Homoeopathic Research in Pediatrics: A Literature Review

It is a necessity of professional and scientific societies in any systems of medicine to have research data in a particular disease condition to establish its efficacy. Moreover there is an ever increasing demand by policy makers for evidence-based data, to make decisions in favor of a particular system of treatment. Homeopathic research is the need of the hour to prove its effectiveness to critics.

Children are frequent visitors for homeopathic consultation. As physicians we must be updated with current research literature for ourselves and also to educate parents. This article is a small effort to provide research updates in last 10 years related to pediatric disorders and role of homeopathy.

In the recent past, some studies suggested that parents use homeopathy more frequently than conventional treatment for their children.¹ An ethnographic study of committed adult users in South London found that they consulted their general practitioners for diagnosis, but took homeopathy for treatment because antibiotics and other drugs were seen as weakening the immune system and counteracting the remedy.¹ Many of these participants were mothers who made health decisions for their children using this same set of beliefs. A recent qualitative study in Norway found similar results. ²

HOMEOPATHY FOR CHILDREN–A GLOBAL VIEW

Homeopathy is a form of complementary/alternative medicines which is considered as a safe and effective form of treatment for children and adults. Within the UK homeopathy use is estimated at 1.9% of the adult population and around 11% for children less than 16 years. The numbers of patients using complementary medicines, including Homeopathy are growing worldwide. The use of complementary medicine, however, is not limited to adults but is also common in children (11–18%) with Homeopathy being one of the most popular systems.

This wide and growing use of complementary medicines implies a perceived deficiency in conventional medical treatment, paralleled by increasing patient dissatisfaction with conventional medicine (drug side-effects, perceived lack of holistic care), and the attraction of longer appointment times with complementary therapists.

Homeopathy for pediatrics population in general

Title of study	Type of study	Results	Conclusion
Thompson EA, Bishop JL, Northstone K. The use of homeopathic products in childhood: data generated over 8.5 years from the Avon Longitudinal Study of Parents and Children (ALSPAC).3	Population based Longitudinal Study of Parents and Children (ALSPAC). Questionnaire provided to mothers.	Eleven and eight-tenths percent (11.8%) of this cohort used a HP at least once up to 8.5 years of age. Chamomilla for teething and Arnica for soft-tissue bruising were the most commonly used products.	Research could focus on greater information delivery to the community and monitoring of potential health and cost benefits, or side-effects of the use of HP for acute and chronic conditions in children.
Spence DS, Thompson EA, Barron SJ. Homeopathic Treatment for Chronic Disease: A 6-Year, University-Hospital Outpatient Observational Study.4	Outcomes were based on scores on a 7-point Likert-type scale at the end of the consultation and were assessed as overall outcomes compared to the initial baseline assessments.	In an observational study of 6544 consecutive patients during a 6-year period, and over 23,000consultations, results showed that 70.7 % reported positive health changes, with 50.7 % recording their improvement as better (+2) or much better (+3). Of the 1270 children that were treated 80.5 % had some improvement, and 65.8 % were better (+2) or much better (+3).	Homeopathic intervention offered positive health changes to a substantial proportion of a large Cohort of patients with a wide range of chronic diseases.
Witt CM, Luedtke R, Baur R, Willich SN. Homeopathic Medical Practice: Long-term results of aCohort Study with 3981 Patients.5	The main outcome measures were: Patient and physician assessments (numeric rating scales from 0 to 10) and quality of life at baseline, and after 3, 12, and 24 months.	In a prospective, multi-centre cohort study with 103 primary care practices treating 3981 patients, disease severity decreased significantly (p<0.001) over a 2 year period. Major improvements were observed for quality of life for adults and young children. 28 % (1130) of the patients were children and 97 % of all diagnoses where chronic with an average duration of 8.8 years.The most frequent diagnoses were allergic rhinitis in men, headache in women, and atopic dermatitis in children.	Disease severity and quality of life demonstrated marked and sustained improvements following homeopathic treatment period.
Güthlin C, Lange O and Walach H. Measuring the effects of acupuncture and homeopathy in general practice: An uncontrolled prospective documentation approach.6		A survey of more than 900 patients treated homeopathically showed substantial improvement in Quality of life over the first 6 months after treatment and this effect remained more or less stable over the following years.
Du Y, Knopf H. Pediatric homeopathy in Germany: results of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS).7	Last-week homeopathy use was recorded among 17,450 children aged 0-17years who participated in the 2003-2006 German Health Interview and Examination Survey for Children and Adolescents (KiGGS).	Nine hundred and fifty-one homeopathic preparations were used by 718 Children (weighted prevalence 4.6%).	Pediatric homeopathy is quite popular in Germany, particularly among children from families with a higher socioeconomic status. The high level of pediatric homeopathy use in Germany warrants a critical review to determine whether it is evidence based and cost-effective.

