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As I approach 30 years in clinical practice, walking into our SSM Health Cardinal Glennon Pediatrics and Integrative Medicine office at SSM Health DePaul Hospital in St. Louis reminds me of the poem I wrote as my mission statement when I was only dreaming of such a possibility.

Holy Encounter:
As I step over the threshold, I ask to be blessed with
    kind usefulness each day.
As I wash my hands, I ask to be mindful and
    motivational each day.
As I brew my morning tea, I ask to be humble and
    receptive each day.
As I take the history, I ask to listen keenly to the
    story each day.
As I recognize the honor, I ask for the courage to be
    connected each day.
As I feel the healing, I ask for the clarity to see the
    wholeness in each day.
As I tend the mind-body-spirit, I ask for surrender
    to the sanctity of each day.
As I nourish and flourish, I offer deep gratitude for
    the privilege of each day.
My presence: holy moment. My journey: holy
    labyrinth.
My office: holy space. My patient: holy encounter.

Sometimes, I pinch myself because 15 years ago, I was in such a different space. I was professionally and personally burned out, disinterested in the revolving sickness door of primary care pediatrics, and exhausted from the merry-go-round of home and work. I had just attended a weekend gathering of integrative healers committed to improving health care for children. In the therapeutic journaling session, we were asked to write about something that had changed who we were professionally and personally. As the room fell silent, I realized that the time had come for me to acknowledge that I was burned out.

AN INTEGRATED PATH TO HEALING
I had lived most of my adult life with chronic disease that had taken its toll on me. It was becoming apparent to me that I was not an effective resource unless I was truly committed to being on the journey to healing myself. Creating tools to build intergenerational resilience in myself, my children, my patients and their caregivers had to become a priority.

In 2011, I answered an email about a fellowship on integrative medicine at the Andrew Weil Center for Integrative Medicine at the University of Arizona. I took a leap of faith and completed the training and board certification in this fledgling specialty.¹ It was a healing-oriented medicine that looked at the whole person/child, teaching appropriate use of both conventional and evidence-informed complementary remedies. I learned about self-care and started to nourish myself and my family through music and art.

The graphic shown below from The National Center for Complementary and Integrative Health of the National Institutes of Health, which researches the use and safety of complementary health approaches, shows how these remedies can be integrated into a whole-person health framework.²

Dr. Kathi Kemper, a respected pioneer in this specialty and professor of pediatrics at The Ohio State University College of Medicine, defines pediatric integrative medicine (PIM) as caring for the whole child in the context of their values, their family's beliefs, their family system and their culture in the larger community. The specialty also considers a range of therapies based on the evidence of their benefits and costs, which aligns with SSM Health's mission and values.

In 2015, Dr. Kemper invited me to be part of the American Academy of Pediatrics (AAP) Section on Integrative Medicine PIM Leadership Summit. The white paper we wrote included compelling data that showed complementary therapies are of great interest to parents and that the use of these therapies in pediatrics is significant. The National Health Interview Survey, conducted by the Centers for Disease Control and Prevention's National Center for Health Statistics in 2012, revealed that 12% of children use complementary therapies chosen by their families, and studies in specific chronically ill populations have reported complementary therapy use in up to 80%.³ More than 1,500 parents solicited through a survey answered questions regarding integrative therapies they'd like to see offered in a pediatric practice and their willingness to advocate for insurance coverage of PIM therapies.

CARDINAL GLENNON'S INTEGRATIVE JOURNEY
In 2019, with the support of leadership at SSM Health Cardinal Glennon Children's Hospital, the PIM office came into being after five years of planning. And, in the last five years, we have had the privilege of being on healing journeys with many courageous families that have children with medically complex illnesses, which has renewed my zest for medicine. Integrative medicine nudged me in a fresh direction and connected me with a vibrant community of healers and teachers, both globally and in my own backyard of St. Louis, who continue to show me how to bring mind-body-spirit medicine into our office and into my home.

