After enduring 50 hours in labor and the Caesarian Section birth of her son Anson, Kim Pham of Seattle did not head straight home from the hospital to rest. She took her 3-day-old son directly to a chiropractor because she was concerned about the effects of the difficult labor and the unnatural tugging and pulling from the C-section on her new baby's spine.

Inna Garkavi of Bellevue regularly takes her 6-year-old son Benji to an acupuncturist to strengthen his immune system and reduce the effects of his asthma. Since beginning acupuncture, Benji has had fewer colds and has not had an asthma attack, allowing him to avoid the steroids commonly used to treat asthma. Garkavi also gives him herbal supplements such as astragalus and elderberry to boost his immune system.

Last spring, now 3-year-old Caden Ward of Seattle was hospitalized three times due to his asthma and suffers from severe food allergies to wheat, oats, soy, peanuts, chocolate and eggs. His mom, Jennifer, sought advice from a registered dietitian. Through diet and the use of supplements such as cod liver oil and acidophilus, Caden has not had another asthma attack and has been able to re-introduce some foods with no allergic reactions.

"I feel it is an important part of parenting to seek out the best treatment for your child. If conventional medicine isn't giving us the answers we need, then it is our job to seek out as much information as possible and make the best choices for our kids," Ward says.

Ward and other parents are among a growing number of Americans branching out from traditional medicine and approaching health in a more holistic manner. With disturbing questions raised in the news about antibiotic overuse and side effects of various drugs, many parents are incorporating both traditional and alternative health care practitioners into their family's health care routine.

"There is a lot of concern about very young people becoming increasingly medicated," says Dr. Bruce Milliman, N.D., a naturopathic physician at Seattle Healing Arts, who has been practicing for 25 years. "Parents ask, 'Is it really possible that my child needs to be medicated before 5 years old?' In the past, that would be unusual, and now it is more commonplace. I think it is disturbing to parents who might be more thoughtful or better educated."

"On average, about 40 percent of Americans use complementary therapies," adds Dr. Anjana Kundu, an M.D. and acupuncturist who is the director of Complementary and Integrative Medicine (CIM) at Children's Hospital and Regional Medical Center in Seattle.

Recognizing the public's strong interest in health care alternatives nationally, the federal government in 1998 created the National Center for Complementary and Alternative Medicine (replacing the Office of Alternative Medicine, founded in 1992) and is pouring $123 million into complementary and alternative medicine (CAM) research this year alone.

Given the increasing number of adults now using a variety of health care therapies, it is not surprising that parents are also choosing those options for their children. A study recently conducted in Boston indicates that about 42 percent of children in that city use complementary or alternative medicine. Although a study of children using CAM has not yet been conducted here, local providers suspect that the numbers could be even higher in the Seattle area.

"Seattle is a hotbed for alternative practitioners," says Dr. Fernando Vega, M.D., a founder of Seattle Healing Arts, an integrative health care practice in Seattle's Green Lake neighborhood. One reason, he says, is the proximity of internationally recognized Bastyr University in Kenmore, a major training and research center for the natural health sciences.

"It is also the culture, the demographics," Vega adds. "We have young people here who may be from somewhere else and have had a larger world experience."

In addition, experts say that complementary therapies dovetail with the philosophy of many Seattle-area parents proactively seeking providers who help their families stay well, rather than waiting to see a doctor after illness strikes.

At Children's Hospital, for example, acupuncture has been so successful that the hospital has hired a second full-time M.D. acupuncturist to start in September. Children's offers an array of complementary practices including acupuncture, acupressure, massage therapy, yoga, music therapy and biofeedback.

"We're very dedicated to developing both the clinical and research aspects of complementary and integrative medicine," Kundu says. "We want to put this on the big map and we want to be one of the well-known institutes offering CIM, but it takes time to develop." According to Kundu, Children's has chosen the term integrative medicine as opposed to alternative because they want to incorporate it with traditional therapy.

The variety of options available can be overwhelming to parents trying to decide how best to help their children. Dr. Cora Collette Breuner, M.D., MPH, director of the Outpatient Adolescent Medicine Clinic at Children's Hospital and the liaison between Children's Hospital and Bastyr University, recommends parents do their research and communicate with their primary health care practitioner.

"I have a lot of respect for my alternative medical colleagues," Breuner says, but adds, "I give my support to those treatments where there are some safety standards or some compelling thoughtful scientific data supporting their efficacy."

Patients are generally wary of speaking to their primary health care provider about alternative therapies -- expecting a negative reaction -- but Breuner says studies indicate that more medical doctors are now open to hearing about alternatives and collaborating as an integrated team with alternative practitioners. Such communication is vital, she says, noting as an example that some herbal remedies can have harmful interactions with antibiotics or medications.