RESPIRATORY DISORDERS IN CHILDREN

It is commonly seen that most children come in for respiratory allergies or infections. Our medication has a definite role in treatment of respiratory disorders such as Asthma, Rhinitis, Bronchitis, Allergies and Pharyngitis. Following are positive as well as negative studies on this particular aspect.

Cost effectiveness in respiratory illness as compare to conventional medicine

Title of study	Type of study	Results	Conclusion
Rossi E, Crudeli L, Endrizzi C, Garibaldi D.Cost-benefit evaluation of homeopathic versus conventional therapy in respiratory diseases.8	A retrospective observational study was conducted on 105 out of 233 patients suffering from chronic respiratory disease.	Homeopathic treatment for respiratory diseases (asthma, allergic complaints, Acute Recurrent Respiratory Infections) was associated with a significant reduction in the use and costs of conventional drugs.	Costs for homeopathic therapy are significantly lower than those for conventional Pharmacological therapy.
Trichard M et al. studied the economic effect of Homeopathy and antibiotic strategies in treatment of rhinopharyngitis in children.9	Prospective, pragmatic study.  Medical effectiveness was assessed in terms of(i) episodes of acute rhinopharyngitis,(ii) complicationsiii) adverse effects. Quality of life was assessed using the Par-Ent-Qol scale. Direct medical costs (medical consultations, drug prescriptions, prescriptions for further tests) and indirect medical costs (sick-leave) were evaluated from three viewpoints (society, patient, Social Security) using public prices and French Social Security tariffs.	The ‘homeopathic strategy’ yielded significantly better results than the ‘antibiotic strategy’ in terms of medical effectiveness	Homeopathy may be a cost-effective alternative to antibiotics in the treatment of recurrent infantile rhinopharyngitis.
David Riley. Homeopathy and Conventional Medicine: An Outcomes Study Comparing Effectiveness in a Primary Care Setting,10	An international multicenter, prospective, observational study in a real world medical setting comparing the effectiveness of homeopathy with conventional medicine.	The adverse events for those treated with conventional medicine was 22.3% versus 7.8% for those treated with homeopathy. Seventy-nine percent (79.0%) of patients treated with homeopathy were very satisfied and 65.1% of patients treated with conventional medicine were very satisfied.	Homeopathy appeared to be at least as effective as conventional medical care in the treatment of patients with the three conditions studied.

Positive studies in Upper Respiratory illnesses

Title of study	Type of study	Results	Conclusion
Max Haidvogl et al. Homeopathic and conventional treatment for acute respiratory and ear complaints: A comparative study on outcome in the primary care setting.11	International, multi-centre, comparative cohort study of non-randomised design. The majority of patients in both groups reported their outcome after 14 days of treatment as complete recovery or major improvement.	However, onset of improvement within the first 7 days after treatment was significantly faster upon homeopathic treatment both in children (p = 0.0488) and adults (p = 0.0001).	In primary care, homeopathic treatment for acute respiratory and ear complaints was not inferior to conventional treatment.
Nita M. Ramchandani.Homeopathic treatment of upper respiratory tract infections in children: Evaluation of thirty case series.12	The number of attacks of the URTIs during the 6 months period preceding the date of commencement of the homeopathic treatment (Control value) and 6 months period following the date of commencement of treatment (Treatment value) were compared.	The results of the study indicated statistically significant differences (p < 0.001%, t-test and Wilcoxon non-parametric test) in the two data sets in favour of homeopathic treated cases.	The results of the study indicate the utility of the homeopathic remedies prescribed based on the concept of individualization in the treatment of URTIs in children vis-à-vis improving the prescribing skills particularly with respect to the process of selection and types of medicines.
Aslak Steinbeck et al. Homeopathic care for the prevention of upper respiratory tract infections in children: A pragmatic, randomised, controlled trial comparing individualized homeopathic care and waiting-list controls.13	Open, pragmatic, randomised parallel-group trial with waiting-list group as control.	There was a significant difference in median total symptom score in favour of homeopathic care (24 points) compared to the control group (44 points) (p = 0.026).	In this study, there was a clinically relevant effect of individualized homeopathic care in the prevention of URTI in children.
A.K.Vichitra et al. Bronchial Asthma14	It was a multi-centric, observational, prospective study (Open clinical trial) carried out during the period 1978 – 2003.	Out of 2107 patients followed up, 52 patients were cured and 1822 patients improved in varying degrees: marked improvement in 856 patients, moderate improvement in 444 patients and mild improvement in 522 patients.	The outcome of the study shows that homeopathic medicines have a role in managing acute attacks of bronchial asthma as well as in controlling recurrent attacks.
Chaturbhuja Nayak et al. A multi-centric open clinical trial to evaluate the usefulness of 13 predefined homeopathic medicines in the management of acute rhinitis in children.Int J High Dilution Res 2010; 9(30): 15-27 16.15	In this multi-centric open clinical trial, a total of 784 children (408 males; 384 females) aged 6 months to 15 years; presenting symptoms of acute rhinitis were enrolled. Symptoms were assessed using an acute rhinitis symptom score (ARSS).	Out of 784 children enrolled, 638 children were followed up and analyzed. A significant change in the score from the baseline (p<0.05) was observed.	This study indicates the usefulness of homeopathic medicines in the management of acute rhinitis of children; controlled studies are needed to investigate their efficacy and effectiveness.

