: Most integrative therapies have not been well-studied in children. Safety in children has not been proven for most of the therapies listed below. Therefore, parents and caregivers should talk to their children's pediatricians before trying integrative therapies.

Good scientific evidence :

Iodine: Povidone-iodine solutions that are applied directly to the eyes have been used in the management of childhood bacterial conjunctivitis (pinkeye), and may be as effective as other anti-bacterial solutions such as neomycin-polymyxin B-gramicidin. This is not an effective treatment for viral conjunctivitis. Medical supervision is recommended.

Reactions can be severe and deaths have occurred with exposure to iodine. Avoid iodine-based products if allergic or hypersensitive to iodine. Do no use for more than 14 days. Avoid Lugol solution and saturated solution of potassium iodide (SSKI, PIMA) with hyperkalemia (high amounts of potassium in the blood), pulmonary edema (fluid in the lungs), bronchitis, or tuberculosis. Use cautiously when applying to the skin because it may irritate/burn tissues. Use sodium iodide cautiously with kidney failure. Avoid sodium iodide with gastrointestinal obstruction. Iodine is safe in recommended doses for pregnant or breastfeeding women.

Psyllium: Psyllium, also known as ispaghula, comes from the husks of the seeds of Plantago ovata. Psyllium contains a high level of soluble dietary fiber and is the main ingredient in many commonly used laxatives, such as Metamucil® and Serutan®. Psyllium has been studied for the treatment of diarrhea, particularly in patients undergoing tube feeding. An effective stool bulking effect has generally been found in scientific studies.

Avoid if allergic or hypersensitive to psyllium, ispaghula, or English plantain (Plantago lanceolata). Prescription drugs should be taken one hour before or two hours after psyllium.

Saccaromyces boulardii: Saccharomyces boulardii is a non-pathogenic yeast strain that has been used to treat and prevent diarrhea that is caused by many different factors. Several trials suggest the efficacy of Saccharomyces boulardii in the treatment of diarrhea in childhood. Further studies are still required. Use of Saccharomyces boulardii may be advantageous in both the reduction of stool frequency per day and the duration of diarrhea in this age group.

Avoid if allergic/hypersensitive to yeast, Saccharomyces boulardii, Saccharomyces cerevisiae, or other species in the Saccharomycetaceae family. Use cautiously in immunocompromised or critically ill patients. Use cautiously with indwelling central venous catheters, colitis, cancer, or constipation. Use cautiously in individuals undergoing chemotherapy and in infants. Use cautiously if taking antidiarrheal agents. Avoid with a yeast infection.

Soy: Numerous studies report that infants and young children (ages two to 36 months) with diarrhea who are fed soy formula experience fewer bowel movements per day and fewer days of diarrhea. This research suggests soy to have benefits over other types of formula, including cow milk-based solutions. The addition of soy fiber to soy formula may increase the effectiveness. Better quality research is needed before a strong recommendation can be made. Parents are advised to speak with a qualified healthcare provider if infants experience prolonged diarrhea, become dehydrated, develop signs of infection such as fever, or experience blood in the stool. A healthcare provider should be consulted for current breastfeeding recommendations and to suggest long-term formulas with adequate nutritional value. A doctor may recommend a specially designed soy formula, but regular soy milk should not be given to infants.

Avoid if allergic to soy. Breathing problems and rash may occur in sensitive people. Soy, as a part of the regular diet, is traditionally considered to be safe during pregnancy and breastfeeding, but there is limited scientific data. The effects of high doses of soy or soy isoflavones in humans are not clear, and therefore are not recommended. There has been a case report of vitamin D deficiency rickets in an infant nursed with soybean milk (not specifically designed for infants). People who experience intestinal irritation (colitis) from cow's milk may experience intestinal damage or diarrhea from soy. It is not known if soy or soy isoflavones share the same side effects as estrogens, such as increased risk of blood clots. The use of soy is often discouraged in patients with hormone-sensitive cancers, such as breast, ovarian, or uterine cancer. Other hormone-sensitive conditions such as endometriosis may also be worsened. Patients taking blood-thinning drugs like warfarin should check with their doctors and/or pharmacists before taking soy supplements.

