Want to clear a room fast? Tell people your kids aren’t vaccinated. Then say, “Not only is that why they’re so healthy – it helps your kids stay healthier too.” Wait. What? Unvaccinated kids, healthier? Aren’t they walking cesspools of infection, recklessly spreading disease in their wake? Aren’t they leeches, getting a free ride away from infections, on the backs of all those good parents who vaccinate their kids?
The CDC maintains that they can’t solve this question for us. Their posture is that it’s unethical to study vaccinated versus unvaccinated kids, presumably because it isn’t safe to not vaccinate anybody. But ongoing survey data show that unvaccinated kids are healthier. They have fewer allergies and asthma, less autism, fewer chronic conditions and are sick less often. Even though these data come from an uncontrolled voluntary survey (over 13,000 participants worldwide and growing), the differences are enough to give anyone pause – and plenty big to warrant formal investigation. By factors of double, triple, or tens of times, vaccinated kids show a higher illness burden than their unvaccinated peers, for conditions like epilepsy, diabetes, thyroid disorders, autoimmune conditions, autism, allergy, asthma, and more.
Meanwhile, the argument that a pool of vaccinated kids is needed to quash a return of infections is starting to crumble (bolstering the position held by some that vaccines can’t confer herd immunity): Even with compliance for most immunizations at over 90% across the US – above the level considered necessary for successful herd immunity – we still have outbreaks of pertussis, measles, mumps, chickenpox, polio, and flu in vaccinated groups. The global level of pertussis vaccine coverage was 83% in 2012 – pretty darn good – but, still: Outbreaks. In fact, vaccinated people may spread infections they are recently inoculated against, as they shed viral and bacterial material from vaccines – just as occurs with wild type, naturally acquired infection. This has been documented for those recently vaccinated against pertussis, polio, flu, chickenpox, rotavirus, and measles.
If vaccines are working less and making kids more sick, do we keep using them? How? Tough questions. Since we began using vaccination some two hundred years ago, we have fiddled more deeply than we know with how immunity travels from generation to generation. For an example, dive into this blog series on polio, which describes how this once mostly benign virus morphed into deadly and debilitating with sanitation, less breastfeeding, and the introduction of vaccines.
Long short: Immunizing our way out of infection hasn’t worked.
The magic bullet idea of it is alluring (not to mention profitable beyond belief), but, perhaps the bill has come due. Vaccination as a one-size-fits-all path to disease eradication is undeniably a pipe dream now: There is not a single disease on the planet that vaccines have wiped out, as was still being promised when I was a public health graduate student in the 1980s. Some infectious diseases (flu, pertussis, varicella) persist at same or even higher levels now than before vaccines were introduced for them. Not only that, it appears we have traded exposures to routine, typically benign childhood infections for chronic disability and illness, thanks to comprehensive scrambling of the immune system early in life with routine vaccinations and less breastfeeding, generation after generation.
When a debate gets this heated, typically, more fear than fact starts flying. No exception here. There are pertinent facts from the realm of infant and child nutrition, as well as public health nutrition and basic epidemiology, that usually go missing from this conversation.
Can we afford to omit that stuff any longer? I don’t think so. It’s time to get solutions oriented, and consider kicking Pharma out of the conference room. Profitability is the driver of the vaccine pipeline, and as long as people fear that only vaccines can save them, they’ll keep buying them. We don’t need fear mongering, or even bigger profits for already-bursting-with-cash Big Pharma. We need a shift in the belief that all infections are bad, and more vaccines are better. We need effective, safe tools that do not leave kids disabled or saddled with chronic illness.
There are pearls from maternal and child nutrition, plus some nutritional epidemiology, that belong in the mix. These aren’t the only factors in play. Environmental toxins, sanitation, living conditions, and even the vagaries of climate change are exerting their influence on our global microbiome. But for sure, host immune response is dependent on nutrition – which is a variable we can leverage.
First on my list? The Cycle Of Nutrition And Infection has been well understood for decades, but it’s virtually absent from general pediatric practice today in the US. It goes like this: When a child is malnourished, they get sick more often; and, when they get sick, they get sicker than kids who are well nourished.