Negative studies in Respiratory illnesses

Some of the studies do not show significant improvement after homeopathic medication.  One of the studies described below shows failure due to flaws in its methodology.

Title of study	Type of study	Results	Conclusion
E S M de Lange de Klerk. Effect of homeopathic medicines on daily burden of symptoms in children with recurrent upper respiratory tract infections.16	Randomised double blind placebo controlled Study. Mean score for daily symptoms, number of antibiotic courses, and number of adenoidectomies and tonsillectomies over one year of follow up.	In both groups the use of antibiotics was greatly reduced compared with that in the year before entering the trial.	Individually prescribed homeopathic medicines seem to add little to careful counseling of children with recurrent upper respiratory tract infection in reducing the daily burden of symptoms, use of antibiotics, and need for adenoidectomy and tonsillectomy.
E.A. Thompson. The feasibility of a pragmatic randomised controlled trial to compare usual care with usual care plus individualized homeopathy, in children requiring secondary care for asthma. Homeopathy, July 2011, Volume 100, Issue 3, 122–130.17	In a pragmatic parallel group randomised controlled trial (RCT) design. Outcome measures included the Juniper Asthma Control Questionnaire, Quality of Life Questionnaire and a resource use questionnaire.	Evidence in favour of adjunctive homeopathic treatment was lacking.	A future study using this design is not feasible, further investigation of a potential role for homeopathy in asthma management might be better conducted in primary care with children with less severe asthma.

DIARRHOEA IN CHILDREN

Diarrhoea is one of the most frequently encountered problems in paediatric age group. The severity of diarrhoea infection varies from patient to patient and from few loose stools with discomfort to severe dehydration. Meta analysis by Jennifer Jacob et al on Diarrhoea RCTs reflects efficacy of homoeopathic medicines in decreasing duration of diarrhoea. Following studies show the utility of homoeopathic medicine in diarrhoea.