Unclear or conflicting scientific evidence :

Acupuncture: Acupuncture plus point-injection has been found beneficial for the treatment of hives, which may occur during an allergic reaction to food. However, more research is needed to confirm these findings. Acupuncture is not safe for infants or young children.

Needles must be sterile in order to avoid disease transmission. Avoid with valvular heart disease, medical conditions of unknown origins, or infections. Acupuncture should not be applied to the chest in patients with lung diseases or on any area that may rely on muscle tone to provide stability. Avoid use in patients with needle phobias. Use cautiously with bleeding disorders, neurological disorders, seizure disorders, or diabetes. Use cautiously in elderly or medically compromised patients. Use cautiously in patients who will drive or operate heavy machinery after acupuncture. Use cautiously if taking anticoagulants.

American pawpaw: American pawpaw (Asimina triloba) is a fruiting tree native to North America. However, the tree is also cultivated in Asia, Australia, and Europe. Pawpaw extract in combination with thymol (thyme oil) and tea tree oil in a shampoo formulation may effectively treat lice. Better-quality studies using pawpaw alone are needed before a firm recommendation can be made.

No well-designed studies on the long-term effects of pawpaw extracts have been conducted. The constituents in pawpaw extract are cytotoxic (poisonous to cells). Therefore, oral use of pawpaw extract is not recommended without the supervision of a physician. Avoid if allergic to Asimina triloba or any other members of the Annonaceae plant family (including other species of Asimina and those in the genera Annona, Deeringothamnus, Disepalum, Goniothalanus, Rollinia, Uvaria, or Xylopia). Use cautiously with gastrointestinal problems or with a history of dermatological reactions.

Arrowroot: Arrowroot refers to any plant of the genus Maranta, but the term is most commonly used to describe the easily digestible starch obtained from the rhizomes of Maranta arundinacea. Arrowroot is an edible starch with proposed demulcent (soothing) effects and is a well-known traditional remedy for diarrhea. Early research suggests it may have a beneficial effect in the treatment of diarrhea in irritable bowel syndrome (IBS) patients. Additional study is needed in this area.

Avoid if allergic or hypersensitive to arrowroot (Marantana arundinacea), its constituents, or members of the Marantaceae family. Use cautiously with a history of constipation.

Belladonna: Belladonna has been used for centuries to treat many medical conditions. Little reliable research is available on the use of belladonna for ear infections. Until additional studies are performed, it remains unknown if this is an effective treatment.

Avoid if allergic to belladonna or plants of the Solanaceae(nightshade) family (such as bell peppers, potatoes, or eggplants). Avoid with a history of heart disease, high blood pressure, heart attack, abnormal heartbeat, congestive heart failure, stomach ulcer, constipation, stomach acid reflux, hiatal hernia, gastrointestinal disease, ileostomy, colostomy, fever, bowel obstruction, benign prostatic hypertrophy (enlarged prostate), urinary retention, glaucoma (narrow angle), psychotic illness, Sjögren's syndrome, dry mouth, neuromuscular disorders (such as myasthenia gravis), or Down's syndrome.

Berberine: Berberine is a bitter-tasting, yellow plant alkaloid with a long history of medicinal use in Chinese and Ayurvedic medicine. Berberine has been evaluated as a treatment for infectious diarrhea, including choleric diarrhea, although the data is conflicting. Therefore, there is currently insufficient evidence regarding the efficacy of berberine in the management of infectious diarrhea.