As a number of parents step away from the idea of having one primary caregiver for their children and look for a holistic team approach, a growing number of Seattle-area practices are becoming more integrated.

Dr. Carol Doroshow, an M.D. and Board-certified pediatrician and homeopathic physician in Seattle, partners with a pediatric chiropractor, Dr. Gita Vasudeva, D.C., FICPA, who has her own flourishing nearby practice and comes into Doroshow's office once a week. Doroshow also refers patients to naturopaths and acupuncturists.

"It is so important to have a team working for your kids. It is about having the right combination of things. We look at the individual and come up with a plan," Vasudeva says.

Doroshow notes that her methodology is different from traditional medical doctors. Her goal is for her clients to be "educated consumers of health," and she encourages an open, dynamic dialogue regarding health choices. For instance, parents are encouraged to bring in any literature they have read regarding health and she will take time to discuss her view of various studies and approaches to the issue.

"My experience has taught me to be very open-minded. There are many ways to look at disease and health based on your perspective," explains Doroshow, who has lived and worked in Ethiopia, Canada and various parts of the U.S.

Doroshow also encourages a healthy skepticism in all patients, saying, "When they take the advice of a physician, I think they need to be encouraged to ask questions. They need to say, 'Do I have any other options? Why are we using antibiotics? Do I have any other choices?' And physicians need to be willing to discuss in an open way what they are thinking about."

Jaimie Edidin of Seattle, who takes his two daughters to Drs. Doroshow and Vasudeva, believes this is a powerful approach and appreciates the open dialogue. "They listen to the parents. It is not the traditional thing where as a parent you listen to the doctor and say, OK, I will do whatever you tell me to do. It is not your typical 'Take these five pills and you will feel better in the morning.' They are open. They see the big picture and work for the betterment of your child."

Edidin's 4-year-old daughter Kaela sees a number of health care providers. Born with a rare infantile epileptic disorder, Kaela requires 24-hour nursing and a ventilator. She suffers from limited mobility and low energy.

"Prior to seeing my kids go through this, I thought chiropractic was just a bunch of bunk. No way. Now I go," Edidin says. Kaela used to have about 1,000 seizures a day and is now down to 10-15, he adds, and they have weaned her off her seizure medication. He also notices that she has increased mobility and more energy after every chiropractic adjustment. The entire family now receives regular chiropractic care and says it has helped lower their stress levels and boost immune function.

Seattle Healing Arts, where Drs. Vega and Milliman both practice, has another unique approach to integrative health care. A variety of independent health care providers are housed in one building and share a common waiting room and front office. The providers, including medical doctors, naturopathic doctors, acupuncturists, chiropractors and licensed massage practitioners, also share office space.

"The concept of collaboration is a theme in the clinic. With the desks in one place, we hear each other's conversations, we hear how each other talks to patients, and we have daily consultations together," Vega says. Providers discuss new things they have learned and pool their knowledge when someone has a "clinical conundrum" such as a mysterious rash, he adds.

A practitioner's specific health care training usually means a different approach to the same medical problem, something parents may want to keep in mind when choosing an alternative provider. "The standard of care in the conventional world of pediatrics might be to use an antibiotic in the first instance, where a naturopathic doctor might try to find an alternative for that," explains Milliman, a family practice naturopath and an adjunct associate professor at Bastyr.

For example, the conventional standard with an ear infection is still to use antibiotics, but Milliman says that standard ear infections can be cured just as effectively and quickly without antibiotics. In the case of eczema, "Instead of first resorting to topical steroids, which we all prescribe, we might look at probable causalities for the eczema," he explains.

"Naturopathic doctors prescribe antibiotics in Washington, and we are not averse to using them. However, if we do use them, we give the patient something like acidophilus to protect the digestive tract," he adds.

Using food and diet to heal the body is another growing trend. Eating more whole foods as opposed to heavily processed foods gives the body more vital nutrients.

"Food is more than fuel; it is information," explains Kelly Morrow, a registered dietitian with a master's degree from Bastyr. She notes that diseases of inflammation such as allergies, eczema and asthma can be eased with essential fatty acids such as high quality fish oil supplements that are mercury-free.

Acupuncture's popularity is clearly growing, too. "Acupuncture is basically a therapy where you are using the stimulation of specific points in your body which are located on meridians, or channels, that run throughout your body," Kundu explains. It is most commonly used and studied as acupuncture analgesia, or pain relief, and she is able to replace or reduce the amount of external substances needed to fight pain, such as morphine.