In her groundbreaking book The Deepest Well: Healing the Long-Term Effects of Childhood Adversity, Dr. Nadine Burke Harris, founder of the Center for Youth Wellness and former Surgeon General of California, writes: "Sleep, mental health, healthy relationships, exercise, nutrition and mindfulness — we saw in our patients that these six things were critical for healing [of adverse childhood experiences]. ... Fundamentally, they all targeted the underlying biological mechanism — a dysregulated stress-response system and the neurologic, endocrine and immune disruptions that ensued."⁴Integrative medicine is dedicated to looking at the whole person and using the latest science to improve health and well-being.

Integrative medicine nudged me in a fresh direction and connected me with a vibrant community of healers and teachers, both globally and in my own backyard of St. Louis, who continue to show me how to bring mind-body-spirit medicine into our office and into my home.

ONE FAMILY'S JOURNEY
When 6-year-old Maya, whose name has been changed for privacy, and her family arrived at our office, they had seen multiple health care practitioners. They were tired, scared, frustrated and looking for answers. As a trauma-informed office, our first goal is always to make sure that we are creating a safe space where the child and family feel seen, heard and affirmed.⁵

The importance of providing this level of care and attention is especially true for a neurodivergent child such as Maya, who is on the autism spectrum with behavioral, sleep and focus concerns. As family physician and psychiatrist Dr. Lewis Mehl-Madrona says in his beautiful book, Narrative Medicine: The Use of History and Story in the Healing Process, "We need to develop an approach that will allow the patient and his or her family to be active collaborators in the healing process."⁶ So, our next goal was to come up with a therapeutic plan — one that was culturally competent, economically affordable and guided by the family — which included all of pediatric integrative medicine's pillars of health (shown in the graphic below).

Building intergenerational resilience is one of the priorities of PIM, and luckily for us, Maya loved music, art and mindful movement. Research on yoga is expanding at the National Institutes of Health, which currently lists several studies on its benefits.⁷ In 2016, recognizing how important the holistic approach to shifting health care paradigms was, AAP's Section on Integrative Medicine released a clinical policy statement on the use of mind-body therapies in children and youth.⁸ A review on the effectiveness of yoga as a complementary therapy for children and adolescents, which I was asked to co-author, was included in the statement.⁹ This inspired me to complete yoga teacher training for kids through the YoYo Yoga School in St Louis.

The practice of yoga has been shown to decrease stress via downregulation of the sympathetic nervous system, the fight or flight response. I enjoyed bringing some of these tools into our office for Maya's treatment plan, including using our breath to hum and buzz like bees as we did our mindful yoga poses of a tree, a mountain and a butterfly.

The benefits of sound and music examined in a scoping review show a range of their effects on the neuro-immune-endocrine systems.¹⁰ In ancient cultures, the use of sound for healing was a highly developed sacred science. In 2018, a pilot study conducted at our SSM Health Cardinal Glennon Pediatric Primary Care Clinic at SSM Health DePaul Hospital was funded and published through the AAP's Section on Integrative Medicine, demonstrating calming brain wave patterns in 25 parent-child volunteers — including improved sleep — who listened to healing harp music.^{11, 12} Music therapy became part of Maya's bedtime routine, in addition to soothing guided imagery routines practiced with her parents.

Once we gained the trust of Maya and her parents, we moved on to discuss incorporating an anti-inflammatory diet into the family's shopping and cooking schedule and adding high-quality supplements and botanicals to support deficiencies we found in her lab work.¹³ In the integrative psychiatry fellowship I completed in 2020, we were taught about the emerging field of nutritional psychiatry, which uses nutrition to optimize brain health and treat and prevent mental health disorders.¹⁴ As noted in an EBioMedicine article, using food as medicine points to the "immune system, oxidative biology, brain plasticity and the microbiome-gut-brain axis as key targets for nutritional interventions."¹⁵

INTEGRATIVE MEDICINE FOR CLINICIANS
It is encouraging for me to see, as someone who has found her way back from it, that burnout prevention is being given priority. The Missouri Chapter of the AAP collaborated with the Missouri Child Psychiatry Access Project¹⁶ and the Missouri Department of Conservation to host a physician wellness retreat in September, where I spoke on the anti-inflammatory diet and how to incorporate it into our homes and offices.

