Many CAM users consider CAM therapies “natural” and equate this with safety. They are often unaware of the fact that many of these therapies have the potential to be directly or indirectly harmful. There are several reports of severe adverse events in children, mostly due to contamination, drug interactions or direct toxic effects of herbs, and dietary supplements (reviewed by Cuzzolin et al. [8]). The problems of toxicity and drug interactions can be extra relevant in young children and infants whose metabolism and organ function is immature and less tolerant of even subtle changes in comparison to the adult. To date, only scant data on the frequency of adverse effects of CAM therapies in children are available. A recent review on safety and efficacy of acupuncture in children found a risk of adverse events of 1.55 in 100 treatments [9]. The authors concluded that acupuncture seems to be a safe CAM modality for pediatric patients, although the risk for an individual patient may be hard to determine because certain patients, such as immunosuppressed patients or infants, can be predisposed to an increased risk, and because acupuncturists may differ with respect to their qualifications, skills, and knowledge. Another study determined the frequency of concurrent use of conventional medications and natural health products and their potential interactions in 1800 children [10]. Concurrent use of allopathic drugs and natural products was documented in 20 % of patients with potential interactions in one quarter of them. The authors did not investigate whether these were true interactions resulting in clinical symptoms, but the significant number of children who used both drugs and natural products stresses the importance of studies investigating the safety of natural health products. A meta-analysis on adverse events associated with pediatric spinal manipulation identified 14 cases of direct adverse events involving neurologic or musculoskeletal events [11]. Incidence rates, however, could not be inferred from these observational data. Finally, some words on homeopathy, which is one of the most commonly used CAM treatments in children [12]. Over-the-counter homeopathic remedies are especially popular and used often for common self-limiting conditions. There is little published data on the safety of homeopathy. The few studies, which have been performed on this subject, show that adverse events to homeopathic drugs exist, but are rare and not severe. CAM therapies can also have indirect harmful effects due to missed diagnoses, delaying more effective treatments, and discontinuation of prescribed drugs [13]. These indirect effects are probably not a reason for concern in most motility and sensory disorders, for which conventional treatment options are often limited.

Infantile colic is a widespread clinical condition observed in 10–30 % of infants [14]. It occurs mostly in healthy infants and is characterized by paroxysms of excessive, inconsolable crying, frequently accompanied by flushing of the face, drawing-up the legs, meteorism, and flatulence. These crying episodes tend to increase at the age of 6 weeks and usually resolve spontaneously at the end of 3 months. The etiology is not clear, and its limited treatment options frustrate both parents and physicians. It is therefore not surprising that many parents turn toward CAM treatments for their infant.

Gastroesophageal reflux (GER ) is defined as the passive flow of gastric contents into the esophagus. It is important to recognize that GER is a normal physiologic phenomenon and therefore occurs to some extent in all infants and children. Symptoms, especially regurgitation, are very common in infancy and are reported by parents to occur at least regularly in 70 % of 4-month-old babies [20].

Regurgitation and vomiting are the most typical symptoms related to GER [21]. However, most of the infants experiencing those symptoms are not considered to have GER disease. A combination of regurgitation and/or vomiting with excessive crying and feed-related irritability is most suggestive of GER disease in infants. Other symptoms such as hematemesis and failure to thrive are indicative of severe disease. Of the many extraesophageal symptoms such as apparent life-threatening events, laryngitis, hoarseness, and asthma, only dental erosions and Sandifer’s syndrome are convincingly shown to be GER related [22].

Parental education, guidance, and support are usually sufficient to manage healthy, thriving infants with symptoms likely to be secondary to physiologic GER. If symptoms persist despite these conservative measures, it can be helpful to eliminate cow milk from the infant’s diet (or in case of breastfeeding, from the mother’s diet). Therefore, formula-fed infants with recurrent vomiting may benefit from a 2- to 4-week trial of an extensively hydrolyzed protein formula [23]. Thickening feeds has been shown to decrease the frequency of regurgitation but not other symptoms and does not decrease acid exposure [24]. Many studies have been performed looking at the effect of posture in the postprandial position. Although some studies suggest a beneficial effect of lifting the head of the cot, there is not enough evidence to support this in clinical practice [24]. Compared to supine position, prone position significantly reduces the number of acid GER episodes but increases the risk for sudden infant death syndrome (SIDS ) [25, 26]. The major pharmacologic agents currently used for treating GERD in children are gastric acid-buffering agents, mucosal surface barriers, and gastric antisecretory agents.

Although many of the simple therapeutic interventions are helpful in infants and children with GER, 40 % of the parents still seek help in the complementary medicine circuit. Despite this high percentage, no well-designed trials exist which evaluate the efficacy of the complementary treatments that are used by parents for this disorder, such as osteopathy or naturopathy. Therefore, this review will only focus on acupuncture with respect to GERD.

Irritable bowel syndrome (IBS ) and functional abdominal pain (FAP ) in childhood are pediatric functional gastrointestinal disorders, which are characterized by chronic or recurrent abdominal pain, and no evidence of an underlying organic disorder. By definition, altered bowel movements and/or relief of pain after defecation are seen in IBS, while defecation pattern is normal in patients with FAP [35]. IBS and FAP are among the most common pain complaints in childhood with reported prevalence’s between 0.3 and 19 % [36]. Quality of life scores of IBS and FAP children are significantly reduced, and many children also suffer from anxiety and/or depression, highlighting the clinical significance [7, 37]. Standard medical treatment is symptomatic and consists of dietary advice, education, and/or pain medication. Sometimes patients are referred to a child psychologist for behavioral therapy. All these interventions may result in reduction of symptoms, but many children continue to experience symptoms for years, even into adulthood. It is therefore not surprising that a significant number of patients consider alternative treatments. Given the high placebo response shown in IBS studies, it is expected that many patients will experience at least a short-term benefit of any of these treatments.