13 Pediatric Diseases – External remedies: Herbal inhalants, liniments, wraps, and baths are very effective in pediatric patients. – Internal remedies: Teas, juices, and suppositories are recommended for pediatric use. – Side effects: Herbal remedies have a typical profile of side effects and contra-indications in children. This should always be taken into consideration. Medications containing alcohol, for example, should never be administered to infants or small children. – Ages 0 to 5 years: Mean dosage approximately one-third of the recommended dose for adults. – Ages 6–9 years: Approximately one-half of the recommended dose for adults. – For further information, we recommend Kinderdosierungen von Phytopharmaka, edited by Kooperation Phytopharmaka, 1998; ISBN 3-929964-14-7., and An Encyclopedia of Natural Healing for Children, Mary N.D. Bove, McGraw-Hill, NY, 2001. – The common cold generally begins with a runny nose and a sore throat (rhinopharyngitis). In children, these symptoms are frequently, but not always, accompanied by a high fever. – Pediatric febrile infections are usually viral. The range of pathogens involved (RS virus, rhinovirus, adenovirus, Coxsackie virus, ECHO virus, parainfluenza virus) differs significantly from that in adults. Bacterial infections (e. g., by streptococci, Haemophilus influenzae, pneumococci, etc.) are rare. – Recurrent infections are common, especially in children, whereas primary immunodeficiencies are rare. – Signs of the absence of immunodeficiency are normal thriving and recurrent infection involving only one organ. – Anatomic and respiratory disorders of the upper respiratory tract, early weaning, failure to build up adequate resistance and insufficient immune training are common reasons for frequent infections. – In early childhood, infections are primarily warded off through nonspecific mechanisms. The specific immune systems does not become fully developed until around the eleventh year of life. – The functional capacity of both the nonspecific (phagocytes) and specific (T lymphocytes) immune systems is impaired in children with atopic dermatitis (neurodermatitis) or allergies. – If bacterial infection plays a role, adjunctive non-herbal measures to lower fever should be initiated as soon as possible to prevent the need for antibiotics. Calf wraps (only if the legs are warm), cooling baths (water temperature 1–2 °C less than the rectal temperature), and similar measures can be recommended. – The preferred dosage forms for children are teas, plant juices, syrups and lozenges or, for external administration, liniments, inhalations, and baths. – The goal of symptomatic treatment is to relieve the symptoms responsible for discomfort. – Herbal diaphoretics (elder or linden flower) used to lower fever can also be combined with mild anti-inflammatory and analgesic drugs such as meadowsweet. – A pleasant taste is extremely important in oral preparations for children. Bitter orange peel and peppermint leaf are effective taste enhancers. – For runny nose and other respiratory tract problems, we recommend chamomile flower steam baths as well as the inhalation and topical application of peppermint oil, mint oil, pine oil, pine needle oil, and/or eucalyptus oil. – Aniseed and fennel preparations are used for catarrhal disorders of the upper respiratory tract. – Sage leaf preparations contain tannins that help to alleviate mouth and throat inflammation. Chamomile flower extracts have anti-inflammatory properties and are used as gargles and mouthwashes. – Mallow, marshmallow root, and Iceland moss sooth inflamed mucous membranes. They can also be used in addition to ribwort plantain to treat dry coughs. Ribwort plantain has local anti-inflammatory and antiphlogistic effects. – Sundew herb is used to treat paroxysmal or hacking cough. – Mullein has high concentrations of saponins and mucilage and is therefore effective in alleviating subacute bronchial irritations. – Thyme herb has antibiotic and bronchospasmolytic action. Camphor induces local hyperemization. White deadnettle flower, not available in North America, has mucilage and saponin components. Teas made from it are used to treat catarrhal disorders of the upper respiratory tract. – Herbal immunomodulators such as preparations of Echinacea purpurea or E. pallida have unspecific immunomodulatory and antiviral properties, as was described in detail in the chapter on immunodeficiency diseases. These herbal remedies contain