Adverse event monitoring, assessment, and reporting in nutraceutical and phytoceutical trials for pediatric neuropsychiatric conditions: A systematic review.

Background: Natural treatments may be used as an alternative or adjunct treatment for childhood neuropsychiatric disorders. Knowledge of benefits and harms is needed to inform use guidelines. We aimed to systematically identify how and which adverse events are monitored, assessed, and reported in pediatric trials that tested nutraceutical and phytoceutical treatments.

Methods: We searched MEDLINE, Embase, PsycINFO, ProQuest Dissertations and Theses Global, Cochrane Library, and Google Scholar from 2012 to 2024. Eligible studies included nutraceutical and phytoceutical trials, experimental or quasi-experimental in design, involving children or adolescents (age 4-19 years) with neuropsychiatric conditions.

Results: Ninety-eight trials were included with 75 reported as completed (77%). The most common natural treatment tested was polyunsaturated fatty acids (36%, 35/98). Most trials focused on treating attention-deficit/hyperactivity disorder (59%, 58/98) or autism spectrum disorder (21%, 21/98). Investigators from 74/98 trials (76%) reported methods that indicated adverse event monitoring. For these trials, events defined a priori for monitoring were identified in 43% (32/74), methods for collecting and recording events were described in 68% (50/74), and assessment of event severity and attribution was described in 49% (36/74) and 26% (19/74), respectively. Over 100 different adverse events were reported across completed trials. The most common events reported were gastrointestinal distress (65%, 49/75) and headache (33%, 25/75).

Conclusions: We found variability in monitoring, assessing, and reporting adverse events in pediatric trials of natural treatments. The adverse events identified in this review reinforces that specific events should be prospectively monitored in future trials.