Avoid if allergic or hypersensitive to berberine, to plants that contain berberine (Hydrastis canadensis (goldenseal), Coptis chinensis (coptis or goldenthread), Berberis aquifolium (Oregon grape), Berberis vulgaris (barberry), and Berberis aristata (tree turmeric), or to members of the Berberidaceae family. Avoid in newborns due to the potential for an increase in free bilirubin, jaundice, and development of kernicterus (brain damage). Use cautiously with cardiovascular disease, gastrointestinal disorders, hematologic disorders, leukopenia (low number of white blood cells), kidney disease, liver disease, respiratory disorders, cancer, hypertyraminemia, diabetes, or low blood pressure. Use cautiously in children due to a lack of safety information. Use cautiously in individuals with high exposure to sunlight or artificial light. Use cautiously for longer than eight weeks due to theoretical changes in bacterial gut flora. Use cautiously if taking anticoagulants, antihypertensives, sedatives, anti-inflammatories, medications metabolized by CYP P450 3A4 including cyclosporin, or any prescription medications.

Bilberry: Bilberry is an herb made from the wrinkled, black berries of a small deciduous shrub. The use of bilberry fruit in traditional European medicine dates back to the 12th Century. Bilberry is used traditionally to treat diarrhea, but there is no reliable research in this area.

Long-term side effects and the safety of bilberry remain unknown. Avoid if allergic to bilberry, anthocyanosides (a component of bilberry), or other plants in the Ericaceae family. Do not consume bilberry leaves. Use cautiously with bleeding disorders or diabetes. Use cautiously if taking anticoagulant/anti-platelet medications or drugs that alter blood sugar levels. Stop use before surgeries or dental or diagnostic procedures that have bleeding risks. Use cautiously in doses higher than recommended.

Bovine colostrum: Bovine colostrum is the pre-milk fluid produced from cow mammary glands during the first two to four days after birth. Bovine colostrum confers growth, nutrient, and immune factors to the offspring. Bovine colostrum may be effective for improving gastrointestinal health. Preliminary evidence suggests that colostrum inhibits the adhesion or activity of certain bacteria to intestinal cells, which may help in the treatment of diarrhea. Additional study is needed in this area.

Avoid if allergic to dairy products. Use bovine colostrum cautiously because toxic compounds, such as polychlorinated biphenyls (PCBs), dichlorodiphenyltrichloroethane (DDT), and dichlordiphenyldichloroethylene (DDE), have been found in human colostrum and breast milk. Thus, it is possible that these agents may be found in bovine colostrum. Avoid with, or if at risk of, cancer. Use cautiously with immune system disorders or atherosclerosis (hardening of the arteries). Use cautiously if taking medications, such as anti-diarrheal agents (e.g. Imodium®), insulin, or CNS agents (such as amphetamines, caffeine).

Calendula: Calendula, also known as marigold, has been widely used on the skin to treat minor wounds, skin infections, burns, bee stings, sunburn, warts, and cancer. Calendula has been studied for reducing pain caused by ear infections. Some human studies suggest that calendula may possess mild pain-relieving properties equal to those of similar non-herbal eardrop preparations. Further studies are needed before a recommendation can be made in this area.

Use cautiously if allergic to plants in the Aster/Compositae family (such as ragweed, chrysanthemums, marigolds, or daisies).

Carob: Carob (Ceratonia siliqua) is a leguminous evergreen tree of the family Leguminosae (pulse family). Traditionally, carob has been used for the treatment of gastrointestinal conditions, especially diarrhea. Preliminary studies used different types of carob products as an adjunct to oral rehydrating solution and showed promising results. Additional study is needed in this area.

Avoid if allergic/hypersensitive to carob (Ceratonia siliqua), its constituents, or any plants in the Fabaceae family, including tamarind. Avoid with metabolic disorders, with a chromium, cobalt, copper, iron, or zinc disorder or deficiency, kidney disorders, or acute diarrhea. Avoid in underweight infants. Use cautiously in patients with anemia, known allergy to peanuts and other nuts, complications with powdered, bulk forming laxative drinks, diabetes, or hyperlipidemia (high cholesterol). Use cautiously if taking oral herbs or drugs. Use cautiously in hypouricemic patients. Avoid if pregnant or breastfeeding.

Chamomile: Chamomile is an herb that has an apple-like smell and taste. It is commonly taken as a tea. Preliminary study reports that chamomile with apple pectin may reduce the length of time that children experience diarrhea. There is a lack of research on this use in adults. Further research is needed before a recommendation can be made.

