Session 2: Infants and Children - Part I · Session 2: Infants and Children - Part I ... syrup or juice ... • Paracetamol should not be administered for pain, but may be

WHMF314

www.endeavour.edu.

au

Session 2:

Infants and Children - Part I

Naturopathic Medicine Department

© Endeavour College of Natural Health endeavour.edu.au 2

Overviewo Infants & Children

• communication

• dosage, dosage forms

• compliance

o Acute conditions

• coughs

• earaches

• colic

• colds and flu

o Case studies to demonstrate clinical management and

herbal prescriptions for these conditions


Reference Text

o Santich, R. & Bone, K. (2008). Healthy children:

Optimising children’s health with herbs. Warwick

QLD: Phytotherapy Press


Communicationo Gather your information

• ask parent questions to answer for child (include child)

• direct appropriate questions to child

• get down at the child’s level e.g. at the toy box

• ask them how they feel and closely observe

• make note of their replies “in their words”

• child friendly stickers/stamps on the dispensed medicine

o Having a sick child can be very stressful

• build child and parent’s trust

• listen to all they have to say

o Know limitations and refer appropriately

• a mild illness can become serious / life threatening


Dosage Formulas

o Ausberger’s weight rule

• based on weight, accounts for faster metabolism in children

• (1.5 x weight in kg + 10) is % of adult dose

• E.g. child weighs 20 kg

– (1.5 x 20) + 10 = 40% of adult dose

o Clark’s basic rule

• (weight in kg ÷ 67) x adult dose = child’s dose

o Young’s rule

• (age in years ÷ (age+12)) x adult dose = child’s dose

o Fried’s rule for young infants (up to 2 years)

• (age in months ÷ 150) x adult dose = child’s dose


Dosageo Rule of thumb

• young babies

– 1/2 mL tid - 10 drops

– check actual measure of ‘drops’

• 1-2 years

– 1/4 adult dose - 1 mL tid

• 2-8 years

– 1/3 to 1/2 adult dose

– keep in mind strength as well as weight

• puberty onwards

– full adult dose - 5 mL tid


Dosage Forms

o Bath

o Topical

o Infusions e.g. diaphoretics

o Glycetracts - especially Althaea officinalis (marshmallow)

o Liquid extracts

• with flavouring, syrup or juice (dark grape juice).

• eye dropper squirt into back of mouth.

o Jellies

o Tablets (remember to adjust dosage) - crushed in honey


Herbs For Breastfed Infants

It is commonly suggested to administer breastfed neonates

via mother, however:

o Lack of information as to dose required for mother to

achieve adequate transfer

o Lack of pharmacokinetics studies

o Conventional medicine does not rely on this practice



o Most phytochemicals and drugs transfer into breast milk by passive diffusion.

o Rate of transfer influenced by:• Stage of lactation

• Chemical characteristics of drug or phytochemical

• Concentration drug/phytochemical reaches in blood

• Composition of the milk (water, lipids, protein content and pH)

o Balance between herbal dose and elimination rate in mother ultimately determines maternal blood and milk levels.



Colostrum

o First 2-3/7 after birth

o Epithelial cells lining alveoli have open junctions – both

small & large molecules (e.g. proteins) are easily

transferred by paracellular diffusion

o Concentration in maternal blood essentially controls

drug/phytochemical transfer into colostrum



o Milk secretion 3-4/7 after birth• Gaps between epithelial cells close

o Major pathway for passive diffusion of drugs/phytochemicals is transcellular

o Mature milk of relatively stable composition produced 2-3/52 after birth• Major components are ions, proteins, lipids

• Lipid fraction important as lipid soluble chemicals may dissolve in liquid droplets as they form in alveolar epithelial cells and thereby co-secreted


Example study on transfer of

phytochemicals into breast milk

Rhein- anthraquinone in Rheum officinale (rhubarb root) and Cassia acutifolia (senna)

o Several studies have shown that rhein appears in blood, with a rapid rise after ingestion, then decline

o Excretion of rhein (from Cassia acutifolia) into breast milk investigated in 100 milk samples from 20 postpartum women

o Rhein concentration in milk samples from every lactation during post-dose 24 hours measured, following daily doses of 5 g of senna (15 mg rhein) for 3 days