polysaccharides that stimulate specific immune system function via the release of mediators and cytokines. • Most of the available pharmacological and clinical study data pertains to purple echinacea herb. The herbal remedy was found to have a beneficial effect on the severity and course of catarrhal disorders and seems to be successful in fighting concomitant infections during chemotherapy. • More recent studies have demonstrated that combinations of medicinal herbs from Echinacea purpurea (Echinaceae purpureae herba), Baptisia tinctoria, and Thuja occidentalis (Thujae herba [Arbor vitae, see p. 119 regarding the extended use of preparations containing thujone]; see Colds and Flu, p. 150) are superior to single-herb products owing to synergism. – Herbal medications can be highly recommended for symptomatic treatment of acute febrile infections in pediatric patients. – Many antibiotics as well as chemical and synthetic febrifuges tend to suppress the immune system, thereby increasing the likelihood of recurrence of disease. – For recurrent infections, we highly recommend Kneipp hydrotherapy measures as well visits to spas by the sea or in the mountains. Herbal immunomodulators such as echinacea (Echinacea purpurea) can be administered at acute infection as an additional measure. Flavored liquid products that include glycerine instead of alcohol are popular for children. – Contraindications • Camphor, eucalyptus, spruce and pine needle oil: Bronchial asthma and whooping cough (can aggravate bronchospasms). • Mint oil, peppermint oil, fennel: Bronchial asthma. Should not be administered to infants and children under three years of age. • All essential oils: Should not be used topically by patients with exanthematous skin conditions or childhood diseases. • Fennel seed: Pregnancy and lactation. • Mint oil and peppermint oil: Gallstones, biliary tract obstruction, cholecystitis, and severe liver disease. • Licorice: high blood pressure. – Restrictions on use • Camphor and eucalyptus; spruce needle, pine needle, peppermint and mint oils: Should not be applied to the face, especially the nose, of infants and small children or used for inhalation. Should not be applied directly onto or near the mucous membranes. • Licorice root: Should not be used for more than 4 to 6 weeks. • Chamomile flower: Do not use to treat the eyes. – Side effects • Fennel seed: Allergic reactions involving the skin and mucous membranes can occur in isolated cases. • Thyme herb: Allergic exanthematous or urticarious skin changes can occur in isolated cases. • Cowslip root: Isolated cases of gastric discomfort and nausea as well as hypersensitivity reactions involving the skin, respiratory tract, and gastrointestinal tract can occur. – Interactions: Local application of herbs containing mucilage can delay the absorption of other herbal preparations and synthetic drugs. – Action: Enhances the blood flow. – Contraindications: See Expectorants above. – Side effects: Contact eczema (rare). Internal Remedies – Dosage and administration • Diaphoretic and febrifuge tea Rx (for adults and children): Tiliae flos (chopped) 70.0, Spireae flos (chopped) 10.0, Menthae piperitae folium (chopped) 15.0, Aurantii pericarpium (chopped) 5.0. Steep 1 teaspoon in 150 mL of boiling water for 10 minutes. Works best when taken while hot. • Tea Rx: Tiliae flos 25.0, Sambuci flos 35.0, Cynosbati fructus 30.0, Liquiritiae radix 10.0. Steep 1 teaspoon in 150 mL of boiling water for 10 minutes. Works best when taken while hot. • Diaphoretic teas work best when taken in the afternoon after a warming bath supplemented with aromatic herbs or pure essential oils, which open up the respiratory passages. • Other teas: Take 1 cup, 3 times a day, sweetened to taste with honey. • Iceland moss lozenges (where available): Allow a lozenge to dissolve in the mouth. Repeat several times daily. • For dry cough due to mouth and throat irritation: English plantain juice (commercial product where available or fresh plant juice; see p. 60); teas made from marshmallow root, mallow, or plantain leaf. The remedies should be taken orally, 3 to 5 times daily (see teas for respiratory tract diseases, p. 156 ff). – Clinical value: A comparative study on the efficacy of linden flower tea in colds showed that the herbal treatment was significantly superior to antibiotics with respect to reducing the duration of infection and the rate of complications. External Remedies – Dosage and administration • Dried