Avoid if allergic to chamomile or any related plants, such as aster, chrysanthemum, mugwort, ragweed, or ragwort. Avoid with heart disease, breathing disorders, hormone-sensitive conditions, or central nervous system disorders. Avoid if taking cardiac depressive agents, central nervous system depressants, respiratory depressive agents, or anticoagulants. Use cautiously if taking benzodiazepine, anti-arrhythmic medications, calcium channel blockers, alcohol, sedative agents, anxiolytic medications, spasmolytic drugs, oral medications, or agents that are broken down by the liver.

Chiropractic: Chiropractic care focuses on how the relationship between musculoskeletal structure (mainly the spine) and bodily function (mainly nervous system) affects health. Chiropractors use many techniques, including spinal manipulative therapy, diet, exercise, X-rays, and other techniques. There is not enough reliable scientific evidence to conclude the effects of chiropractic techniques in the management of ear infections in children.

Avoid with vertebrobasilar vascular insufficiency, aneurysms, arteritis (inflammation of the arteries), or unstable spondylolisthesis (a slippage of the vertebrae in the spine). Avoid use on post-surgical areas of para-spinal tissue. Use cautiously with acute arthritis, brittle bone disease, conditions that cause decreased bone mineralization, bleeding disorders, migraines, or if at risk of tumors or metastasis of the spine. Use extra caution during cervical adjustments.

Chlorophyll: Taking chlorophyll by mouth as a liquid was reported to be an effective treatment for chickenpox. More research is needed before a firm conclusion can be made.

Avoid if allergic or hypersensitive to chlorophyll or any of its metabolites. Use cautiously with photosensitivity, compromised liver function, diabetes, or gastrointestinal conditions or obstructions. Use cautiously if taking immunosuppressant agents or agents used to treat diabetes. Avoid if pregnant or breastfeeding.

Clove: Clove is commonly used as a fragrant or flavoring agent. There is a risk of blindness if it comes in contact with eyes. Clove oil (eugenol) has been used for its pain-relieving, local anesthetic, anti-inflammatory, and antibacterial effects. Animal studies suggest that intravenous clove may help lower fevers, but no reliable human studies are available.

Avoid if allergic to clove, eugenol, or some licorice products or tobacco (clove cigarette) products. Use cautiously if allergic to Balsam of Peru. Avoid with a history of seizures, stroke, or liver damage. Use cautiously if taking medications that treat diabetes. Use cautiously with diabetes, low blood sugar levels, bleeding problems, or impotence. Stop use two weeks before and immediately after surgery/dental/diagnostic procedures with bleeding risks.

Eyebright: Eyebright has been used in eye solutions for centuries to manage multiple eye conditions. Currently, there is insufficient scientific evidence to recommend for or against the use of eyebright in the treatment of conjunctivitis.

Avoid if allergic to eyebright, any of its constituents, or members of the Scrophulariaceae family. Use cautiously as an eye treatment, particularly with homemade preparations, due to the risk of infection if the preparation is not sterile. Use cautiously with diabetes and drugs that are broken down by the liver.

Goldenseal: Goldenseal is one of the five top-selling herbal products in the United States. Berberine has been used as a treatment for diarrhea caused by bacterial infections (including diarrhea from cholera). Due to the very small amount of berberine in most goldenseal products, it is unclear whether goldenseal contains enough berberine to have the same effects. Therefore, there is currently not enough scientific evidence to make a recommendation in this area.

Avoid if allergic or hypersensitive to goldenseal or any of its constituents, like berberine and hydrastine. Use cautiously with bleeding disorders, diabetes, or low blood sugar.

Hibiscus: The Hibiscus genus contains several species, many of which have been used medicinally. Currently, there is limited available evidence evaluating the effects of hibiscus for the treatment of head lice. Study participants were treated with creams containing hibiscus tea plus henna. Additional studies involving hibiscus alone are warranted in this area.

Avoid if allergic or hypersensitive to hibiscus, its constituents, or members of the Malvaceae family. Use cautiously with high or low blood pressure.