Continued next slide…


Rhein in breast milk study continued…

o Values varied from 0 - 27ng/ml

o < 10ng/ml in 94% of samples

o Median values demonstrate 0.007% of rhein intake

excreted into breast milk

o No abnormal stool consistency in breastfed infants

o Conclusion: unlikely that normally recommended doses

of most herbal medicines taken by mother will have

therapeutic effect in infant (Santich & Bone, 2008)

o NB Herbs contraindicated in breastfeeding remain

contraindicated


Complianceo Poor compliance is a significant issue (non compliance

for conventional medicine ranges from 25 – 60%) with a

peak during adolescence

o Palatability is important

o Your materia medica may be limited by what children will

actually take!

o Children are more partial to sweet taste

o Parent’s attitude often dictates child’s willingness to take

remedy


General Considerationso Child’s vital force is powerful self-correcting mechanism

o Child’s recovery rate greater than adult

o Children generally are energetically warmer than adults

o Most common condition acute infection (‘hot’ in nature)

o Cooling remedies often important (e.g. diaphoretics and

bitters)

o Occasionally mild illnesses can quickly become serious

o Most prominent systems

• Respiratory, gastrointestinal, immune

o Average child experiences 5 to 6 respiratory infections

per year (usually mild)

o This is normal & of benefit in developing immune system


Vitality Naturopathic philosophy posits allowing / supporting the

body to heal itself. Conventional medicine also in line with

this position:

• Fever suppression not advocated (see next slide…)

• No treatment needed for mild croup with cough only https://www.rch.org.au/kidsinfo/fact_sheets/Croup/

• Antibiotics for otitis media not routinely prescribed/recommended

Antibiotics modestly more effective for treatment of otitis media,

compared to no treatment (adverse effects 4%-10% of children)

(Coker, Chan, Newbury & Limbos 2010)

https://www.rch.org.au/kidsinfo/fact_sheets/Croup/


Fever o Body temperature >38º C

o Inform parents of the protocol of fever management as

per Royal Children’s Hospital which reassures them that

the fever seen in common childhood infections is not

harmful, helps the body's immune system fight off the

infection and states that there is no advantage to

lowering child's fever except for comfort.

• Paracetamol should not be administered for pain, but may be

used for pain associated symptoms

https://www.rch.org.au/kidsinfo/fact_sheets/Fever_in_children/

http://www.rch.org.au/kidsinfo/fact_sheets/Febrile_Convulsions/

https://www.rch.org.au/kidsinfo/fact_sheets/Fever_in_children/

http://www.rch.org.au/kidsinfo/fact_sheets/Febrile_Convulsions/


Fever

ANY infant or neonate under 8 weeks

old presenting with a fever must be

sent to emergency department

irrespective of severity or duration of

fever


Diaphoretic teaso YEP

• Equal parts: Achillea millefolium (yarrow), Sambucus nigra (elder

flowers), Mentha piperita (peppermint)

o Weiss:

• Equal parts: Sambucus nigra (elder flowers), Tilia spp. (lime

blossom), Matricaria recutita (chamomile flowers)

o Directions:

• 2-3 teaspoons dried herb to 250ml almost boiling water

• Leave to infuse for 10 minutes

• Take as soon as possible and as warm as possible


Immunityo Contributions to a weakened immunity can include:

• Breast or bottle fed

• Diet

• Caesarean section or vaginal birth

(Jakobsson, Abrahamsson, Jenmalm & Harris, 2014)

• Having parents who smoke

(Al-Sayed & Ibrahim, 2012)

o Importance of wholesome diet as preventative strategy


Treatment Considerations

o In treating children be cautious as to when to treat

exclusively or when to recommend they seek medical

treatment or advice.

