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A relational database was constructed from enrollment, claims, and pharmacy files received from each insurance company.

Data included unique enrollee identification codes, birth year, sex, residence ZIP code, product type, contract number, Employee Retirement Income Security Act status, month of active enrollment, Aclaim number, service date, service location, International Classification of Diseases, Ninth Revision (ICD-9) codes.

Data were included for all individuals enrolled in health insurance plans covered by Washington’s Every Category of Provider requirement.

This excludes Medicare, Medicaid, state supplemental programs, federal employees insurance, and self-insured plans that are exempt from state regulation under the Employee Retirement Income Security Act.

Surveys have described differing rates of pediatric CAM use, in part due to differing definitions of CAM found that among a sample of children with cancer in Washington state, 73% used at least 1 form of alternative treatment or therapy and that 21.3% used the services of alternative professionals, including chiropractors, acupuncturists, massage therapists, naturopathic physicians (NDs), and nonlicensed alternative professionals.

Surveys of pediatric health services use are a challenge to conduct.

Visits to chiropractors or massage therapists nearly always yielded diagnoses of musculoskeletal conditions.

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Both χOf 187 323 children covered by 2 large insurance companies, 156 689 (83.6%) had any claims during the year.

From our enrollment data, we generated variables for age and county of residence.

Age was calculated as the difference between birth year and study year.

Although use of chiropractic and massage was almost always for musculoskeletal complaints, acupuncture and naturopathic medicine filled a broader role.

Little is known about the role professionals in complementary and alternative medicine (CAM) play in pediatric primary care.

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