Lactobacillus acidophilus: Lactobacilli are bacteria that normally live in the gastrointestinal track, mouth, and vagina. A small amount of human research suggests that Lactobacillus acidophilus may not be effective when used to prevent diarrhea in travelers or in people taking antibiotics. Several studies report that the related species, Lactobacillus GG, may be helpful for the prevention of diarrhea in children and travelers. Additional study is needed in these areas before a firm conclusion can be drawn.

Lactobacillus acidophilus might be difficult to tolerate if allergic to dairy products containing L. acidophilus. Avoid with a history of an injury or illness of the intestinal wall, immune-disease, or heart valve surgery. Avoid if taking prescription drugs (such as corticosteroids) because of the risk of infection. Use cautiously with heart murmurs. Antibiotics or alcohol may destroy Lactobacillus acidophilus.Therefore, it is recommended that Lactobacillus acidophilus be taken three hours after taking antibiotics or drinking alcohol. Some individuals can use antacids to decrease the amount of acid in the stomach one hour before taking Lactobacillus acidophilus.

Mullein: Mulleins have been used in natural medicine for centuries and are among the oldest known medicinal plants. There are some clinical studies using mullein (Verbascum thapsus) in combination with other herbal products as an eardrop to treat earaches caused by ear infections. It is not clear what the effects of mullein alone are on ear infections because the product studied was a combination of different herbal products. Additional study is needed before a firm conclusion can be made.

Avoid if allergic/hypersensitive to mullein (Verbascum thapsus), its constituents, or any of the Scrophulariaceae (figwort) family. Use cautiously if taking anticoagulants (blood thinners). There are reports that mullein may contain a toxin called rotenone, which is an insecticide.

Probiotics: Probiotics are beneficial bacteria that are sometimes called "friendly germs." They help maintain a healthy intestine and help the body digest foods. They also help keep harmful bacteria and yeasts in the gut under control. Most probiotics come from food sources, especially cultured milk products. Preventive use of Lactobacillus GG may reduce the risk of nosocomial (originating in a healthcare setting) diarrhea in infants, particularly diarrhea caused by rotavirus gastroenteritis.

Probiotics are generally considered safe and well-tolerated. Avoid if allergic or hypersensitive to probiotics. Use cautiously if lactose intolerant.

Saccaromyces boulardii: With the introduction of broad-spectrum of antibiotics into clinical practice, Clostridium difficile infection has become a common cause of infectious diarrhea in hospitalized patients. For the treatment of recurrent Clostridium difficile-associated diarrhea, Saccharomyces boulardii has been shown to decrease recurrences by about 50%, especially when combined with high-dose vancomycin. Further well-designed and reported studies are still required.

Avoid if allergic/hypersensitive to yeast, Saccharomyces boulardii, Saccharomyces cerevisiae, or other species in the Saccharomycetaceae family. Use cautiously in immunocompromised or critically ill patients. Use cautiously with indwelling central venous catheters, colitis, cancer, or constipation. Use cautiously in the elderly, in individuals undergoing chemotherapy, and in infants. Use cautiously if taking antidiarrheal agents. Avoid with a yeast infection.

Tai chi: Tai chi is a system of movements and positions believed to have developed in 12th Century China. A small study showed that treatment with tai chi might increase immunity to the virus that causes shingles. This may suggest the use of tai chi in the prevention of chickenpox, but further well-designed large studies should be performed.

Vitamin A: Vitamin A is an essential fat-soluble vitamin. Vitamin A may reduce the severity and duration of diarrheal episodes in malnourished children but not in well-nourished children. Since diarrhea is a major cause of morbidity and mortality in developing countries, vitamin A supplementation may be considered in undernourished children with diarrhea.

Avoid if allergic or hypersensitive to vitamin A. Vitamin A toxicity can occur if taken at high dosages. Use cautiously with liver disease or alcoholism. Smokers who consume alcohol and beta-carotene may be at an increased risk for lung cancer or heart disease. Vitamin A appears safe in pregnant women if taken at recommended doses.