o In chronic conditions, realistic treatment goals may be to

reduce the need for pharmaceutical intervention over

time as herbal and naturopathic treatment takes hold.

o Application of the therapeutic order in restoring health for

the child…


Naturopathic Therapeutic Ordero 1. Establish the Conditions for Health

By addressing the Determinants of Health:

a) Identify and remove disturbing factors (obstacles to cure)

b) Institute a more healthful regimen

o 2. Stimulate the Vis Medicatrix Naturae

o 3. Tonify Weakened Systems(Including constitutional and family weaknesses)

o 4. Correct Structural Integrity

o 5. Address Pathology: a) Natural Substances

b) Pharmacologic or Synthetic Substances

o 6. Suppress or Surgically Remove Pathology


Assessment of the child

o Use the resource “When should I worry?- your guide to

Coughs, Colds, Earache & Sore Throats” as a review of

the common childhood illnesses for children over six

months old.

• Signs and symptoms

• Usual course of the illness

• Signs and symptoms which warrant concern and are signs of

serious illness

http://www.whenshouldiworry.com/view-booklet.php

http://www.whenshouldiworry.com/view-booklet.php


Herbal Treatment and Prevention of Infection

o Immune enhancing herbs (e.g. Echinacea spp.,

Andropgraphis paniculata, Astragalus membranaceus).

o Diaphoretic herbs (e.g. Tilia spp.) to focus immune

function, plus warming herbs (e.g. Zingiber officinalis).

o Support area, organ, system that infection is located in

(e.g. expectorants for lung infections).

o Antibacterial herbs where appropriate (e.g. Agathosma

betulina for UTIs or Melaleuca alternifolia for skin

infections).

o Antiviral herbs as appropriate (e.g. Hypericum

perforatum for enveloped viruses, Melissa officinalis

topically for herpes virus).


Otitis media

o One in 4 children will have at least 1 episode of acute

otitis media (AOM) by age 10 years.

o AOM results from infection of fluid that has become

trapped in the middle ear.

o The bacteria that most often cause AOM are

Streptococcus pneumoniae, Haemophilus influenzae,

and Moraxella catarrhalis.

o Need to differentiate AOM from otitis media with effusion

(OME)

• Although fluid is present in the middle ear in both conditions, the

fluid is not infected in OME as is seen in AOM patients.

(Dickson, 2014).


Acute otitis media (AOM)

o AOM is diagnosed on the basis of acute onset of pain

and fever; a red, bulging tympanic membrane; and

middle ear effusion.

o Medical management : analgesia (paracetamol or non-

steroidal anti-inflammatory drugs).

o Antibiotic therapy is minimally effective for most patients

• Most effective for children < 2 years with bilateral otitis media

and for children with discharging ears.

• National guidelines recommend antibiotic therapy for Indigenous

children


Otitis media with effusion

o Otitis media with effusion (OME) is diagnosed as the

presence of middle ear effusion (type B tympanogram or

immobile tympanic membrane on pneumatic otoscopy)

without AOM criteria.

• Well children with OME with no speech and language delays can

be observed for the first 3 months; perform audiological

evaluation and refer to an ear, nose and throat (ENT) specialist if

they have bilateral hearing impairment > 30 dB, or persistent

effusion.

• Children with effusions persisting longer than 3 months can

benefit from a 2-4-week course of amoxycillin.


Chronic suppurative otitis media

Chronic discharge through a tympanic membrane

perforation.

o Medical management:

• regular ear cleaning (dry mopping or povidone-iodine [Betadine]

washouts) until discharge resolves, topical ear drops (e.g.

ciprofloxacin);

• audiological evaluation, and ENT review.

(Gunasekera, O’Connor, Vijaasekaran & Del Mar, 2009).


Fig: I Tympanic Membrane

A, Normal TM. B, TM with mild bulging.

C, TM with moderate bulging. D, TM with severe bulging. (Hoberman, 2013)

Lieberthal A S et al. Pediatrics 2013;131:e964-e999

©2013 by American Academy of Pediatrics


Otitis Media

o Anatomical differences between infant & adult

Eustachian tubes promotes development of conditions in

children.

