, the mission today is pretty specific.

We're going to walk through this chapter exactly as it's written.

We're going to translate the technical nursing concepts into plain English.

We're going to decode the diagrams that often confuse students.

And we are going to look at the tables that usually get skipped over.

Because, let's be honest, in the textbook, those tables are where the exam questions hide.

And even more importantly, that is where the real -life safety data lives.

Precisely.

The focus today is complementary and alternative health modalities, and specifically in the world of pediatrics.

Our goal is to give you a comprehensive summary.

We're talking about everything from herbs that mess with anesthesia to understanding indigenous healing practices to why a coin rub might look like abuse, but isn't.

It's about building a toolkit.

Because as a nurse or any health care provider, you are the bridge.

You're the one who has to navigate between what the doctor prescribes and, well, what the family's doing at home.

That's the perfect way to put it.

So let's start at the very beginning.

The chapter throws an acronym at us immediately.

C -A -H -M.

Let's unpack that.

Right.

It stands for complementary and alternative health modalities.

Now, in casual conversation, you'll hear people use complementary and alternative just interchangeably, like they mean the same thing.

Yeah, I probably do that myself.

We all do.

But in nursing, and in this text specifically, they absolutely do not.

The distinction is, frankly, crucial for safety.

Okay.

So let's draw the line.

What is the actual difference between complementary and alternative?

Think of it this way.

Complementary means you are using a therapy with conventional Western medicine.

It's an add -on.

It's a partnership.

The text is a really great example treating high blood pressure.

Right.

So if I'm taking my prescribed blood pressure medication, say a beta blocker, but I'm also doing biofeedback or relaxation techniques to help lower my stress,

that's complementary.

I'm doing both.

Exactly.

You're complementing the standard care.

You aren't rejecting the science.

You are augmenting it.

You're adding to it.

Okay.

So then what's alternative?

Now, alternative is different.

Alternative therapy is used in place of conventional therapy.

So using that same example, if you decided I'm not going to take the blood pressure medication, I'm only going to use herbal remedies or traditional practices instead, that is alternative.

That's a huge difference when it comes to patient safety.

I mean, if a patient is using a complementary therapy,

we're mostly worried about interactions.

But if they're using an alternative one, then we are worried about the disease itself going completely untreated.

It's a whole different level of risk.

And the chapter mentions other terms too, right?

Like integrative therapy.

It does.

You'll also hear terms like integrative therapy or holistic healing, which all kind of fall under this big CAHM umbrella.

And it's important to remember the World Health Organization points out that for a lot of the world, what we in the West call alternative is actually just medicine.

It's the mainstay.

It's how they've treated illness for centuries.

And it's not some niche thing in Canada either.

The stats in this chapter, they blew me away.

It says more than three quarters of Canadians have used at least one form of CAHM in their lives.

Three quarters.

That is a massive, massive majority.

It's mainstream.

It absolutely is.

And the trends are shifting.

The text mentions that things like massage, yoga and acupuncture are skyrocketing in popularity.

Massage is actually the most common, with something like 44 % of Canadians having tried it.

Wow.

And interestingly, the use of other things like high dose vitamins and some folk remedies is actually declining a bit.

People seem to be moving more towards body work and movement -based therapies.

So if everyone is doing it, how do we know any of this is safe?

I feel like I walk into a health food store and it's just walls and walls of bottles.

It can be totally overwhelming.

And that brings us to regulation.

This is a really key part of the Canadian context that the chapter lays out.

We have something called natural health products or NHPs.

NHPs.

And this covers basically everything.

Herbs, supplements, vitamins, anything from a natural source that claims a health benefit but isn't a prescription drug.

So who is watching over this?

Is it the Wild West?

No, not at all, actually.

Health Canada has a specific branch called the Natural and Non -Prescription Health Products Directorate or NNHPD.

That's a mouthful.

It is.

But their job is to balance access with safety.

They want you, the consumer, to have the freedom to choose your cultural or personal remedies, but they also want to make sure the bottle doesn't contain lead or arsenic.

So as a nurse or even as a consumer, what am I looking for on the bottle?

Is there some kind of code or a seal?

There is.

And this is a great practical tip from the chapter.

If a product has been licensed and reviewed in Canada, it will have a specific code on the label.