Title of study	Type of study	Results	Conclusion
C. Nayak et al. A Prospective Multicentre Observational Study to Determine the Usefulness of Predefined Homoeopathic Medicines in the Management of Acute Diarrheal Disease in Children. HOMOEOPATHIC LINKS – Spring 2010, Vol 23: pg. 60-63.18	A prospective, multi-centre observational study.A total of three hundred twenty seven children in the age-group 6 months to 12 years were included. Diarrhea index score was assessed before and after treatment.	The difference in the mean number of stools and diarrhea index score was found to be statistically significant (p=0.000, <0.05) after the prescription of trial homoeopathic medicines in 321 children.	This was an observational study with positive results leads to further validation by suitable Randomized Control Trial(s).
Manoj Patel et al. An approach to acute diarrhea disorders through sector and Constitutional homoeopathic treatment in adivasi children attending Balwadis in palghar & vikramgarh taluka, thane district, Maharashtra. Indian Journal of Research in Homoeopathy, Vol. 4, No.4, October-December 2010.19	Randomised case control single blind trial.Three group Acute medicine Group, Acute followed by constitutional group & placebo group. 3 years of follow up study.	Acute medicine has definite role in altering course of diarrhoea and in group which followed by constitutional medicine shown significant impact in bringing down the frequency, duration & intensity of diarrhoea.	Definite management strategy in acute diarrhoea.
Jacobs J et al. Homeopathic treatment of acute childhood diarrhea: results from a clinical trial in Nepal. Altern Complement Medorrhinum 2000 Apr;6(2):131-9.20	Randomized, double-blind, placebo-controlled trial.Children received either an individualized homeopathic medicine or   placebo, to be taken one dose after each unformed stool for 5 days.	Of the 126 children initially enrolled, 116 completed treatment. The mean number of stools per day over the entire 5-day treatment period was 3.2 for the treatment group and 4.5 for the placebo group (P = 0.023).	These results are consistent with the finding from the previous study that individualized homeopathic treatment decreases the duration ofdiarrhea and number of stools in children with acute childhood diarrhea.
Jacobs J et al. Treatment of acute childhood diarrhea with homeopathic medicine: a randomizedclinical trial in Nicaragua. Pediatrics. 1994 May;93 (5):719-25.21	A randomized double-blind clinical trial comparing homeopathicMedicine with placebo.	The treatment group had a statistically significant (P < .05) decrease in duration of diarrhea, defined as the number of days until there were less thanthree unformed stools daily for 2 consecutive days. There was also a significant  difference (P < .05) in the number of stools per day between the two groups after72 hours of treatment.	The statistically significant decrease in the duration of diarrheain the treatment group suggests that homeopathic treatment might be useful inacute childhood diarrhea.
J. Jacobs et al. Homeopathy for Childhood Diarrhea: Combined Results and Meta-analysis from Three Randomized, Controlled Clinical Trials.22	Three double blind clinical trials of diarrhea in 242 children ages 6 months to 5 years were analyzed as 1 group. Children were randomized to receive either an individualized homeopathic medicine or placebo to be taken as a single dose after each unformed stool for 5 days	Combined analysis shows a duration of diarrhea of 3.3 days in the homeopathy group compared with 4.1 in the placebo group (P = 0.008).	The results from these studies confirm that individualized homeopathic treatment decreases the duration of acute childhood diarrhea and suggest that larger sample sizes be used in future homeopathic research to ensure adequate statistical power.
Trial with Homoeopathic Combination medicine &Non significant results
Jacobs J et al.Homeopathic combination remedy in the treatment of acute childhood diarrhea in Honduras.23	A double-blind randomized controlled trial. A total of 292 children with acute diarrhea was recruited; 145 were randomized to the experimental group and 147 to the placebo group. There was no significant difference in the likelihood of resolution of diarrheal symptoms between the treatment and placebo groups. Children in the treatment group had an average of 2.6 unformed stools per day compared to 2.8 among those in the placebo group; this difference was not significant (p = 0.43).		The homeopathic combination therapy tested in this study did not significantly reduce the duration or severity of acute diarrhea in HonduranChildren.

SKIN DISORDERS IN CHILDREN

Recently there has been a constant increase in the number of cases of allergy, particularly in developed countries, to such an extent that expressions like “disease of the third millennium” and “allergic epidemic” have been used to describe the phenomenon. There has been an increase in the use of ‘complementary’ or ‘alternative’ medicine in patients affected by skin disease, in particular those with chronic or inflammatory dermatosis. The prevalent use of complementary and alternative medicine (CAM) in children has been estimated to be higher than 40% in the USA and it has been reported recently that in the Tuscany Region of Italy more than 25% of children use CAM, and 23.4% of these consume homeopathic products. The following data suggests the utility of homoeopathy in skin diseases for children.