• Infant Eustachian tube:

– relatively short, making reflux more likely

– more horizontal, less efficient muscular action of

tensor palatini that opens the tube

– softer with more compliant cartilage which

predisposes to collapse

– has a smaller lumen more readily occluded by

mucosal inflammation


NPS guidelines for treatment of

otitis media o Otitis media will often get better by itself in a few days as the

body’s immune system can take care of the infection without

any treatment.

o Most children older than 2 years won’t need antibiotics

treatment, e.g. infection will clear up by itself in a few days.

o However, many children younger than 2 years may need

antibiotics to treat the infection.

o Antibiotics won’t help relieve child’s ear pain.

• Research shows 6 out of 10 children will have no ear pain after

the first 24 hours without any treatment antibiotic or analgesia

http://www.nps.org.au/conditions/ear-nose-mouth-and-throat-disorders/ear-nose-and-

throat-infections/ear-infection-middle/for-individuals/medicines-and-treatments

http://www.nps.org.au/conditions/ear-nose-mouth-and-throat-disorders/ear-nose-and-throat-infections/ear-infection-middle/for-individuals/medicines-and-treatments


Otitis Media ...herbal treatment o Anti-catarrhal

• Nepeta cataria (ground ivy)

• Euphrasia officinalis (eyebright)

• Solidago virgaurea (golden rod)

o Immune enhancing

• Echinacea spp. (echinacea)

• Pelargonium sidoides (pelargonium)

o Ear infection specific

• Verbascum thapsus (mullein), infused flower in oil often

combined with garlic (1 - 3 drops)

o Treatment of URTI


Prevention of Otitis media

o Breastfeeding for at least 4 to 6 months reduces episodes of AOM

and recurrent AOM

o Dose response: some protection from partial breastfeeding and the

greatest protection from exclusive breastfeeding through 6 months

of age.

• Any formula used in the first 6 months of age significantly

associated with increased incidence of OM

o Eliminating exposure to passive tobacco smoke

o Bottles and pacifiers have been associated with AOM.

• Avoiding supine bottle feeding (“bottle propping”) and reducing

or eliminating pacifier use in the second 6 months of life

(Lieberthal, Carroll, Chonmaitree, Ganiats & Hoberman, 2013)


Otitis Media.

o Research on a herbal eardrop was associated

with significant benefit:

• In a trial of 103 children aged 5-18 years with AOM,

infused oils of Allium sativum (garlic), Verbascum thapsus

(mullein), Calendula officinalis (calendula) and Hypericum

perforatum (St John’s wort) significantly reduced ear pain.

• Effect was comparable to anaesthetic ear drops.

(Sarrell, Mandelburg & Cohen, 2001)


Otitis Mediao An RCT of 171 children with OM studied an eardrop

containing Allium sativum (garlic), Verbascum thapsus

(mullein), Calendula officinalis (calendula), Hypericum

perforatum (St John’s wort), Lavandula officinalis

(lavender) and Vitamin E.

o The trial had 4 treatment arms including A) the herbal

eardrop, B) the herbal eardrop plus topical anaesthetic,

C) oral amoxicillin with the herbal eardrop or D) oral

amoxicillin with a topical anaesthetic.

o Reduction in pain was greater in the herbal eardrop

groups than in the respective control groups.

(Sarrell, Mandelburg & Cohen, 2001)


Case 1

o A 3 year old child is brought in by a parent with a “cold”

that started 13 days ago. The child has a runny nose

with thin green/yellow discharge and a “chesty cough”.

The child plays happily at the toy box while you speak to

the parent. The parent says child had fever for 2 days at

start of cold and was off her food but now appetite is

back to normal.

o What examinations are appropriate?

o What is your clinical management?

o Herbal prescription

o Other advice, recommendations, referral?


