Top 3 Mistakes Functional Medicine Doctors Make When Working With Kids
Functional medicine is all about resolving the root cause for chronic conditions, by giving the body tools to repair and heal itself beyond just prescription drugs to mask symptoms. The idea is to be well to potential, not just un-sick. But there’s a problem, when it comes to babies, toddlers, kids and teens: Those people are not little adults. The functional medicine model that works for grown ups sometimes leaves out critical pieces for kids – and I see these mistakes in my pediatric nutrition practice, regularly!
If you know me, you know I work in an office with a fabulous functional medicine doc, author, and speaker Jill Carnahan MD. Before moving into our new office digs in 2015, we shared space with Robert Rountree MD, another renown educator, author, speaker and founding IFM member (here’s just one of his fabulous pearls of wisdom). Just being in the same room with those two is a joy, as both are fonts of knowledge and experience!
I meet many kids who have come into my practice having already worked with a functional medicine practitioner elsewhere in the US – but often, these kids are still sick, not getting better, or even getting worse. Does this mean functional medicine doesn’t work for kids?
Nope. It means a few key pieces got left out. I see this a lot. Work these bits into your child’s care with your provider, and things might go a lot better. Here’s the top 3 goofs that I encounter, when working with families who tried functional medicine care for a child, but didn’t see great results.
1 – Your Doctor Forgot About The Food
Sounds crazy, but it’s true: The most important piece for children of any age to feel better with a chronic condition (or even leave it behind) is food. How much? What protein sources are safe? How much fat? What carbs are okay? What do you make for dinner? What goes in the lunch box? How many ounces of formula, and what formula is best for the baby? How much breast milk? Should mom be on an elimination diet too? Which foods should she remove, which foods can she replace those with? Should your child eat fermented food, GAPS, ketogenic diet, Autoimmune Paleo (AIP), gluten, low oxalate foods, avoid nightshades, low FODMAPs foods?
All those questions need specific answers and specific instructions.
But… What I often see is that parents are just told what not to feed their kids, without details about what to feed them instead. This often leaves kids over-restricted, not eating enough. I also find that foods are eliminated without a good reason (“aren’t carbs bad for you?” … “I was told potatoes are inflammatory, so we cut those too.” … “I don’t want to feed yeast – the doctor said to go ketogenic just to be safe.”) Or, sometimes, a food that is not a fit gets over-used, like daily high oxalate juices with spinach, kale, and beet juice; or coconut everything, when we find coconut to be a high IgG trigger food or too high FODMAPs for that child. Long short, you really gotta know what food is right for your child, and how much. That is based on lab studies, signs, symptoms, and history – not on any dogma about the “best” diet.
The flip side of looking in detail at what and how much your child is eating daily is growth pattern. Growth is the single most important measure of a child’s nutrition status, especially in children under age five. It can be assessed in great detail, to include stuff like Z scores for body mass index for age, velocity, regression, or level of malnutrition. This is a big blind spot in the functional medicine model, which was borne out of how to manage chronic conditions for adults – who aren’t growing!
Growing dramatically changes how we use energy (calories), protein, fats, carbs, and even some micronutrients like folic acid, zinc, or iron. Just your kid’s brain uses more energy per ounce daily than yours does! Not to mention all the other stuff going on in a growing person.
I request a food diary with each new patient intake, and often at follow up appointments too. This isn’t about watching what parents are doing right or wrong (it’s not about you!). Food diaries reveal a lot about a child’s body, what they feel like eating, what they are absorbing well, what nutrients they may be losing, why they are fatigued or hyper, or what sort of dysbiosis may be active.
Matching this info up with a growth analysis is a gold mine of information about why a child isn’t feeling well. Growth impairments can be subtle or even invisible, without a skilled assessment (which pediatricians generally don’t do either – they don’t have time). Even mild growth impairments matter – they are costly for children. They affect sleep, behavior, mood, self regulation, timing of puberty, and stamina.
And.. Guess what: That Holy Grail of healing leaky gut? It can’t and doesn’t happen when a child has a growth impairment. Just being even a little underweight can, in itself, make a child’s gut leaky. The functional medicine community often overlooks this. You can eat all the kombucha and bone broth you like, but if you’re five years old and off your expected growth pattern, it won’t work so well. There won’t be enough energy and construction material to manage the demands for growth, and the demands of tissue repair and restoration. These heighten a child’s macronutrient needs (protein, calories, fats, and carbs) dramatically – and they have to be the right macronutrients for your child… Or, you guessed it, all your efforts can flop.
I often find that a child will be sprinkled with supplements for toxicity and neurotransmitter support, when all they needed to function better was the right food in the right amounts, consistently, day to day. The only way to find this out is by looking at detailed food diaries and making a deep dive into growth data – including life long growth pattern from birth. This helps identify what the expected growth pattern is in the present day.
2 – Your Doctor Ran Too Many Fancy Lab Tests
…that didn’t really add up to an action plan for the family.
There’s no shortage of super interesting lab tests available now, that broaden our understanding of how the immune system is managing food, how we manage toxic exposures, or what our microbiome is up to. But what do you do with it all?
Sometimes this information isn’t actionable. That is, there isn’t going to be anything you can do with it.