This cycle is active even in mildly undernourished kids – like so many I meet right here in my pediatric nutrition practice in the US. The course of their infections is longer, more severe – because they don’t have the nutrient and tissue stores to mount a good fight. Then, once they’ve battled an illness, they’re left even more malnourished, having exhausted whatever stores they had. In this weakened nutrition status, they get more sick, again. Then they deplete nutrition further. And so on it goes, in a vicious cycle that can quickly become deadly for infants and young children.
Malnutrition begets infection and vice versa
I’ll say it again as I’ve seen it so often: This Cycle is active even when kids are only mildly to moderately malnourished.
In poor countries, or in poor regions of the developed world (including in the US), malnutrition starts in utero. Children who don’t have enough high value food to eat will get sick and die more often, whether they are vaccinated or not. Nutrition status is so intertwined with immune function that UNICEF priorities for global health don’t separate the two. This doesn’t just apply to severely malnourished kids with ribs poking out, stick-like limbs, sunken eyes, and pot bellies. Many kids I’ve encountered in my pediatric nutrition practice meet nutrition failure criteria. A child who is below 90% of his ideal body weight is mildly malnourished. An example of this would be a four year old child with an expected weight of 40 pounds (based on birth weight, parents’ stature, and other factors), who weighs 36 pounds or less. Or, a thirteen year old whose body mass index is hovering around the sixth percentile. Or, an eight year old whose progress for stature has flattened from 40th percentile last year, to 15th this year. Or, a child with chronic loose wet stool, or chronic constipation. Is this your kid?
Next question: When was the last time your pediatrician asked you for a food diary, to show exactly what your child eats day in and day out? Has s/he ever assessed grams of high value protein taken in on most days? Weak protein intake means weak immune response. Anyone do testing to rule out food allergy and sensitivity? These can deplete nutrition status and immune reserves if not managed correctly. At your last office visit for your child’s colds, flu, or ear infections, did anyone check status for vitamins A or D, intake of varied healthy fats and oils, or look at zinc and iron? All are critical for vigorous immune response, and for ideal responses to vaccines. Nutrition is a symphony, not a single note. All pieces need to be present at the same time, doing their jobs.
How much not-food do your kids eat?
These are first world examples. Kids can grow, more or less, and still be eating pretty horrible diets – especially with the bounty of processed, vacant, genetically modified food heavily marketed here to moms and kids. After fifteen years evaluating food intakes of kids across the US, I can tell you this: Most kids I’ve encountered have suboptimal food intakes, bad enough to impair growth, behavior, learning, sleep, focus, attention, and infection fighting. And, nobody noticed – not their pediatricians, gastroenterologists, neurologists, psychiatrists, biomed/DAN doctor, or most any other specialist they’ve been to. Nobody actually looked at the food.
Now, that’s just dumb. Because nutrients and food, not vaccines, provide the building material that we use to fabricate an immune system, regardless of vaccination status. The physical components of an immune system come from whatever nourishment a child got in utero or takes in himself. Eating well builds up the savings account for the rainy days when the immune system needs to make a big withdrawal. It takes a lot of energy, and unusual amounts of certain nutrients, to mount a fever and fight infection – especially when you are growing, a demanding daily metabolic task for every cell in the body of a child.
This is why unvaccinated children in strong nutrition status who eat healthy, well-rounded diets will fight infection better than vaccinated peers who are underweight, have failure to thrive, chronic diarrhea, or constipation, or who eat limited diets. The nutritionally sound child may get infections and get sick, but will have a more vigorous response, will be sick for a shorter period of time, and will then have stronger, longer-lasting immunity than vaccines give. This process of naturally developing immune competence may be crucial to averting allergies, asthma, or other chronic disease later in life.
Vaccines don’t alter the cycle of nutrition and infection. The only way to interrupt this cycle is with food (and supplements in some cases). Without it, malnourished children get sick and die more often, period.
So. Do malnourished kids need vaccines even more? I’ve met many families with frail underweight children or children with chronic conditions who are loyal to the vaccine schedule. Their children still get sick often, even for some of the diseases they are vaccinated against. They’ve been told at every turn that their child needs vaccines most because they are more vulnerable. True, those kids are. But do more vaccines help or harm in these cases? Even with shots, there is a demand placed on the immune system to respond – that is the whole point of vaccinating, after all. This response will consume more nutrient stores.