Case 2 o At the first post partum visit for a mother that you have

been treating during her pregnancy, when asked about

her baby the mother happily recounts that all is going

well, except baby has a slight runny nose. The baby is

breast feeding during the consultation and engaging with

the mother. She asks whether you can give the baby

anything to “boost the baby’s immune system”. You ask

to examine the baby - there is no rash, no swollen

glands, throat appears normal, temperature is 38.6º C.

o What is your management of this baby?

o What would you prescribe for the baby or the mother?


Case 3 o 2-year old child presents with cold symptoms for the last

5 days. He has a runny nose and sits on his mother’s lap

instead of playing with the toys as he usually does.

o On examination, which is a struggle as he is reluctant to

let you take his temperature or examine his ears, he has

a temperature of 39.1 and bilateral red tympanic

membranes with no bulging

o What is your clinical management?

o What is your herbal prescription?

o Does this patient need medical referral or

pharmaceutical medication?

o When do you next need to review?


Neonate Colic o Diet

• In breast fed babies, a low allergen maternal diet avoiding cow’s

milk and dairy food for at least 2 weeks to test efficacy

• Bottle fed babies: formulas based on partially hydrolyzed whey

proteins with prebiotic oligosaccharides effective

(Savino, Ceratto, De Marco & Cordero di Montezemolo, 2014).

o Lactobacillus reuteri reduces symptoms of infantile colic(Savino, Ceratto, Poggi & Cartosio,2014).

o Maternal Stress

• A number of studies link increased maternal stress / anxiety with

increased colic risk (Santich & Bone, 2008).


Herbal treatment of Colic

o Foeniculum vulgare (fennel), Matricaria recutita

(chamomile) & Melissa officinalis (lemon balm) may help

calm the infant & reduce abdominal distension (mice)

(Savino, Cresi, Castagno, Silvestro & Oggero R., 2005)

o Foeniculum vulgare (fennel) seed oil emulsion superior

to placebo in RCT

(Alexandrovich, Rakovitskaya, Kolmo, Sidorova & Shushunov., 2003)


Dyspepsia/Reflux

o Iberogast® indicated for functional dyspepsia

o May be useful for reflux and colic in infants

o Easy to administer

(Ottillinger, Storr, Malfertheiner & Allescher, 2013; Perez, Youssef, 2007).


Pelargonium sidoides

o Also known as umckaloabo, is a member of the

Geranium family and is native to South Africa.

• “Umckaloabo" is derived from the two Zulu words, "umkhuhlane"

(fever and cough-related illnesses) and "uhlabo" (chest pain

related to pleurisy)

• Traditionally used for centuries for the treatment of respiratory

diseases, diarrhoea, dysmenorrhea, and hepatic disorders

o An aqueous formulation of the roots of Pelargonium

sidoides, called EPs 7630®, has been examined in

clinical trials as a potential treatment for bronchitis

(acute) acute pharyngitis (acute non-group A beta-

hemolytic streptococcus tonsillopharyngitis), and the

common cold.


Pelargonium sidoides

Relevance & Safety

o Specifically indicated for children.

o Safety in children: safe when used orally and

appropriately, for short periods.

o A specific extract (Umckaloabo, EPs 7630®, Schwabe

GmBh, Germany) in doses of 3mL per day (20 drops)

has been safely used in children aged 6-10 years for up

to seven days.


Class Activity

o Break into 4 small groups. Each group will be allocated

one of the Phytomedicine papers on Pelargonium.

o Critically review and present a summary to the class. Tahana, F., Yamanb, M. (2013). Can the pelargonium sidoides root extract EPs® 7630

prevent asthma attacks during viral infections of the upper respiratory tract in

children? Phytomedicine 20,148–150

Matthys, H., Kamin, W., Funk, P., Heger, M. (2007). Pelargonium sioides preparation

(EPs ®7630) in the treatment of acute bronchitis in adults and children.

Phytomedicine 14 (SV1) 69-73.

Haidvogl, M., Heger, M. (2007). Treatment effect and safety of EPs® 7630-solution in

acute bronchitis in childhood: Report of a multicentre observational study.