For example: A Cyrex Panel 3 for Wheat Proteome Reactivity and Autoimmunity is as detailed as you can get, to see what an immune system “thinks” about gluten. It costs about $300, out of pocket. But if you’re just trying to figure out if a gluten free diet would help, all you need to establish that is deamidated gliadin antibody test. Your pediatrician or PCP can do that, and bill your insurance. (Your pediatrician will tell you it’s “normal” if the result is less than 20. But I will tell you to withdraw gluten if your child has any suspect symptoms for gluten intolerance, with a value above 10). Even if you pay cash for this simple test, it isn’t likely to cost more than about $50.
Or you might see a test for red blood cell toxic and essential metals, like this one. I like this test because it captures a lot of information in one sample. But, in children especially, iron needs more detailed digging than this test can show. If iron is marginal, it’s easier to absorb toxic metals like lead. The only way to know if iron is truly marginal is to do some standard stuff that, once again, your pediatrician can do very inexpensively or on your insurance. Include ferritin, CBC, transferrin, saturation, and serum iron to get this picture. Plus, kids show signs of mineral deficits clearly in behavior, sleep pattern, mood, hair, or skin. For children, a nutrition focused physical exam should be included in assessment too, not just lab tests. And by the way, here in my practice and in the practice of Jill Carnahan, we don’t use hair testing for mineral analysis, because we don’t find it to be terribly accurate or useful.
Another popular (and costly) test is the NutrEval by Genova Diagnostics, which runs close to $400 out of pocket. Some insurances may cover this test; in my own practice, this is rare. Many functional medicine docs rely on this for nutrition assessment. While it does do several tests for one fairly decent price, it does not assess children as well as it does adults. Nutrition assessment in children must include growth and food intake data, as well as clinical signs and symptoms. No one lab test can do this, even a comprehensive panel like the NutrEval. Because it is sold as a comprehensive, complete tool, it tends to mislead into thinking that all solutions lie in the supplement protocols that come with your test results. How often I have seen this fail!
The NutrEval also includes an analysis of essential fatty acids. I think you can skip that: It’s easy to see things like essential fatty acid deficits in kids, based on their food records (are they eating any?), behavior, and clinical signs that relate to essential fats. You don’t really need a blood test for this in my opinion, unless you are revisiting how to dose a fatty acid supplement protocol that doesn’t seem to be working. Even then, you can check other parameters in signs, symptoms, or other less costly labs to find out.
Another common misunderstanding I encounter with parents who have done a NutrEval is they believe that their kids’ protein status has been assessed, because there is an amino acid profile in it. Amino acid profiles don’t assess protein status or intake, which is crucial for kids. The amino acid profile rules out inherited metabolic disorders, another common and often insurance-covered test that you don’t need a functional medicine doctor to order for you. Protein status in kids is assessed with a metabolic panel (a common and cheap LabCorp or QuestLab test that your pediatrician can do), and by looking at clinical signs, growth, feeding, and elimination patterns.
For more cost saving tips on what lab tests to start with, without spending thousands out of pocket with a functional medicine doc, see my e book on 5 Essential Lab Tests For Kids With Autism. Goes for any kid, with a chronic condition! Any practitioner skilled in Nutrition Focused Physical Exam for children can save you a lot of time, trouble, and money – and help you avoid a care plan that backfires.
3 – Your Child Has Been Over-Treated, or Treated Too Aggressively
There are so many cool tricks and tools for wellness potential that insurance doesn’t pay for. These are the things that your functional medicine doctor is trained to use – cutting edge stuff that includes everything from far infrared saunas and nutritional or immunoglobulin IVs, to highly specialized supplement protocols and ozone suppositories, or novel ways of using prescription drugs off label, for special circumstances. It’s hard to hold back, when we want to help people heal!
But here’s the thing: Children are delicate little creatures. Especially really young ones, like, babies. Or kids of any age who have been overwhelmed with mold toxicity or Lyme disease, or who didn’t tolerate the vaccine schedule. Their bodies are overwhelmed. Don’t overwhelm them all over again, with a barrage of treatments, all at once.
I have seen children go from bed-ridden to literally jumping, enjoying school, and playing normally again simply by suggesting a family stop treating their child for all these found problems, and by helping to re-boot with nourishing, gentle foods that fit that child’s needs. Then we pick and choose which “layer” the child might successfully address first. Are they anemic, or are there other mineral imbalances? Can they absorb foods and nutrients in the first place, or is there achlohydra, SIBO, SIFO? Are they pooping comfortably? Can they detoxify ….anything? Where can we gently support some detox?
When children are over-treated, they get sick, tired, weak, anxious, fatigued, depressed; they don’t eat right; they can’t play, they’re weepy or more angry, with volatility; they have rashes, fevers, or get every cold and bug more easily. It’s not necessary to go through this. It can be easier, gentler, and work better.
Functional medicine is the way health care is trending. We all want to feel really good, not just live “meh”, without sickness. Kids deserve it too. If your child is not playing, sleeping well, eating well, and enjoying activities they love, take a look at whether these mistakes are in the mix with your functional medicine provider. Re-boot the plan, and your child can feel better.