The Care for the Caregiver program at SSM Health Cardinal Glennon Children's Hospital, through the generosity of the SSM Health Cardinal Glennon Children's Foundation, facilitates weekly sessions for all the hospital's care team members that include meditation, breath work, yoga, pet therapy, art therapy, massage and more. I was grateful to be invited to share a virtual sound healing meditation at one of the sessions this past fall with my Tibetan bowls. The baby steps we suggest to our patients and their families for lifestyle modification become important stepping-stones for our own healing journeys so that we can all find what brings pleasure and fulfillment in our lives.

Dr. Andrew Weil, a world-renowned leader and pioneer in the field of integrative medicine, emphasizes that good medicine should be based on good science, be inquiry-driven and open to new paradigms where one should use natural, effective, less-invasive interventions whenever possible.¹⁷ Maya had been showing steady improvement in all her symptoms as we addressed her sleep, diet, relationships and physical environment. She was back in school and getting the full benefit of all her therapies while the burden of worry on her parents had lifted considerably. Our wonderful PIM team makes these success stories possible.

Dr. Weil also discusses how important it is to train the next generation of practitioners to be models of health and healing, committed to the process of self-exploration and self-development. The Academic Consortium for Integrative Medicine & Health includes more than 75 academic medical centers, nursing schools and health systems that advance integrative health care education, research and clinical care.¹⁸ The SSM Health Cardinal Glennon Children's Foundation sponsored a grant in 2014 that supported our SSM Health Cardinal Glennon Pediatric Primary Care at SSM Health DePaul Hospital in offering an elective accredited by the Accreditation Council for Graduate Medical Education in integrative medicine for third-year Saint Louis University pediatric residents as part of the Pediatric Integrative Medicine in Residency pilot.¹⁹

When the Integrative Medicine for the Underserved policy committee went to Capitol Hill in 2018 to attend a bipartisan congressional caucus on integrative approaches to address the chronic pain epidemic, I went with them and saw firsthand how sharing information on rigorous scientific research and sustainable models of clinical care can inform current health care policy.²⁰ I am honored to be a clinical mentor for pediatricians who are currently doing their fellowship training in integrative medicine at the Andrew Weil Center for Integrative Medicine and giving back to the program that started my own journey to better health.

THE ART OF CONTINUING TO LEARN
As we enter the new year, it will be 25 years for me with the mission of SSM Health, and I look forward to the next five-year plan of expanding our integrative medicine services to continue to provide equitable, affordable, accessible and holistic pediatric care to all children regardless of their social determinants of health. I continue to research how music, mindfulness and art can rebuild and rewire brains and hearts, and I look forward to going to work each day.

Many of us get defined by the diseases we are told that we have. I was labeled with so many, and I thought I would have to coexist with them for the rest of my life. Painting "I Am" affirmations became a joyful way to connect with my two beautiful daughters and my own inner child. The affirming art that I created to bring me back from the brink of burnout is now hanging in the waiting room and exam rooms of our SSM Health Cardinal Glennon PIM office.

Maya was inspired by my "I Am Centered" artwork hanging in one of our exam rooms and gifted me with her interpretation of it, which sits proudly on my desk at work. I have come full circle, helping children and families access their innate self-regulatory systems as I continue to learn how to access mine.

DR. ANU FRENCH is an integrative pediatrician with SSM Health Cardinal Glennon Pediatrics and Integrative Medicine in St. Louis and is also an artist, musician and author.