Title of study	Type of study	Results	Conclusion
Elio Rossi et al. Homeopathy in paediatric atopic diseases: long-term results in children with atopic dermatitis.24	Data derive from an observational longitudinal study carried out on 213 children (38.6%) with atopic diseases out of 551 children consecutively examined from September 1998 to December 2008. We used the Glasgow Homeopathic Hospital Outcome Score to evaluate the results that were classified on the basis of a Likert scale.	The parents of paediatric patients suffering from AD, who had started homeopathic treatment at <4.9years of age were invited to follow-up assessment 8years later and 40 children (mean age 12.9) were examined; 28/40 (70%) had a complete disappearance of AD, 12/40 children (30.0%) were still affected by AD; 8/40 (20%) had asthma and 8/40 patients had, or developed, allergic rhinitis.	These preliminary results seem to confirm a positive therapeutic effect of homeopathy in atopic children. Furthermore, according to the data from the literature paediatric patients treated with homeopathy seem to show a reduced tendency to maintain AD and develop asthma (and allergic rhinitis) in adult age.
Comparative trials (Homoeopathy vs Conventional) on atopic dermatitis
Witt CM. Homeopathic versus conventional therapy for atopic eczema in children: medical and economic results.25	In a prospective multicentre comparative observational non-randomised study, 135 children (homeopathy n = 48 vs. conventional n = 87) with mild to moderate atopic eczema were included. The primary outcome was the SCORAD (Scoring Atopic Dermatitis) at 6 months. The adjusted SCORAD showed no significant differences between the groups at both 6 months & 12 months. Adjusted costs were higher in the homoeopathic than in the conventional group. Quality of life was not	Significantly different between both groups.	Homeopathy & conventional treatment are equally effective.
Keil T.Homoeopathic versus conventional treatment of children with eczema: a comparativeCohort study.26	Prospective multi-centre cohort study. Patients (or parents) assessed eczema symptoms by numericalrating scales as well as disease-specific Atopic Lebensqualitaets-Fragebogen (ALF) and general quality of life (KINDL, KITA) at 0, 6 and 12 months.	Eczema symptoms (assessed by patients or theirparents) improved from 0 to 12 months for both treatment options, Disease-related quality of life improved in both groups similarly.	Over a period of 12 months, both therapy groups improved similarlyregarding perception of eczema symptoms (assessed by patients or parents) andDisease-related quality of life.
Scabies
Chandrasekhar Goda et al. Role of homeopathic constitutional treatment in scabies infection in adivasi children attending ashram shalas (resident school) in palghar & vikramgarh taluka, thane district, Maharashtra.27	Prospective randomised controlled trial.Three groups were made; Constitutional, Acute totality & Placebo, followed for three years.Results analysed at end of each year.	At end of First Year=Constitutional G= 90% improvement, Acute G=27%, Placebo G= 4%Second year:Constitutional G= 98% improvement, Acute G=48%, Placebo G= 12%.Improvement in constitutional group was significant & prevalence of scabies in school dropped from 52% to 17% when prevalence in other schools is not changed.	This study shows the importance of constitutional treatment in cure and control of scabies & its utility in communicable diseases.

PSYCHIATRIC DISORDERS

ADHD, Autism, Mental retardation are common causes of consultation for homoeopaths, since our system deals with both mental and physical symptoms of children. Webster’s Universal Dictionary defines temperament as “a characteristic combination of bodily, mental, and moral qualities, which together constitute the character and disposition of an individual and predispose him to act and behave in a particular manner”. Every child though not diseased has certain traits / temperaments, which may not be suited to their growth. Each child develops certain behaviors or habits, which are quite often out of proportion. For example, some of the children want to cling to the mother strongly while sleeping and without the mother they can’t sleep. Some children in anger break things and hit others, while some are so shy that they hide or run away the moment they see any stranger or guest.

These behaviors do not show any obvious signs of illness, but are indications, which point to their inner disturbances. Every Homoeopath tries to understand these inner disturbances, through various clues,  such as fears, dreams, fantasies, preferred movies and cartoons, their reaction to illness etc. By understanding all this and subsequently treating them, it not only frees the child of his disease and enhances his immunity, but it improves the child’s attitude towards life. It channels the child’s energy in a proper direction, so he can explore his potential and creativity to the maximum.

Some studies are available which show the utility of homoeopathy in this field of psychiatric illness in children.