You're looking for an NPN that stands for natural product number.

NPN.

Or for homeopathic stuff, a DINHM, which is a homeopathic medicine number.

Okay, so NPN or DINHM.

If I see that on the bottle, what does it actually guarantee?

It means Health Canada has reviewed that product for safety, quality, and some extent, the health claims it's making.

It's a seal of approval that the manufacturing process is regulated.

It doesn't necessarily guarantee it will cure your disease efficacy as a different higher bar, but it ensures the product is what it says it is, and it's free from major contaminants.

Which is a perfect segue into the first major section of our deep dive here,

pediatric vulnerability.

Because even if a bottle has that NPN on it, that doesn't mean I could just give it to a two -year -old, right?

Absolutely not.

And this is the core, core message of the pediatric section of this chapter.

Children are not just small adults.

It's a mantra in pediatrics.

Their physiology is fundamentally different.

Their organ systems, their livers, their kidneys are less mature.

They're still developing.

They process things differently.

A dose that's safe for me might not be safe for them.

Exactly.

They metabolize drugs and herbs at different rates.

Something that an adult clears from their system in a few hours might linger in a child's system for days, potentially building up to toxic levels.

Or it might cause a completely different unexpected reaction altogether.

We call this the therapeutic window, and in kids, it is so much narrower.

In the scary part, which the text really highlights, is the information gap.

There's a serious lack of evidence -based research specifically for kids.

It's a huge blind spot in medicine.

Most clinical trials are done on adults for ethical and practical reasons.

So when parents read testimonials online, oh, this worked wonders for my aunt's arthritis.

They often don't realize that the evidence for using it on a three -year -old just isn't there.

We are often flying blind, relying on anecdotal evidence rather than rigorous science.

So what is the nurse's role here?

If a parent comes in and they're using these things on their child, do we just say, stop doing that?

No, and that's where the art of nursing really comes in.

The text emphasizes that the nurse is a partner in decision -making.

If you just shut them down and judge them, they'll just stop telling you what they're doing, and that's the most dangerous outcome.

You need open lines of communication.

So step one is assessment.

Assessment is everything.

And you have to specifically ask.

The text warns that parents often won't volunteer this information.

They might think, oh, it's natural.

It's just a tea.

It's not a drug, so I don't need to list it on the medication form.

So you have to be direct.

You have to ask, are you giving your child any herbs, vitamins, teas, or seeing any other healers?

Exactly.

And it has to be nonjudgmental.

It's about cultural competence.

Healing is influenced by culture and environment.

You want to respect their choices while using your critical thinking to spot the dangers.

You are the safety net.

Speaking of safety nets and dangers, let's unpack table 21 .1.

This is the preoperative cautions table.

This feels like one of those things that if you're a student listening, you need to highlight this.

You need to memorize this.

You really, really do.

This table lists common herbs that must be stopped two weeks before any surgery.

Two weeks?

That seems like a really long time.

It is, but it's absolutely necessary.

These compounds can linger in the system, and they interact with anesthesia or the surgery itself in ways that can be life -threatening.

Okay, let's run through them.

I want to understand the why for each one.

First up on the list,

echinacea.

I mean, everyone takes this for colds.

Why do you have to stop it before surgery?

So the text lists two reasons.

One, it can cause an unpleasant pace sensation, which is minor, you know, not a big deal.

But the big one is potential liver toxicity.

Liver toxicity, okay.

If your liver is busy dealing with the compounds in echinacea, it can't process the anesthesia drugs properly.

The book specifically says it may potentiate barbiturate toxicity.

So the anesthesia could become toxic because the liver is,

it's, it's distracted basically.

It's distracted.

That's a great way of putting it.

Okay.

Next group,

garlic and ginger.

These are in everyone's kitchen.

This feels different.

And in food amounts, it's usually fine, but we're talking about supplements here.

Concentrated capsules of garlic or ginger extract.

And as supplements, they act as blood thinners.

They increase bleeding time.

So it's a disaster.

Garlic can cause hypertension, low blood pressure,

and gender increases the risk of not being able to control blood flow.

You do not want a patient bleeding out on the table because they were taking garlic capsules to lower their cholesterol.

No, you do not.

