Five Things Your Pediatrician Doesn’t Know About Nutrition
Has your pediatrician helped you tap nutrition solutions to these common problems? Take this check list with you to your appointment. There are straight forward, nutrition-focused solutions to all of the problems on this list. These have potential to help your kids avoid dependence on unnecessary medications, costly weekly therapies, or ongoing visits to behavior clinics. Simple measures may resolve these without spending weeks feeling frustrated and exhausted with measures that didn’t work. If your pediatrician is stumped about how to use real food and nutrition tools, peruse my blog, books, and join my mailing list here for my (roughly) quarterly newsletter. I also regularly share pearls (and recipes!) on my FB and IG pages too.
1 – Diarrhea is not a developmental phase
How often have I heard, “my doctor said it’s ‘toddler diarrhea'” or “Clostridia difficile is common in kids, it doesn’t need treatment” or “it’s okay because my kid is still growing” or “it’s because he has FPIES“. Yes, infants and toddlers have varying stool patterns, but there is usually a reason for it that can be fixed. And it should be, because chronic diarrhea robs your child’s brain and body of critical nutrition. Teething, fevers, and stomach bugs can disrupt potty pattern for sure, but the operative word here is transient. Funky poop should resolve back to a comfortable pattern within a few days or a two weeks at most. Expect a baseline pattern of formed (not hard, not dry) stools every day that are easy to pass. Ongoing loose, explosive, mucousy, irritable, burning, or foul stool is not healthy, normal, or necessary to put up with. It is a sign that something is awry – food intolerances or allergies, background infections, reflux, or weak nutrition status to name a few. It can also make it harder for kids to potty train, when they never know what’s coming!
The other clear sign for good digestion and nutrient absorption in kids is steady growth pattern, with no flattening trend for weight, height, or body mass index. Daily eliminations that are soft formed (or soft gold mush for breast fed babies) are a sign that your child is digesting and absorbing his food well (in ancient Ayurvedic medical traditions, anything less than a soft formed elimination after each meal is considered constipation!).
Kids who have chronic diarrhea also often exhibit what can be misconstrued (and fruitlessly treated) as behavior or psychiatric problems like anxiety, irritability, low motivation (fatigue), bad sleep patterns, or inattention. What I so often find is that once digestion and stool pattern are supported, these problems fade too, as kids absorb nutrients and energy more reliably. Who wouldn’t feel better?
Long short – if you have a cranky little who can’t sleep well and who has a lot of loose messy stools, investigate. Don’t mask symptoms with long term drug dependence – fix the underlying problem. Your child’s gut health can likely improve with non-drug, nutrition-focused measures… even with conditions like FPIES. And if your school aged child is struggling with chronic loose stools, fatigue, and poor energy, expect it to be better. If your pediatrician can’t help, and a gastroenterology referral was a dead end too, consider integrative nutrition. My practice is generally full, but if you’d like to check if there is an opening with me contact me here.
2 – Kids don’t have to get sick all the time, and nutrition determines this
Did you know? Nutrition status is the single most critical factor (of the “greatest public health importance“) to influence whether kids get sick, how often, for how long, and whether or not they have complications with illnesses or infections.
The truth is, when kids have infections or serious illnesses, well nourished kids fare far better. Long ago, data showed us that well nourished kids are far more likely to have fewer complications, a shorter course of illness, and make a full recovery. For over seventy years, data have piled up to show what a huge impact nutrition has on the immune system, from several angles – from a child’s tissue stores of vitamin A, to total protein intake, growth status, weight percentile, iron or zinc status, inflammatory chemistry, and more. The blind spot in pediatrics today is that nutrition status is not investigated or assessed at routine visits, or even in most specialist referrals. Kids can appear well enough, but be depleted on many counts (hello! Picky eaters especially!). This means a child will get sick more often, stay sick longer, and become more vulnerable to the next infection with every cold or cough that comes along.
You can help your kids stay well even as they are surrounded by sniffles and coughs at daycare or school, by setting them up with tip top gut health and food. Judicious use of supplements, probiotics, and herbs can work wonders too – especially when these are tailored to your child – skip the one-size-fits-all approach. Music to my ears: When parents whom I’ve worked with tell me, “We didn’t have any colds this whole winter!” It happens.
So what is nutrition status? It isn’t what supplements you’re eating, whether you’re vegan or Paleo, or even what food you give your kids. It’s a number of measurable things to assess how healthy a child really is. These are not typically included in a standard well check or school physical, but some may be added on if you ask your doctor. Strong nutrition status means…
- There is a solid growth pattern in your child’s expected channels for weight, height, and body mass index. Look at your child’s growth charts. Whether it’s weight for age, stature (or length in children under 3 years old) for age, or body mass index (BMI), dropping more than fifteen percentile points away from the expected channel warrants investigation. Don’t wait until your child is hovering near the bottom of these charts to look for answers.
- Mid range lab findings for serum iron and ferritin (not at high or low edge of the range); normal blood count; normal chemistry panel with serum protein, albumen and other findings in mid lab range. Your pediatrician can order these inexpensive and ordinary lab studies if need be.
- Your child has few illnesses with short duration and full recovery. Few means 1-2 per year at most.