Fair negative scientific evidence :

Probiotics: Although probiotic therapy has been shown to help treat diarrhea in children as well as infectious diarrhea, fair evidence suggests that it is not helpful in treating HIV-associated diarrhea. Probiotic therapy with these "friendly germs" is well tolerated in HIV-infected patients on antiretroviral therapy, but may not be helpful for gastrointestinal symptoms.

Probiotics are generally considered safe and well-tolerated. Avoid if allergic or hypersensitive to probiotics. Use cautiously if lactose intolerant.

Strong negative scientific evidence :

Bael fruit: Indian bael, an indigenous plant of India, has spread over wide areas of Southeast Asia. Indian bael has traditionally been used as a treatment for diarrhea. However, capsules of dried powder of the unripe fruit were not effective in treating diarrhea in patients with shigellosis. Additional study investigating different preparations of bael fruit would help confirm this finding.

Avoid if allergic or hypersensitive to Indian bael or any of its constituents. Avoid dosages that exceed those of use in traditional medicine. Indian bael in large quantities theoretically may result in digestive complaints and constipation, given that tannins are constituents. Use cautiously if taking hypoglycemic agents or thyroid hormone, herbs for thyroid disorders, or herbs that may exacerbate or induce hyperthyroidism.

Traditional or theoretical uses lacking sufficient evidence :

Aconite: The aconite plant grows in rocky areas. It is often found in the mountainous woodlands of many parts of Europe, especially France, Austria, Germany, and Denmark. It has been proposed that aconite may help treat middle ear infections. However, a firm conclusion cannot be made until human studies are performed in this area.

A case study also suggests that aconite may help treat patients with lice. However, until well-designed human studies are performed, it remains unknown if this is a safe and effective treatment.

It has been suggested that aconite may help reduce the symptoms of fevers. Homeopaths often prescribe aconite preparations at the start of a fever. However, studies are currently lacking in this area.

Aconite is highly toxic and is not safe for human consumption. Avoid with heart disease, irregular heartbeat, hemodynamic instability (abnormal blood flow), and gastrointestinal disorders (such as ulcers, reflux esophagitis, ulcerative colitis, spastic colitis, or diverticulosis). Use cautiously with diabetes or suicidal tendencies.

Chamomile: Chamomile is an herb that has an apple-like smell and taste. It is commonly taken as a tea. Although it has been suggested that chamomile may help treat ear infections, studies are currently lacking. It remains unknown if this is a safe and effective treatment for humans.

Avoid if allergic to chamomile or any related plants, such as aster, chrysanthemum, mugwort, ragweed, or ragwort. Avoid with heart disease, breathing disorders, hormone-sensitive conditions, or central nervous system disorders. Avoid if taking cardiac depressive agents, central nervous system depressants, respiratory depressive agents, or anticoagulants. Use cautiously if taking benzodiazepine, anti-arrhythmic medications, calcium channel blockers, alcohol, sedative agents, anxiolytic medications, spasmolytic drugs, oral medications, or agents that are broken down by the liver.

Lavender: Oils from lavender flowers are used in aromatherapy, baked goods, candles, cosmetics, detergents, jellies, massage oils, perfumes, powders, shampoo, soaps, and teas. It has been suggested, but not scientifically proven, that lavender may help treat lice.

Avoid if allergic or hypersensitive to lavender. Avoid with a history of seizures, bleeding disorders, eating disorders (anorexia, bulimia), or anemia (low levels of iron). Avoid consuming lavender if pregnant or breastfeeding. Lavender taken by mouth may stimulate menstruation.

Lemongrass: Lemongrass oil is an essential oil used in deodorants, herbal teas, skin care products, fragrances, and insect repellents. It is also commonly used during aromatherapy. Theoretically, lemongrass may help treat scabies. However, studies have not evaluated the safety or effectiveness of this therapy.

Avoid if allergic to lemongrass, its constituents, or any members of the Poaceae family. Use cautiously if taking diabetic or heart medications or medications that are broken down by the liver. Use cautiously with liver conditions.