People choose acupuncture for a wide variety of reasons, including pain management, postoperative nausea and vomiting, asthma, allergies, sinusitis, medical illness, Irritable Bowel Syndrome, insomnia, bedwetting and to fight side effects of cancer or medications.

She says the term needle is really a misnomer and compares it to a tiny, flexible toothpick. For wiggly little kids terrified of needles, Kundu has plenty of tricks up her sleeve. "I do acupuncture on myself, the parents or even on their favorite toy. I let them feel the needle and ask me questions, so there is a lot of preparation and creativity that goes into it," she says, adding that distractions such as blowing bubbles sometimes work.

Studies of chiropractic care -- which stereotypically is considered a treatment for adults with back pain but more broadly addresses the nervous system and its role in overall health -- are also showing impressive results for children, including treatment for asthma, respiratory infections, colic, ear infections and ADHD.

Vasudeva points out that the way a child receives a spinal adjustment is very different from an adult adjustment. It looks more like a massage, and she compares the amount of pressure to the amount you would use checking to see if a tomato is ripe. And if her young patients are nervous, her pediatric chiropractic table shaped like a bus with an enticing net of sea creatures hanging above helps the youngsters relax

"In this society we base so much on symptoms," Vasudeva says. "When we are in pain we are not well, and if we are not having pain we seem to think we are OK -- but that is where we are lagging and have to think more progressively."

Jolene Gensheimer is a Bellevue-based freelance writer and mother of two.

A closer look at CAM therapies

The National Center for Complementary and Alternative Medicine (NCCAM) classifies CAM therapies into five categories. Visit www.nccam.nih.gov/health/ for more detailed information, including evidence of efficacy, in each category:

• Alternative medical systems: Built upon complete systems of theory and practice and often evolving apart from - and earlier than - the conventional medical approach used in the U.S. Examples in Western cultures include homeopathic and naturopathic medicine; in non-Western cultures, examples include Traditional Chinese Medicine and Ayurveda.
• Mind-body interventions: Techniques designed to enhance the mind's capacity to affect bodily function and symptoms, including meditation, prayer, mental healing and therapies that use creative outlets such as art, music or dance.
• Biologically based therapies: Therapies that use substances found in nature, such as herbs, foods and vitamins. Examples include dietary supplements, herbal products and other "natural" but as yet scientifically unproven therapies (for example, the use of shark cartilage to treat cancer).
• Manipulative and body-based methods: Techniques that involve manipulation and/or movement of one or more parts of the body. Examples include chiropractic or osteopathic manipulation and massage.
• Energy therapies: Involving the use of energy fields, there are two types: Biofield therapies are intended to affect energy fields that purportedly surround and penetrate the human body. Examples include qi gong, Reiki and therapeutic touch. Bioelectromagnetic-based therapies involve the unconventional use of electromagnetic fields, such as pulsed fields, magnetic fields or alternating-current or direct-current fields.

How to choose a provider

Selecting what type of complementary or alternative health care treatment is right for your child can be a formidable challenge. Many practices make similar claims and the lack of set standards in the arena mean that practitioners in the same field may operate very differently.

Fernando Vega, M.D., says there are no pat answers in navigating the complementary and alternative medicine (CAM) world. He recommends keeping an open mind and a healthy skepticism.

"Few people hunt a doctor in the Yellow Pages. It is usually by asking people they trust," Vega says, adding that the same approach is true for CAM practitioners. Ask friends and family members about the results they have experienced with a practitioner they are seeing, Vega recommends. Also check credentials and inquire specifically about how frequently the provider you are considering treats the health issue in question.

The National Center for Complementary and Alternative Medicine offers detailed information about selecting a CAM practitioner, including questions to ask after you have selected a practitioner. The Web site is www.nccam.nih.gov/. Among the suggestions:

• Seek recommendations from a primary health care providers or others you believe to be knowledgeable about complimentary and alternative medicine regarding the therapy in which you are interested.
• Contact a professional organization (see related sidebar, this page) for the type of practitioner you are seeking. These organizations have information on standards of practice and also will provide referrals to providers in your area.
• Check with your insurer to see if the cost of therapy will be covered.
• After you select a practitioner, make a list of questions to ask at your first visit. You may want to bring a friend or family member who can help you ask questions and note answers.
• Come to the first visit prepared to answer questions about your health history, including injuries, surgeries and major illnesses, as well as prescription medicines, vitamins and other supplements you may take.
• Assess your first visit and decide if the practitioner is right for you. Did you feel comfortable with the practitioner? Could the practitioner answer your questions? Did he or she respond to you in a way that satisfied you? Does the treatment plan seem reasonable and acceptable to you?