sage leaf: Pour 250 mL of boiling water onto 1 heaped teaspoon of the herb, then cover and steep for 10 minutes. A mixture (equal parts) of sage leaves and chamomile flowers can be used instead. • Tea Rx: Matricariae flos 30.0, Salviae folium 20.0, Thymi herba 10.0. Pour 250 mL of boiling water onto 2 heaped teaspoons of the herbs, then cover and steep for 5 minutes. • Use the recommended infusions to gargle or rinse the mouth several times each day. – Clinical value: When treatment is initiated early and the restrictions on use are heeded, these remedies can prevent complications of acute grippal infections and they are very well tolerated. – Dosage and administration: Depending on age, 20 to 50 drops of the tincture are taken several times a day. Lozenges, tablets and capsules made from purple echinacea extract can be used instead. Unless otherwise directed, they should be taken 3 times a day for a period of 2 weeks. There is a lack of data supporting the use of the herbal remedy for longer periods. – Clinical value: Comparable synthetic and/or chemical medications do not exist. Patients should seek the advice of a health care practitioner before purchasing these herbal remedies (see Self Care Management, p. 226). – A throat infection is generally a sign of a cold. In children, these symptoms are frequently, but not always, accompanied by a high fever. – The tonsils should always be inspected. • Tonsillitis due to adenovirus infection is likely to be present if the tonsils are red and swollen but otherwise normal, and there is difficulty in swallowing, fever and, in some cases, swollen lymph nodes at the angle of the mandible. – If the mucous membranes are coated and other changes are detected, infection with beta-hemolytic streptococci (group A), staphylococci, coxsackie-virus, herpesvirus, or Epstein–Barr virus may be present. – Inflammations of the mouth can be caused by viral and bacterial pathogens and by various dental problems. Allergies and poisoning are other occasional causes. – Tannin-bearing and aromatic herbs are used to treat inflammations of the respiratory passages. Tannins seal the capillaries and inhibit inflammation. The bonds that form between mucosal proteins and tannins are irreversible. – Calendula flower has antimicrobial and immunomodulatory effects. – Sage flower has antibacterial properties. – Chamomile flower is an aromatic herb that inhibits inflammation, protects the mucosae, and promotes epithelialization. – If in doubt, the patient should consult a health care practitioner before initiating self- treatment. This is especially important in the case of high fever, unusual changes in the tonsils, and unclassifiable changes in the oral mucosa. – Herbal remedies are used for symptomatic treatment of mouth and throat disorders. The available data on their in vitro antibacterial and immunomodulatory effects does not suffice for an assessment of their efficacy. – Action: The local anti-inflammatory effects help to counteract mouth and throat inflammation. – Contraindications: For chamomile, see p. 48. – Dosage and administration • Silverweed: Steep 4 g of the finely chopped herb in 500 mL of hot water for 15 minutes. • Dried bilberry: Boil 2 to 3 tablespoons of the herb in 500 mL of water for 30 minutes. • Chamomile flower: Pour 250 mL of boiling water onto 2 teaspoons of the herb, then cover and steep for 5 minutes. • Calendula flower: Steep 2 teaspoons of the herb in 150 mL of boiling water for 10 minutes. • Ribwort plantain: Preparations should be made using the freshly collected herb (see details regarding catarrhal disorders of the respiratory tract, p. 158). • Dried sage leaf: Pour 250 mL of boiling water onto 1 teaspoon of the herb, then cover and steep for 10 minutes. A mixture of sage leaves and chamomile flowers (equal parts of each) can also be used. • Tea Rx: Matricariae flos 30.0, Salviae folium 20.0, Thymi herba 10.0. Pour 250 mL of boiling water onto 2 teaspoons of the herbs, then cover and steep for 5 minutes. • The preferred infusion or decoction should be used for gargling several times a day. • Commercial preparations should be used as recommended by the manufacturer. – Side effects: None known. – Clinical value
13.1 Introduction
Clinical Considerations
Since herbal remedies have few or no side effects, they are especially suitable for pediatric use. Herbs with mild effects are more highly recommended, since the more potent ones generally are not as well tolerated.