Title of study	Type of study	Results	Conclusion
Frei H et al. Homeopathic treatment of children with attention deficit hyperactivity disorder:a randomised, double blind, placebo controlled crossover trial.28	The aim of thisstudy was to obtain scientific evidence of the effectiveness of homeopathy inADHD.	During the crossover trial, CGI parent-ratings were significantly lower under verum (average 1.67 points) than under placebo (P =0.0479). Long-term CGI improvement reached 12 points (63%, P<0.0001).	The trial suggests scientific evidence of the effectiveness of homeopathy in the treatment of attention deficit hyperactivity disorder, particularly in the areas of behavioral and cognitive functions.
Homeopathic treatments in psychiatry: a systematic review of randomized placebo-controlled studies.29	To systematically review placebo-controlled randomized trials of homeopathy for psychiatric conditions.	Twenty-five eligible studies were identified from an initial pool of 1,431. Study quality according to SIGN 50 criteria varied, with 6 assessed as good, 9 as fair, and 10 as poor. Outcome was unrelated to SIGN quality.	The database on studies of homeopathy and placebo in psychiatry is very limited, but results do not preclude the possibility of some benefit. Meaningful safety data were lacking in the reports, but the superficial findings suggested good tolerability of homeopathy.
B Indira et al.Behavioural Problems of Mentally Challenged Children.30	Study were to identify a group of most useful homoeopathic medicines in the treatment of behavioral problems found in mentally challenged children and to identify their reliable indications, most useful potencies, frequency of administration and relationship with other medicines.	Eight hundred and thirty five (835) children were followed up, out of which 531 children showed improvement in common behavioral problems of mentally challenged children like aggressiveness, destructiveness, disruptiveness etc., whereas 304 children did not improve.	Most useful medicine were Belladonna, Baryta carb, Baryta mur etc.
Dolce Filho R. Homeopathic approach in the treatment of patients with mental disability. 31	The author describes his experience assisting mentally disabled patients with homeopathy. In these patients’ anamneses, common traits shared by some syndromes,pathologies and behavior, were taken into consideration, mainly to choose the most characteristic symptoms in each case.	The study includes 58 cases of Patients suffering from this pathology: 28 females and 30 males, ages ranging from 1 to 49 years (mean 20).Forty-seven had some improvement.	Homeopathy is aUseful alternative to relieve pathologies associated with mental disability.

CONCLUSION

After going through the research literature, it is apparent that there is genuine need of more research in pediatric disorders for the progress of our profession. In clinics we are seeing results, but they are not getting documented due to lack of orientation in research publication or documentation.

            This article is an effort to create awareness among professionals about homeopathy studies in pediatrics. Hopefully, this will lead to more acceptance of homeopathy.

References:

1. Barry C. The body, Health and Healing in Alternative and integrated Medicine: An Ethnography of Homoeopathy in South London. Brunel University; 2003.

2. Steinsbekk A, Brentzen N, Brien S: Why do parents take their children to a homeopath?  Forchende Komplementarmedizin 2006, 13:88-93.

3. Thompson EA, Bishop JL, Northstone K. The use of homeopathic products in childhood: data generated over 8.5 years from the Avon Longitudinal Study of Parents and Children (ALSPAC).J Altern Complement Medorrhinum 2010 Jan; 16(1):69-79.

4. Spence DS, Thompson EA, Barron SJ. Homeopathic Treatment for Chronic Disease: A 6-Year, University-Hospital Outpatient Observational Study. The Journal of Alternative and Complementary Medicine. Volume 11, Number 5, 2005, pp. 793-798. 

5. Witt CM, Luedtke R, Baur R, Willich SN. Homeopathic Medical Practice: Long-term results of  a Cohort Study with 3981 Patients. BMC Public Health 2005, 5:115.

6. Güthlin C, Lange O and Walach H. Measuring the effects of acupuncture and homoeopathy in general practice: An uncontrolled prospective documentation approach. . BMC Public Health 2004, 4:6.

7. Du Y, Knopf H. Paediatric homoeopathy in Germany: results of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS). Pharmacoepidemiol Drug Saf. 2009 May; 18(5):370-9.

 8. Rossi E, Crudeli L, Endrizzi C, Garibaldi D.Cost-benefit evaluation of homeopathic versus  conventional therapy in respiratory diseases. Homeopathy. 2009 Jan; 98(1):2-10

9. Trichard M, Chaufferin G, Nicoloyannis N. Pharmacoeconomic comparison between homeopathic and antibiotic treatment strategies in recurrent acute rhinopharyngitis in children. Homeopathy 2005 Jan; 94(1):3-9.

10. David Riley. Homeopathy and Conventional Medicine: An Outcomes Study Comparing Effectiveness in a Primary Care Setting, The Journal Of Alternative And Complementary Medicine Volume 7, Number 2, 2001, pp. 149–159.