Research and alternative health

The Western medicine model is highly evidence-based; therefore patients, doctors and the government are calling for clear proof that complementary and alternative medicine work.

However, not all CAM practices lend themselves to the standard Western medical research practices. With pharmaceutical trials, testers are divided into two groups, where one group typically receives the medication being tested while the other group receives a placebo, or fake pill. Then experts compare the results to prove efficacy.

The clear problem lies in the sham treatment with some alternatives. How do you fake a massage or pretend to insert acupuncture needles? While studies have taped acupuncture needles to the control group instead of inserting them, some still question the results and many believe that any form of touch can be therapeutic.
Additionally, one of the biggest claims is that many patients say they experience fewer and shorter colds and illnesses, as well as an overall stronger sense of health. "How do you prove that you feel better?" points out Fernando Vega, M.D., a long-time Seattle family practitioner and founder of Seattle Healing Arts Funding is yet another obstacle to research. Pharmaceutical companies spend millions of dollars testing and advertising drugs, looking to make top dollars through sales. There are few corporate dollars available to prove, for example, that acupuncture relieves pain just as effectively as pharmaceutical drugs - even though most parents would prefer to minimize use of powerful, addictive substances like morphine for post-operative pain in their children.

It is clear that new technology and methods need to be developed to study CAM. Dr. Anjana Kundu, an M.D. acupuncturist and the director of Complementary and Integrative Medicine (CIM) at Children's Hospital and Regional Medical Center, points out that the use of Magnetic Resonance Imaging, or MRI, has made tremendous strides in proving the efficacy of acupuncture, allowing researchers to see the parts of the brain that acupuncture stimulates.

"MRI has been able to provide validity. It is a dynamic change occurring as you are observing it," Kundu says.

Holistic health resources

Web sites:

• www.nccam.nih.gov National Center for Complementary and Alternative Medicine site contains comprehensive information from basic to detailed regarding research, health issues, clinical trials and current CAM news.
• www.hpakids.org Holistic Parenting Association site for parents and health professionals. They offer a free monthly newsletter.
• www.wholehealthmd.com American WholeHealth Network has a section organized by health condition with detailed information about the condition and what may be helpful, including recipes high in recommended nutrients.
• www.naturalchoice.net Online version of the Natural Choice Directory of Puget Sound, "The Healthy Yellow Pages."
• www.icpa4kids.org The International Chiropractic Pediatric Association site has basic chiropractic information; details current and past studies regarding pediatric chiropractic care.
• www.medicalacupuncture.com American Academy of Medical Acupuncture site. The learning center provides helpful information about acupuncture and frequently asked questions.
• www.nccaom.org National Certification Commission for Acupuncture and Oriental Medicine.
• www.amta-wa.org American Massage Therapy Association, Washington chapter site has information about Washington licensed practitioners and types of massage available.
• www.cspinet.org, Center for Science in the Public Interest is an advocate group for nutrition, health and food safety.
• www.consumerlab.com Independently tests various supplements to see if products actually have what they claim, and they also test for ingredients that should not be there, such as excessive lead.

Books:

• How to Raise A Healthy Child in Spite of Your Doctor, by Robert S. Mendelsohn, M.D. Ballantine Books. Recommended by Dr. Vega, the front cover says "One of America's leading pediatricians puts parents back in control of their children's health."
• Enter the Zone: A Dietary Road Map by Barry Sears and Bill Lawren, ReganBooks. Dr. Doroshow recommends this book to understand the biochemistry of food.
• Encyclopedia of Natural Medicine, by Michael Murray, N.D., and Joseph Pizzorno, N.D., Three Rivers Press. Recommended by Dr. Doroshow, this comprehensive book provides a naturopathic medicine perspective. Co-author Joe Pizzorno is one of the founders of Bastyr University.
• Feeding The Whole Family: Whole Foods Recipes for Babies, Young Children and their Parents, by Cynthia Lair, Moon Smile Press. Recommended by Kelly Morrow, this cookbook by a Bastyr instructor emphasizes whole foods and simple ingredients.
• Fast Food Nation: The Dark Side of the All-American Meal, by Eric Schlosser. Houghton Mifflin. Recommended by Kelly Morrow, this book is full of startling information about practices of the meat and fast food industries.
• Chiropractic First: The Fastest Growing Healthcare Choice Before Drugs or Surgery, by Terry A. Rondberg, and Chicken Soup for the Chiropractic Soul, by Jack Canfield, Mark Hansen, and Dr. Fabrizio Mancini, HCI. Both recommended by Dr. Vasudeva, they are available at www.amazon.com