What about ginkgo biloba?

I know that's usually marketed for memory.

Right.

And ginkgo is a triple threat in a bad way here.

First, it causes platelet dysfunction.

So again, a major bleeding risk, but it also decreases the effectiveness of intravenous barbiturates.

The drugs used to put you to sleep.

Oh, wow.

So you have a patient who is bleeding more than they should be and who also might not stay fully sedated.

That's terrifying.

Okay.

St.

John's wort.

I know this is a big one for mood and depression is very common.

St.

John's wort is the heavy hitter of drug interactions.

It induces liver enzymes.

Basically it makes your liver work too fast.

The text says it interferes with the way too quickly.

Plus it also increases bleeding risk.

It's an absolute nightmare for the anesthesiologist.

Okay.

Next up ginseng.

Ginseng is a stimulant during surgery that can cause hypertension, which is high blood pressure and tachycardia, which is a rapid heart rate.

You want the heart to be steady and boring during surgery, not racing out of control.

Right.

Boring is good and no R.

Okay.

Two more.

Kava kava.

I've heard of this for anxiety.

It is.

Kava is used for anxiety.

It's a sedative.

The problem is it works too well with anesthesia.

It dramatically increases the level of sedation.

It can lead to a coma.

And on top of that, it's really tough on the liver.

There's a risk of liver failure.

So it's a double whammy sedation and liver damage.

Exactly.

And finally, ephedra, which is also known as ma huang.

This one is incredibly dangerous.

It's a stimulant that used to be used for weight loss or asthma.

In surgery, it can cause fatal cardiac dysrhythmias.

That's irregular heartbeats, especially when it interacts with volatile anesthetics like halothane.

It can also cause a stroke.

This one is a massive red flag.

If a patient is on ephedra, the surgery might actually need to be postponed.

Okay.

So that's the scary stuff.

But the chapter pivots here in a really interesting way.

It moves from this tone of be careful to a tone of be respectful.

We're moving into section two,

indigenous traditional healing.

And this is such an important part of Canadian nursing practice.

The text explicitly links this section to the truth and reconciliation commission's calls to action.

It says nurses have a duty to advocate for indigenous approaches and work respectfully with traditional healers.

It's not just about allowing it.

It's about recognizing its value and its legitimacy.

It's moving away from the idea that western medicine is the real medicine and everything else is just folklore.

Right.

For many indigenous people's first nations, METI's Inui healing is holistic.

It's not just about fixing a broken leg.

It's a journey that involves the spiritual, the emotional, the mental, and the physical.

You can't treat one part without treating the whole person.

And to help visualize this, the book provides figure 21 .2, which is the medicine wheel.

For anyone listening who doesn't have the book in front of them, can you sort of paint a picture for us?

Yeah, absolutely.

So picture a perfect circle and it's divided into four equal quadrants, like a pie cut into quarters.

And that number four is sacred in many indigenous cultures.

The quadrants, they represent the four directions, north, south, east, west.

They represent the four seasons.

And crucially for nursing, they represent the four aspects of health,

spiritual, mental, physical, and emotional.

And what's in the middle of the The center represents balance.

It represents learning, self -balance, beauty, and harmony.

The idea is that illness comes from an imbalance in the wheel.

If your spiritual health is suffering, your physical health will eventually suffer too.

They're all connected.

The text also lists the four sacred medicines that are often associated with this.

Yes.

Tobacco, sweetgrass, cedar, and sage.

These are used in various ceremonies and rituals.

Tobacco, for instance, is often used as offering, a way of giving thanks or asking for help from the creator or from elders.

And the text details a few of those healing methods.

I think most people have probably heard of smudging, but how is it described here from a clinical perspective?

Smudging involves burning those sacred medicines, usually sage or sweetgrass, and using the smoke to cleanse the body, the spirit, or space.

The text describes a person putting their hands in the smoke and carrying it to their body, especially to areas that need healing, like over their eyes, their heart, their mind.

It's a cleansing ritual.

And this happens in hospitals now?

It does.

Many hospitals now have policies to allow smudging, often in special ventilated rooms, to respect these practices.

What about sweats?

A sweat lodge ceremony.

This is a very powerful cleansing ritual using intense heat steam created by pouring water over hot rocks, often with sacred medicines added.