NOTES

1. "Andrew Weil Center for Integrative Medicine," The University of Arizona, https://awcim.arizona.edu.
2. "What Does NCCIH Do?," National Center for Complementary and Integrative Health — National Institutes of Health, https://www.nccih.nih.gov.
3. Lindsey Black et al., "Use of Complementary Health Approaches Among Children Aged 4–17 Years in the United States: National Health Interview Survey, 2007–2012," National Health Statistic Report 10, no. 78 (February 2015): 1-19; Anna Esparham et al., "Pediatric Integrative Medicine: Vision for the Future," Children 5, no. 8 (August 2018): https://doi.org/10.3390/children5080111.
4. Dr. Nadine Burke Harris, The Deepest Well: Healing the Long-Term Effects of Childhood Adversity (Mariner Books, 2018).
5. "Professional Tools and Resources for Trauma-Informed Care," American Academy of Pediatrics, https://www.aap.org/en/patient-care/trauma-informed-care/professional-tools-resources.
6. Dr. Lewis Mehl-Madrona, Narrative Medicine: The Use of History and Story in the Healing Process (Bear & Company, 2007).
7. "Yoga: Effectiveness and Safety," National Center for Complementary and Integrative Health — National Institutes of Health, August 2023, https://www.nccih.nih.gov/health/yoga-effectiveness-and-safety.
8. Section on Integrative Medicine, "Mind-Body Therapies in Children and Youth," Pediatrics 138, No. 3 (2016): https://doi.org/10.1542/peds.2016-1896.
9. Dr. Lawrence Rosen, Dr. Anu French, and Grace Sullivan, "Complementary, Holistic, and Integrative Medicine: Yoga," Pediatrics in Review 36, No. 10 (2015): https://doi.org/10.1542/pir.36-10-468.
10. Genevieve A. Dingle et al., "How Do Music Activities Affect Health and Well-Being? A Scoping Review of Studies Examining Psychosocial Mechanisms," Frontiers in Psychology 12 (September 8, 2021): https://doi.org/10.3389/fpsyg.2021.713818.
11. Dr. Anu French and Kristy Shaughnessy, "Testing the Impact of the 'The Magic Mirror' Harp Music as a Cost-Effective Biofeedback/Neurofeedback Tool to Relieve Stress, Build Intergenerational Resilience and Teach Self-Regulation," Pediatrics 144, No. 2 (August 2019): https://doi.org/10.1542/peds.144.2MA6.530.
12. "Pediatric Pilot Study: Presentation at the American Academy of Pediatrics National Conference," Amy Camie: The Healing Harpist, https://www.amycamie.com/pediatricpilotstudy.html.
13. "Dr. Weil's Anti-Inflammatory Diet," Dr. Weil, https://www.drweil.com/diet-nutrition/anti-inflammatory-diet-pyramid/dr-weils-anti-inflammatory-diet/.
14. Dr. Drew Ramsey, "What is Nutritional Psychiatry?," Drew Ramsey, MD, July 7, 2022, https://drewramseymd.com/brain-food-nutrition/what-is-nutritional-psychiatry/.
15. Felice N. Jacka, "Nutritional Psychiatry: Where to Next?," EBioMedicine 17 (March 2017): http://dx.doi.org/10.1016/j.ebiom.2017.02.020.
16. "Missouri Child Psychiatry Access Project (MO-CPAP)," University of Missouri School of Medicine, https://medicine.missouri.edu/departments/psychiatry/research/missouri-child-psychiatry-access-project.
17. "Meet Dr. Weil," Dr. Weil, https://www.drweil.com/health-wellness/balanced-living/meet-dr-weil/.
18. "Academic Consortium for Integrative Medicine & Health," https://imconsortium.org.
19. "Integrative Medicine in Residency," Andrew Weil Center for Integrative Medicine at the University of Arizona, https://awcim.arizona.edu/education/imr.html.
20. "IM4US: Integrative Medicine for the Underserved," https://im4us.org.