- Your child has healthy shiny hair that isn’t brittle or easy to fall out, clear skin, healthy teeth, and clear strong nails. There are no or few cavities in the child’s lifetime. Nails aren’t flat, ridged, peeling, cracked or showing white spots. Acne can signal entrenched gut dysbiosis, zinc deficit, poor protein intake, or other nutrition problems.
- Your child can to play, sleep, learn, and eliminate comfortably.
3 – Your child may need iron even if s/he is not anemic
It’s common at annual physicals to check hemoglobin for kids, which is done with a finger stick blood test. This tests checks for iron deficient anemia.
The problem with this is that this is a low sensitivity test. It doesn’t notice B12 deficient anemia, anemias secondary to poor protein intake, or anemias that involve copper. It also can’t pick up pre-anemia. Pre-anemia is a thing! In pre-anemia, iron stores are nearly depleted, but hemoglobin is still in the normal range. These kids need iron support, better protein intake, or both. Depending on diet, food intake and other factors, the fix may be the right food, including better protein sources and iron rich foods. Or, the right iron supplement (there are several) may do the trick. High dose prescription iron is not usually needed in pre-anemia, but functioning can change dramatically nevertheless. Kids in pre-anemia will have any or all of these features:
- shiners under eyes, pallor
- more frequent infections and colds; may take longer to recover
- irritable; crabby one minute, happy the next
- hyperactivity with fatigue – “crash and burn” pattern
- math may be most difficult subject (iron is related to math learning!)
- difficult sleep pattern, insomnia, restless legs, can’t settle to sleep or sleep through
- picky or weak appetite; may want to chew non food items
- in girls in puberty, menstrual flow may be heavy, fatiguing, and/or with clots
Since iron is poisonous as well as essential to our bodies, don’t give iron supplements without guidance. Request thorough testing to find out if your child needs iron, vitamin B12, protein, or just the right food to correct anemia. I can help you with this as well, by finding an easy to tolerate iron supplement or B12 protocol, as well as how to work in replenishing foods.
4 – That allergist referral won’t find all your kids’ food reactions
Allergists check one thing: Allergies. They look for reactions by checking IgE (immunoglobulin E) responses to foods or other substances. They may measure histamine and tryptase levels too, among other things that relate to those swift and dangerous reactions that have you grabbing the Epi Pen. But there are many other types of reactions to foods that disrupt stools, skin, behavior, and functioning. If allergy testing was negative for your child, but there are frequent colds or congestion, asthma, eczema, messy irritable stools, weak picky eating, or other nebulous symptoms, assess more deeply. So far, while insurance coverage for food allergy testing is common, it is not common for testing for food sensitivity reactions, or other immune responses to foods. Identifying these can make life a whole lot better for kids struggling with multiple symptoms – but, be prepared to go out of network and possibly pay out of pocket for these tests. Depending on your insurance and your child’s nutrition diagnosis, it may or may not be covered. I guide parents with this testing, can authorize it if your doctor does not know how, and interpret findings to build a nourishing diet for your kids.
5 – Nutrition CAN reduce ADHD symptoms without medication
Big topic. Pediatricians are trained to offer behavior therapy as a first line of intervention for young children with ADHD; if that doesn’t work, their next recommendation is for medication with behavior therapy. But what they don’t learn is how to help children achieve functional focus with nutrition, gut health, and food. So much can be done! Stimulant medications have many drawbacks and side effects. Search my blog posts on nutrition and ADHD – there is ample to mine there. Watch my podcast with Jill Carnahan MD about nutrition, gut health and ADHD.
Children as young as three years old can be given stimulant medication, per FDA guidelines. It may seem like an easy quick fix, but there are other options. This is not without costs to your child’s health and well being; suicidality may increase in older kids given these medications. Help your child eat and absorb the nutrients his brain needs to focus. Take out the toxins, inflammation, and noise in the body. You may be amazed at the difference nutrition care can make.
Why doesn’t my doctor practice nutrition?
Pediatricians don’t have a lot of time when they meet with you for a school physical or well check. Insurance contracts tightly control what topics your doctor can cover in those visits, how long the visit can take, and how much a doctor is paid for that service. When your pediatrician wanders from the format, s/he essentially won’t get paid by the insurance contract. Add to this that doctors need high volume to make money, with 20-30 patients per day – meaning even less time to listen to you, educate you on meals and nutrition, or research new topics on their own.
Further discouraging nutrition in pediatrics is that drugs are so profitable. Drug companies wield heavy influence over pediatric care, from the time a doctor begins medical training to every week in practice, when drug company sales reps visit with samples, glossy brochures, pens, free lunches, treats, or incentives to write prescriptions. It’s irresistible and easy. There is no such format for nutrition intervention for complex problems. Last but not least, pediatricians are not required to complete much training in nutrition. They simply may not know what to do.
In my nutrition practice, I give clients lengthy appointments to integrate all facets of your child’s care into an individualized nutrition care plan, including lab studies, history, growth status, food intake, and aspects of your lifestyle. I write detailed care plans for each encounter. This takes a lot of time that pediatricians don’t have. If you’re stuck, get started today with an appointment. Or go to my home page to download your free Sensory Nutrition Checklist (scroll down) – begin today with some easy tricks to help your kids function better!