It's a form of physical and spiritual purification.

It happens inside a lodge, which is usually a small domed structure.

It also mentions healing circles.

What are those?

That's a form of group healing.

The key concept there is that everyone has a voice.

There's often a talking stick or an eagle feather that gets passed around, and only the person holding it can speak.

It's democratic and it provides incredible communal support.

It helps break the isolation that so often comes with illness.

And finally, diet.

Yes.

Returning to traditional foods like

fish and berries is seen as a form of medicine in itself, connecting the person back to the land and to their culture.

It's really about connection to community, to the earth, to the spirit.

Now moving on to section three, we get into manual healing and bodywork.

This is the hands -on stuff.

Right.

The basic theory here is that the body has a powerful self -healing ability, but sometimes it gets stuck.

It needs some kind of physical manipulation to get started again, to get a push in the right direction.

And massage therapy is the big one.

We mentioned it's the most popular CAHM in Canada.

What is it used for specifically in kids?

The list is surprisingly diverse.

The text mentions things like asthma, arthritis, even eating disorders.

But there is a specific note about premature infants that I just love.

It says gentle touch massage helps pre -knees gain weight faster.

It promotes bonding.

It lowers their stress hormones.

And it just calms them in the often overwhelming environment of the NICU.

It's a really powerful, low -tech, high -impact intervention.

But just like the herbs, there are times you absolutely do not massage a child.

Right.

The contraindications.

This is another safety checklist.

You don't massage if the child has cancer because of the theoretical worry about spreading cancer cells or metastasis.

You don't do it if they have osteoporosis because the bones are too fragile.

That makes sense.

And you don't do it over a localized infection like cellulitis because massage increases blood flow.

If you have an infection, you don't want to flush more blood through it and potentially spread the bacteria throughout the body.

And there are two specific pediatric cautions that really stood out to me.

The first one was about children with Down syndrome.

Yes.

This is critically important for nurses to know.

Children with Down syndrome are prone to cervical spine anomalies, specifically something called atlantoaxial instability.

Did you break that down?

It means the bones in the upper part of their neck, right at the base of the skull, are not as stable as they should be.

So you have to be extremely careful.

Any kind of forceful manual manipulation of the neck could cause a very serious injury to the spinal cord.

And the other caution was regarding a history of abuse.

This is all about trauma -informed care.

If a child has been sexually or physically abused, touch can be a major trigger.

It might not feel relaxing.

It might feel like a threat.

The text emphasizes that you must ask permission before touching.

A child with that history might not respond well to touch therapy at all.

And you have to respect that.

Now we have to talk about figure 21 .3.

This is the cow geo image.

If you're looking at the book, you see a photo of a child's back and it looks like they've been beaten.

There are these long, red striated marks all over their skin.

Yes, this is coin rubbing.

It's a traditional healing practice that's common in Vietnamese and Asian cultures.

The belief is that you rub the skin with a coin or a spoon, often with an oil, to bring the body into alignment or to draw out an illness like a fever or a cold.

But visually,

it is shocking.

Visually, it looks exactly like physical abuse.

It leaves linear bruises or petechiae.

The critical nursing insight here is differentiation.

If a nurse sees this and immediately calls child protective services for abuse, they might be making a terrible mistake and traumatizing a family that was actually trying to heal their child using a traditional method.

So you have to ask.

You have to use your assessment skills.

You have to know what it is.

You check for safety, of course.

Make sure there are no open wounds or signs of infection.

But you recognize it as a cultural practice cow geo, not necessarily as battery.

You ask the parents how did you treat your child's fever.

And if they explain the coin rubbing, you have your answer.

You document it as a cultural practice.

That's a fine line to walk, but such an important one.

The section also mentions osteopathy and rolfing very quickly.

Right, just briefly.

Osteopathy combines manipulation with traditional medicine, treating the whole person, often using pressure points.

And rolfing is much deeper.

It's about manipulating the fascia, the connective tissue, with intense pressure and stretching to improve muscle and bone function.

It's known for being quite intense.

Let's slide into section four, energy healing and sensory therapies.

This is where we get into things that are a bit more invisible, a bit more abstract.

Right.