11. Max Haidvogl et al. Homeopathic and conventional treatment for acute respiratory and ear complaints: A comparative study on outcome in the primary care setting. BMC Complementary and Alternative Medicine 2007, 7:7doi:10.1186/1472-6882-7-7)

12. Nita M. Ramchandani. Homeopathic treatment of upper respiratory tract infections in children: Evaluation of thirty case series, Complementary Therapies in Clinical Practice, Volume 16, Issue 2, May 2010, Pages 101-108.

13. Aslak Steinbeck et al.Homeopathic care for the prevention of upper respiratory tract infections in children: A pragmatic, randomised, controlled trial comparing individualized homeopathic care and waiting-list controls. Complementary Therapies in Medicine Volume 13, Issue 4 , Pages 231-238, December 2005.

14.  A.K.Vichitra et al. Bronchial Asthma. Clinical Research Studies | Series 1 | 2008 | Pg 27-40.

15. Chaturbhuja Nayak et al. A multi-centric open clinical trial to evaluate the usefulness of 13 predefined homeopathic medicines in the management of acute rhinitis in children. Int J High Dilution Res 2010; 9(30): 15-27 16.

16. E S M de Lange de Klerk. Effect of homoeopathic medicines on daily burden of symptoms in   Children with recurrent upper respiratory tract infections. BMJ 1994;309:1329-32

17. E.A. Thompson. The feasibility of a pragmatic randomised controlled trial to compare usual care with usual care plus individualized homeopathy, in children requiring secondary care for asthma. Homeopathy, July 2011, Volume 100, Issue 3, 122–130.

18. C.Nayak et al. A Prospective Multicentre Observational Study to Determine the Usefulness of Predefined Homoeopathic Medicines in the Management of Acute Diarrheal Disease in Children. Homoeopathic Links – Spring 2010, Vol 23: pg. 60-63

19. Manoj Patel et al. An approach to acute diarrhea disorders through sector and Constitutional homoeopathic treatment in adivasi children attending Balwadis in palghar & vikramgarh taluka, thane district, Maharashtra. Indian Journal of Research in Homoeopathy, Vol. 4, No.4, October-December 2010.

20. Jacobs J et al. Homeopathic treatment of acute childhood diarrhea: results from a clinical trial in Nepal. Altern Complement Medorrhinum 2000 Apr;6(2):131-9.

21. Jacobs J et al.Homeopathic combination remedy in the treatment of acute childhood diarrhea in Honduras. J Altern Complement Medorrhinum 2006 Oct; 12(8):723-32.

22.  Jacobs J et al. Homeopathy for Childhood Diarrhea: Combined Results and Meta-analysis from Three Randomized, Controlled Clinical Trials. Pediatrics. 2003 Mar; 22(3):229-34.²²

23.  Jacobs J et al.Homeopathic combination remedy in the treatment of acute childhood diarrhea in Honduras. J Altern Complement Medorrhinum 2006 Oct; 12(8):723-32.

24. Elio Rossi et al. Homeopathy in paediatric atopic diseases: long-term results in children with atopic dermatitis. Homeopathy, Vol. 101, No1, 2012.

25.  Witt CM. Homoeopathic versus conventional therapy for atopic eczema in children: medical and economic results. Dermatology. 2009; 219(4):329-40. Epub 2009 Oct 13.

26.  Keil T.Homoeopathic versus conventional treatment of children with eczema: a comparative    Cohort study. Complement Ther Medorrhinum 2008 Feb;16(1):15-21. Epub 2006 Dec 27.

27.  Chandrasekhar Goda et al. Role of homoeopathic constitutional treatment in scabies infection in adivasi children attending ashram shalas (resident school) in palghar & vikramgarh taluka, thane  district, Maharashtra. Indian Journal of Research in Homoeopathy, Vol 4, No. 2, April-June 2010.

28.  Frei H et al. Homeopathic treatment of children with attention deficit hyperactivity disorder: a randomised, double blind, placebo controlled crossover trial. Eur J Pediatr. 2005 Dec; 164(12):758-67. Epub 2005 Jul 27.

29. Homeopathic treatments in psych systematic review of randomized placebo-controlled studies. J Clin Psychiatry. 2011, Jun, 72 6 – 795-805.

30.  B Indira et al.Behavioural Problems of Mentally Challenged Children. Clinical Research Studies, Series 1, 2008, Pg 15-26.

31. Dolce Filho R. Homeopathic approach in the treatment of patients with mental disability.  Homeopathy.   2006 Jan; 95 (1):31-44.