Phytomedicine 14 (SVI) 60–64

Taofikat, B., Agbabiakam T.B., Guo, R., Ernst, E. (2008). Pelargonium sidoides for acute

bronchitis: A systematic review and meta-analysis. Phytomedicine 15, 378–385


Withania somnifera

o General tonic, adaptogen, antiinflammatory, mild sedative, nervine tonic, immunomodulatory, antianemic, antioxidant, haemopoietic.

o It is commonly used in emaciation of children –considered the best tonic for children:

• traditionally decocted in milk

• promoting growth in children

• increasing serum iron in children

• inflammatory conditions e.g. asthma, bronchitis

• promoting learning & memory

• enhancing immune function


Withania somniferao Early research supports a role for Withania somnifera in

children:

• In a randomised, double blind, placebo-controlled trial - milk

fortified with Withania (2g/day of herb for 60 days) significantly

increased mean corpuscular haemoglobin, serum albumin,

blood haemoglobin, serum iron, body weight & strength of hand

grip in children aged 8 to 12 years

• Placebo group did not show any significant change or tendency

to change

(Venkataraghavan et al.,1980),


Whooping Cough / Pertussiso Recognise symptoms - usually starts with cold –like

symptoms, runny nose and dry cough, which last for

about one week.

o Followed by development of a more definite cough,

which may last for many weeks. The cough comes in

long spells and often (but not always) ends with a high

pitched 'whoop' sound when they breathe in.

o Recap the infective nature of the disease and treatment.

o NB. Especially dangerous in babies under 6 months of

age - usually requires admission to hospital.o http://www.rch.org.au/kidsinfo/fact_sheets/Whooping_cough/

http://www.rch.org.au/kidsinfo/fact_sheets/Whooping_cough/


Whooping Cough Treatment

Role of herbalist includes:

o Relieving and minimising the “100 day cough” that

follows the infection with:

• Immune system support

– Immune stimulants Echinacea spp.

– Antimicrobial/antibacterial – Garlic, Thyme, Pelargonium

• Cough relief: Demulcents, Antitussives, Expectorants

– Prunus serotina, Inula helenium, Plantago lanceolate

• Drosera longifolia (sundew) - specific for whooping cough

(antispasmodic, relaxing expectorant, demulcent)


References

Al-Sayed, S.M. & Ibrahim, K.S. (2012). Second-hand smoke and

children. Toxicology and Industrial Health 30(7), 635-644

Alexandrovich, I., Rakovitskaya, O., Kolmo, E., Sidorova, T., Shushunov, S.

(2003). The effect of fennel (Foeniculum vulgare) seed oil emulsion in

infantile colic: a randomized, placebo-controlled study. Alternative

Therapies in Health and Medicine, 9, 58–61.

Coker, T.R., Chan, L.S., Newbury, S.J., Limbos, M.A., (2010). Diagnosis,

microbial epidemiology, and antibiotic treatment of acute otitis media

in children: a systematic review. JAMA 304(19), 2161-9.

Dickson, G.(2014). Acute otitis media. Primary Care 41(1), 11-8.

Gunasekera, H., O’Connor, T.E., Vijaasekaran, S. & Del Mar, C.B. (2009)

Primary care management of otitis media among Australian children.

Medical Journal of Australia 191(Suppl),S55-9.

Jakobsson, H.E., Abrahamsson, T.R., Jenmalm, M.C., Harris, K. (2014).

Decreased gut microbiota diversity, delayed Bacteroidetes

colonisation and reduced Th1 responses in infants delivered by

caesarean section. Gut 63(4), 559-66.


References cont’d

Lieberthal, A.S., Carroll, A.E., Chonmaitree, T., Ganiats, T.G. & Hoberman, A.

(2013). The diagnosis and management of acute otitis media.