The central concept here is the idea of energy fields, the belief that there is an electromagnetic flow or a life force that emerges from a therapist's hands.

Think of things like reiki or therapeutic touch.

The idea is that the healer can channel this energy to the patient to rebalance them and promote healing.

But this category also includes things we see in hospitals all the time, like TNS units.

Exactly.

TNS stands for Transcutaneous Electrical Nerve Stimulation.

You often see these as wrist bands now, used to prevent nausea for chemotherapy patients or for pregnant women with morning sickness.

It uses a tiny, harmless electrical current to block the nausea signals from reaching the brain.

Now, there's a very complex diagram here, figure 21 .4.

It shows three human figures with all these lines drawn over them.

But the lines mean three very different things.

We need to distinguish them.

Meridians, dermatones, and reflexology.

This is a classic point of confusion for students.

Let's break them down one by one.

Figure A shows meridians.

This is an ancient Chinese concept.

These are imaginary lines that are believed to carry chi or life force energy.

The text says there are 12 main meridians and about 150 acupuncture points along them.

So the goal of acupuncture is to unclog these energy lines.

Basically, yes, to realign the energy flow.

The theory is that if the energy gets blocked in a meridian, you get sick.

The needle is meant to release that blockage.

Okay, so that's an energy concept.

Now, figure B shows dermatomes.

How is that different?

Looks like lines on the body too.

Dermatomes are Cure Western Anatomy.

Totally different concept.

A dermatome is a specific strip of skin that is supplied by a single spinal nerve root.

It's not about energy flow.

It's about the body's hard wiring.

Like an electrical map?

Precisely.

If you block the nerve at the spine, say the L4 nerve root, that specific strip of skin down the leg goes numb.

Anesthesiologists use this map every single day to place epidurals and nerve blocks.

Got it.

So meridians are about energy flow.

Dermatomes are about physical nerve wiring.

And the last one, figure C, is reflexology.

Reflexology divides the body into 10 longitudinal zones from head to toe.

The theory is that the foot or the hand is a map of the whole body.

So if you massage a specific spot on the arch of the foot, it's believed to treat a corresponding organ, like the stomach or the kidney.

It's the idea that the part represents the whole.

So that's the visual guide.

The text then uses that to contrast acupuncture and acupressure.

It's a pretty straightforward distinction.

Acupuncture uses hair -thin needles inserted into those meridian points.

The idea is to stimulate endorphins, the body's natural painkillers.

Acupressure uses firm finger pressure on those same points.

Acupressure is probably better for kids.

Much better for kids because there are no needles involved.

The text notes it's very effective for nausea and motion sickness.

And it mentions shiatsu as well.

Shiatsu is a Japanese form of acupressure.

The text describes it as finding the balance between pain and pleasure, applying deep rhythmic pressure to prevent disease and maintain health.

Let's smell the roses for a second.

Aromatherapy.

I love a good essential oil, but again, the chapter reminds us that for kids, and especially for pregnant women, there are rules.

Essential oils are powerful.

They are highly concentrated plant essences.

They aren't just perfumes.

They are active chemicals.

The good list in the text includes things you'd expect.

Lavender, chamomile, and sandalwood.

These are great for pain, for anxiety, for calming.

Peppermint is listed as a respiratory stimulant good for clearing sinuses.

And the bad list.

The ones to avoid specifically in pregnancy.

This is a critical safety point.

The text lists juniper, thyme, nutmeg, pennyroyal, and mugwort.

These specific oils can induce uterine activity, meaning they could actually start contractions, or they can have toxic effects on the fetus.

Just because it smells like a spice rack doesn't mean it's safe.

A pregnant woman should always check before using essential oils.

Moving from smell to the mind.

The text covers mon -body techniques like hypnotherapy and guided imagery.

Right.

Hypnotherapy is described as an induced sleep or trance -like state used for things like pain control or smoking cessation.

It works for some people, but not for others.

Guided imagery is a bit simpler.

It's using the mind to go to a happy place to reduce stress.

It helps a child disassociate from a painful procedure, for example.

And biofeedback.

The text mentions this for ADHD.

That's a really interesting one.

Biofeedback uses machines to show you your own body's tension in real time.

You might see a line on a screen that represents your heart rate or your muscle tension.