And, besides injecting antigens, vaccines also rely on toxins (like aluminum) to jump start the body’s immune response. An already weakened system may not be able to manage additional toxins. Immune response is impaired in children with compromised nutrition, and this will be true whether an antigen is injected or encountered through natural infection. Children may be more vulnerable to adverse vaccine events if they are vaccinated while sick – intuitively, because they are already moving available resources to manage the illness underway, and can’t respond properly to an injected antigen plus toxins as well. Instead of dosing weak children with multiple shots, it may be safer and more effective to resolve their poor progress for weight, height, and food intake.
Next on my list would be breastfeeding – a topic I’ve covered in an earlier blog. Spoiler: It may well trump vaccination for preventing infections in babies, depending on mom’s immune status. It is so potent an immune booster that it somewhat disables rotavirus vaccine, and possibly others. But now, thanks to vaccination, childbearing women in the industrialized world may have never experienced measles, mumps, chickenpox. If they breastfeed, they don’t pass the immunity to their babies that my mother would have – born in 1926, she had all of the above, including scarlet fever. At 92, she’s never had a flu shot, is sharp as a tack, still drives, and still works part time selling real estate.
These are sweet enough to substitute for candy if you grow your own or find locally
So let’s bring this piece to the table: Nutrition status, not vaccination, has the more profound impact on illness severity and frequency in infants and children. Meanwhile, we can adjust the focus on our lens for child health in the US. It’s not all about vaccines. Here are the top ten causes of death for US infants for 2010, according to the CDC (children up to 1 year old):
1. Congenital malformations, deformations and chromosomal abnormalities (congenital malformations)
2. Disorders related to short gestation and low birth weight, not elsewhere classified (low birth weight)
3. Sudden infant death syndrome (SIDS) (accounted for 2,063 deaths in 2010, or 8.4% of all infant deaths in the US).
4. Newborn affected by maternal complications of pregnancy (maternal complications)
5. Accidents (unintentional injuries)
6. Newborn affected by complications of placenta, cord and membranes (cord and placental complications)
7. Bacterial sepsis of newborn
8. Respiratory distress of newborn
9. Diseases of the circulatory system
10. Necrotizing enterocolitis of newborn (the baby’s intestinal tissue dies, and the baby starves to death)
None of these are “vaccine preventable” conditions – ironically, with the exception of SIDS, which is an acknowledged side effect of a vaccine adverse event, reimbursable by the government’s Vaccine Injury Compensation Program. Infectious diseases aren’t in the top ten. Is it because we vaccinate? Or is it because we are better-fed, have cleaner water, have access to antibiotics or other treatments, and cleaner living conditions than the developing world?
It likely is not either-or, but we clearly need a new vision for our children. US children face shorter life spans than their parents, and have more chronic disease and disability than any generation of children before them. Vaccines as we now use them have arguably created a stunning and costly burden of chronic disease and disability. As health insurers wise up, will they opt out of the usual carte-blanche coverage for every vaccine Pharma produces? Sooner rather than later, the cost burdens of over-vaccinating will come to light. And we can at the very least use the well pedigreed body of evidence in child nutrition to support robust immune function, any time you’re ready.
COVID-19 is our moment to rethink infection, and to rethink health. It’s a big moment.
By now, you know that we’ve seen corona viruses before: Middle Eastern Respiratory Syndrome (MERS) in 2012. Sudden Acute Respiratory Syndrome (SARS) in 2002. In fact, corona viruses were first discovered in the 1960s and have long been understood to cause a “substantial” portion of upper respiratory infections in children (that is, common colds). Despite decades of scientific effort, we haven’t emerged from any of this with sure fire preventives, drug treatments, or vaccines.
COVID-19 has been wreaking havoc and defying experts worldwide. COVID-19 behaves so differently in different persons that Atlantic Monthly has called it “a disease of the immune system”. Robert Murphy MD, a professor of medicine and the director of the Center for Global Communicable Diseases at Northwestern University, was quoted in that piece to say this: “’There’s a big difference in how people handle this virus…It’s very unusual. None of this variability really fits with any other diseases we’re used to dealing with’…When doctors see this sort of variation in disease severity, ‘that’s not the virus; that’s the host.’”