Preferred herbal preparations
Some commercial herbal products previously used by children in North America now bear the warning, “Should not be used by children under 12 years age.” In many cases, the warning was added simply to point out the lack of sufficient study data on the safety and efficacy of the herbal remedy or herbal preparation in children, and does not usually indicate any existing reports or studies of actual side effects in children. This also applies to the recommended dosages, which are often established through empirical experience as opposed to scientific dose-finding methods.
General dosage guidelines (if none are provided by the manufacturer):
13.2 Acute Febrile Infections
Clinical Considerations
General comments
Herbal treatment measures
These applications should not be used in infants and small children.
Clinical value of herbal medicine
Recommended Herbal Remedies (Overview)
For details on the individual herbal preparations, see Respiratory Diseases, p. 148 ff, and Diseases of the Mouth and Throat, p. 161 ff.
Astringents and Antibiotics
Sage leaf (Salviae folium, see p. 114); thyme herb (Thymi herba, see p. 120); ribwort plantain herb (Plantaginis lanceolatae herba, see p. 60).
Antiphlogistics
Meadowsweet flower (Filipendulae ulmariae flos, see p. 92); sage leaf (Salviae folium, see p. 114); chamomile flower (Matricariae flos, see p. 47); licorice root (Liquiritiae radix, see p. 85).
Demulcents and Antitussives
Marshmallow root (Althaeae radix, see p. 91); Iceland moss (Lichen islandicus, see p. 79); mallow flower/leaf (Malvae flos and folium, see p. 89), ribwort plantain herb (Plantaginis lanceolatae herba, see p. 60); white deadnettle flower (Lamii albi flos, see p. 127); sundew herb (Droserae herba, see p. 118).
Sweat-inducing Preparations (Diaphoretics)
Linden flower (Tiliae flos, see p. 87); elder flower (Sambuci flos, see p. 62).
Expectorants and Secretolytics
Eucalyptus oil (Eucalypti aetheroleum, see p. 61); spruce needle oil (Picea aetheroleum); pine needle oil (Pini aetheroleum, see p. 104); aniseed (Anisi fructus, see p. 34); fennel seed (Foeniculi fructus, see p. 65); thyme herb (Thymi herba, see p. 120); ivy leaf (Hederae helicis folium, see p. 158); cowslip root (Primulae radix, see p. 105); licorice root (Liquiritiae radix, see p. 85); mullein flower (Verbasci flos, see p. 94); white deadnettle flower; Lamii albi flos, see p. 127); elder flower (Sambuci flos, see p. 62).
Cold Receptor Stimulators
Mint oil (Menthae arvensis aetheroleum); peppermint oil (Menthae piperitae aetheroleum, see p. 103). For details, see p. 148.
Irritants
Camphor tree (Cinnamomi camphorae aetheroleum, see p. 45). For details, see p. 148.
Immunomodulators
Purple echinacea herb (Echinacea purpureae herba, see p. 156); pale echinacea root (Echinacea pallidae radix, see p. 56).
Range of Applications
Acute Febrile Infections
Linden flower; meadowsweet flower; peppermint leaf; chamomile flower; thyme herb; aniseed; fennel seed; ivy leaf; Iceland moss.
Acute Febrile Infections
Eucalyptus oil (see p. 61); spruce needle oil (see p. 104); pine needle oil (see p. 104); peppermint oil (see p. 103); mint oil (see p. 103); camphor (see p. 45); sage leaf (see p. 114); chamomile flower (see p. 47); aniseed oil (see p. 34).
To Strengthen Immune Defenses of Infection-prone Children
Purple echinacea; pale-flowered echinacea (see p. 56).
13.3 Mouth and Throat Inflammations
Clinical Considerations
General comments
Herbal treatment measures
Clinical value of herbal medicine
Recommended Herbal Remedies and Range of Applications
Tannin-bearing herbs: Silverweed herb (Potentillae anserinae herba, see p. 117); bilberry (Myrtilli fructus); calendula flower (Calendulae flos, see p. 90); sage leaf (Salviae trilobae folium, see p. 114).
Aromatic herbs: Chamomile flower (Matricariae flos, see p. 47).
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