And you learn to consciously relax your muscles to make the line go down.

The text notes it's being explored as an experimental treatment for ADHD, teaching kids to self -regulate their own physical states of arousal.

Okay, we're about halfway through the chapter's content.

Let's talk about section five, chiropractic and homeopathy.

Right.

Chiropractic care is huge in Canada.

It focuses on the spinal column and the nervous system.

The text makes a very specific and important point about regulation here.

Chiropractors are the only CAHM therapists that are regulated across all of Canada.

They have a different legal standing than, say, an herbalist or a reflexologist.

That's a big distinction.

But there's also a warning from the CPS, the Canadian Pediatric Society.

Yes.

The CPS advises pediatricians to specifically ask if a chiropractor is treating a child, and the big red flag they point to is neck manipulations or forceful thrusts.

The pediatric spine, especially in an infant, is very delicate.

High velocity adjustments can be risky.

Then there's homeopathy.

I feel like this is the one that people understand the least.

The whole, like, cures -like thing is confusing.

It is a confusing philosophy.

The idea is you take a substance that would cause certain symptoms in a healthy person, and you dilute it down to a minute, almost untraceable dose to treat those same symptoms in a sick person.

It's supposed to stimulate the body's own immune system to heal itself.

But the text raises some serious safety flags here.

It does.

First, many of the liquid remedies are alcohol -based.

You don't want to be giving an alcohol tincture to a baby.

Second, some traditional homeopathic remedies contain things like mercury or arsenic.

Even in highly diluted doses, that's scary.

And third, efficacy.

The CPS states quite clearly.

There is limited research showing benefits.

We need more rigorous studies before we can say it definitely works.

So proceed with extreme caution.

Now, Section 6.

We are doing a deep dive into Table 21 .2, Common Pediatric Herbs.

This is the other massive must -know table in the chapter.

This is the What's in the Medicine cabinet section.

The text notes that something like 80 % of people worldwide use herbs as a primary form of medicine.

Many of our modern drugs originated as herbs digitalis for the heart comes from the foxglove plant.

But the key takeaway is natural does not mean safe.

Right.

Labels can be inaccurate, and contamination with pesticides or heavy metals is a real possibility if the product isn't regulated.

Let's break down the herbs by what they're used for, starting with the tummy common GI issues in kids.

Okay.

For colic or indigestion, the text lists fennel, chamomile, and peppermint, all very common in gripe water or teas.

But wait, there's a big caution on peppermint.

Yes.

This is a great clinical pearl.

Peppermint is great because it relaxes smooth muscle, which helps with cramping.

But it also relaxes the valve at the top of the stomach, the lower esophageal sphincter.

So if a child has GERD or reflux, peppermint will make it much, much worse.

It just lets all that acid splash back up into the esophagus.

Ginger.

Great for nausea and motion sickness.

We know that works.

But the caution is that high doses can cause heartburn.

And psyllium.

That's just fiber, like metamucil.

It's used for constipation.

But the caution here is huge and often missed.

You must take it with enough fluid.

If you take a big dose of fiber without enough water, it can turn into a cement -like block in the intestines and cause an obstruction.

Let's look at herbs for the skin.

The text lists the classics.

Aloe vera for burns,

tea tree oil, which is very effective for acne and lice, and evening primrose oil for eczema.

These are generally topical and safer, but you always have to watch for skin allergies.

What about for anxiety and sleep?

Galarian is listed for sleep disorders, but a common side effect is GI upset.

And then there's meltonin.

Melatonin is everywhere now.

Parents give it to their kids like candy, you can buy it in gummy form.

And the text urges serious caution.

It states that melatonin may suppress puberty because it interacts with the body's hormonal cycles.

And you have to be very careful using it with children who have seizure disorders.

It's not just a harmless gummy, it's a powerful hormone.

That puberty point is something I rarely hear mentioned.

What about for ADHD?

Parents were often desperate for alternatives to stimulant medications like Ritalin.

The table lists things that parents often try, like blue -green algae, pycnogenol, and Siberian ginseng.

But the text is pretty blunt here.

It says these are often not supported by scientific studies.

Parents might prefer them because they seem more natural, but the evidence that they work just isn't strong.

And finally, the danger zone in this table.

We already mentioned ephedra from the surgery list.