Pediatrics, 131, e964–e999

NPS MedicineWise. (2012). Conditions: Ear nose mouth and throat

disorders. Retrieved from http://nps.org.au/conditions/ear-nose-mouth-and-throat-

disorders/ear-nose-and-throat-infections/ear-infection-middle/for-individuals/medicines-and-treatments

Ottillinger, B., Storr, M., Malfertheiner, P., Allescher, H.D. (2013). STW5

(Iberogast®) – a safe and effective standard in the treatment of

functional gastrointestinal disorders. Wiener Medizinische

Wochenschrift, 163(3-4),65-72.

Perez, M.E. & Youssef, N.N. (2007). Dyspepsia in childhood and

adolescence: insights and treatment considerations. Current

Gastroenterology Report, 9(6), 447-55.

Royal Childrens Hospital. (2017). Kids Information: Fact sheets–

whooping cough. Retrieved from http://rch.org.au/kidsinfo/fact_sheets/Whooping_cough/

Royal Childrens Hospital. (2017). Clinical Guide: Laryngotracheobronchitis.

Retrieved from http://rch.org.au/clinicalguide/guideline_index/Croup_Laryngotracheobronchitis/

http://nps.org.au/conditions/ear-nose-mouth-and-throat-disorders/ear-nose-and-throat-infections/ear-infection-middle/for-individuals/medicines-and-treatments

http://rch.org.au/kidsinfo/fact_sheets/Whooping_cough/

http://rch.org.au/clinicalguide/guideline_index/Croup_Laryngotracheobronchitis/


References cont’d

Royal Childrens Hospital. (2017). Kids Information: Fact sheets–fever in

children. Retrieved from http://rch.org.au/kidsinfo/fact_sheets/Fever_in_children/

Royal Childrens Hospital. (2017). Kids Information: Fact sheets–febrile

convulsions. Retrieved from http://rch.org.au/kidsinfo/fact_sheets/Febrile_Convulsions/

Santich, R. & Bone, K. (2008). Healthy children: Optimising children’s health

with herbs. Warwick, QLD: Phytotherapy Press.

Sarrell, M., Mandelburg, A. & Cohen, H.A. (2001). Efficacy of naturopathic

extracts in the management of ear pain associated with acute otitis

media. Pediatrics, 111(5),574-579. Retrieved from https://archpediatrics.com

Savino, F., Cresi, F., Castagno, E., Silvestro, L., Oggero, R. (2005). A

randomized double-blind placebo-controlled trial of a standardized

extract of Matricariae recutita, Foeniculum vulgare and Melissa

officialis, (ColiMil), in the treatment of breast-fed colicky infants.

Phytotherapy Research 19, 335–40. doi: 10.1002/ptr.1668

Savino, F., Ceratto, S., De Marco, A. & Cordero di Montezemolo, L. (2014).

Looking for new treatments of infantile colic. Italian Journal of

Pediatrics, 40 (53). doi: 10.1186/1824-7288-40-53.

http://rch.org.au/kidsinfo/fact_sheets/Fever_in_children/

http://rch.org.au/kidsinfo/fact_sheets/Febrile_Convulsions/

https://archpediatrics.com/


Savino, F., Ceratto, S., De Marco, A. & Cordero di Montezemolo, L. (2014).

Looking for new treatments of infantile colic. Italian Journal of

Pediatrics, 40 (53). doi: 10.1186/1824-7288-40-53.

Savino, F., Ceratto, S., Poggi, M.E. & Cartosio, L. (2014). Preventive effects of

oral probiotic on infantile colic: a prospective, randomised, blinded,

controlled trial using Lactobacillus reuteri DSM 17938. Beneficial

Microbes, 8,1-7. doi: 10.3920/BM2014.0090

Venkataraghavan et al. (1980). Select herbs in evidence based research in

Ayerveda. Retrieved from: https://scribd.com/doc/126538990/Select-Research-Papers-

on-Evidence-Based-Drugs-in-Ayurveda

https://scribd.com/doc/126538990/Select-Research-Papers-on-Evidence-Based-Drugs-in-Ayurveda


Documents

Session 2: Infants and Children - Part I · Session 2: Infants and Children - Part I ... syrup or juice ... • Paracetamol should not be administered for pain, but may be