Right.

Hypertension, psychosis, death,

avoid at all costs.

And St.

John's wort shows up again.

It does.

Aside from the anesthesia risk we already talked about, it causes photosensitivity.

A kid on St.

John's wort can get a severe sunburn just from being outside playing.

And this is critical.

It renders oral contraceptives ineffective.

If you have an adolescent female patient who is taking the pill and also taking St.

John's wort for depression, she is at a very high risk of an unintended pregnancy.

That is a critical, critical interaction that needs to be assessed.

Before we leave herbs, let's talk math for a second.

The dosage rules.

This is where huge mistakes happen.

A capsule is not a tea.

The text says that herbal capsules are about four times stronger than teas.

And herbal extracts, the liquid tinctures, are four to eight times stronger than the capsules.

So if a recipe calls for a cup of tea and you use a teaspoon of extract instead.

You are overdosing by a factor of potentially 32.

It is not interchangeable.

Dosage for children must always be weight -based.

You cannot guess.

Wow.

Okay, section seven.

The final heavy hitters in the chapter.

Cannabis and hyperbaric oxygen.

Right.

Cannabis in Canada.

Everything changed with legalization in 2018.

But the text reminds us.

Legal for adults who are 18 or 19 and up, depending on the province, does not mean safe for kids.

Especially the adolescent brain.

The brain is still actively developing until the mid -20s.

The text warns that cannabis causes functional and structural changes in the adolescent brain.

This can lead to cognitive decline and lower school performance.

Then what about mental health?

It's strongly linked to an increased risk of depression, anxiety, and psychosis, especially in vulnerable teens.

And interestingly, the text notes it's often a gateway to initiating tobacco use.

What is the CPS stance on medical marijuana for kids?

Is it ever recommended?

They are very skeptical.

They state that there is insufficient evidence to support its use for most conditions in children.

And they are very, very clear on one point.

Smoking is never an acceptable delivery method for a child.

And lastly, hyperbaric oxygen therapy or HBOT.

What is this?

This is when a patient is placed in an airtight enclosure that's filled with 100 % compressed oxygen.

It's the standard evidence -based treatment for carbon dioxide poisoning or for decompression illness, you know, the bends from scuba diving.

But people use it for other things, right?

Some wellness centers market it for a lot of other conditions.

But the big life -threatening contraindication the text points out is pregnancy.

Why is that?

High levels of oxygen in the mother's blood can trigger the premature closing of the ductus arteriosus in the fetus.

That's a crucial bypass valve in the fetal heart that allows blood to skip the non -functioning lungs.

If that valve closes while the baby is still inside the womb, it can cause fetal heart failure and death.

That is a massive safety pearl to end on.

It really is.

So we've unpacked the acronyms.

We walk through the tables, the diagrams, the herbs, the dangers.

What does this all mean for the listener, for that nursing student?

It means that as a nurse, you have to be an investigator and you have to be a diplomat.

You don't need to be an expert in every single herb.

You can't be, but you must be an expert in asking about them.

What else are you taking?

Are you seeing anyone else for this?

Exactly.

And then documenting it.

If it's not in the chart, it didn't happen.

And when the anesthesiologist is reviewing the patient's file before surgery, they absolutely need to know about that St.

John's wort the patient forgot to mention.

It's also about that balance we talked about right at the very beginning.

Right.

That line between alternative and complementary is blurring.

As more research comes out, things that used to be considered fringe are becoming part of standard care like we talked about with massage for preemies or using ginger for nausea in chemo patients.

But the nurse's role remains the constant.

Respect the culture, respect the patient's choice, but protect them from the harm they might not see.

Use your critical thinking.

That's the job.

So for a final thought, I guess it's interesting to consider that as the usage of these modalities grows and as the evidence base for some of them gets stronger,

this so -called alternative is more complementary.

How will the role of the nurse and the healthcare system as a whole need to evolve as those lines blur even further?

That's the big question for the next decade of healthcare.

Thank you for joining us on this deep dive into Lifer chapter 21.

We really hope this makes those tables a little less intimidating and your patient assessments a little more thorough.

Stay curious and keep asking questions.

This has been the Deep Dive from the Last Minute Lecture Team.

Thanks for listening.