Essentially, COVID-19 kills people best when their immune systems over-respond with uncontrolled cascades of inflammation. It appears to exploit whatever your weak link is, and destroy from there, whether it’s lung, kidney, gut, heart, or brain tissue. Apparently, this virus isn’t picky, but it sure is wiley. Not everybody’s immune system is doing this. As more are screened for exposure status, we are seeing death rate drop, to perhaps as low as half a percent. #COVID19 is looking like an infection that serves up a catastrophic clinical course, but only for a subset of vulnerable people.
One option is to take the cue from Dr Murphy quoted above. It’s time to figure out why that half percent gets hit so hard.Maybe the solution is not about the virus. Maybe it is about our immune systems, which vary widely in their status, functionality, and readiness, and in our own risk factors, which are virtually exponential in complexity when we consider genetics, nutrition, health habits, toxic exposures, stress, drug use (recreational and prescription), and more. All of these impact each other, creating potential synergies in any direction, when you toss COVID-19 into the mix.
Right now, our health care system is a reductionist one that silos health problems into discreet specialties. It doesn’t pay much attention to nutrition or food, or toxic exposures, in routine care. COVID-19 has laid bare what a catastrophic fail this is, as it devastates a select few of us in so gruesome and terrifying a fashion. By “few”, I mean this: Tens upon tens of thousands of deaths is a lot. Relative to the total population, it’s a very little. A long list of other conditions, infections, and diseases affect many more of us. But we don’t shutter the globe in response. We figure it out.
We are likely to get it too, as COVID-19 becomes endemic. This appears to be well underway, as reports roll in of deaths from COVID-19 identified as having occurred in the US in early February. New York just announced a finding of positive antibodies in 14% of a sample of people tested in that state, suggesting that the death rate is closer to one half percent. Why are some of us getting so sick, some of us dying swiftly, some of us feel hit with a bad cold, or some just a minor sniffle, some GI symptoms – or even more peculiar, a fatal stroke? There are more viruses than there are stars in the universe; they are here to stay and part of life on earth. Can we figure out how to live with them, rather than die by them?
Developing a COVID-19 vaccine is fraught with challenges – not the least of which is that corona virus vaccine efforts have posed “unique safety challenges” in that it may trigger responses that vary as wildly as the infection itself. It may kill or injure people, it may cause infection in some, it may give some people immunity, and it may give others no immunity at all while weakening their response when re-exposed. Recently, the World Health Organization (WHO) suggested that immunity to this virus isn’t a protective certainty after infection. If that holds true, then a vaccine may be doomed. The entire premise of vaccination is that antibodies triggered by the injection will protect you. If naturally acquired antibodies don’t work, how could triggering you to make your own from an injected version of the virus work?
Without usual process for safety and efficacy, such as has been proposed in the scramble to have a vaccine, these are ominous frustrations. Peter Hotez MD, PhD is a researcher you may have heard about who has tried to make a corona virus vaccine in the past. So far, no good. In Congressional testimony, he describes unexpected reactions from an experimental vaccine and mentions that two children died (at minute 25:40 in this transcript) in a human trial of his most recent attempt. As a vaccine scientist who invents vaccines, he’d like more than anyone to see this work. In a recent podcast, he eloquently thumbnails what we’re up against. He points out the footdragging the US had on testing and quarantine, which we now know let COVID-19 circulate for a long time. He describes what we’ve all heard many times over too, about who is most at risk, with an odd twist not often mentioned. We know that kids and adolescents are less affected. The elderly are at high risk. Anyone who is immunosuppressed or with underlying conditions is in trouble too. And, this obvious, but rarely stated, twist: Health care workers contract a severe version of the virus, despite their age – young or old. Why? Why don’t they get sick like other exposed young people, and recover?
An opportunity lies there to dig for clues. Health care workers are the most highly vaccinated among us; they receive boosters at least annually for influenza (some workplaces require these biannually), and boosters of other vaccinations more often than most of us likely do. Shouldn’t this somehow be protective? Or is this part of the problem? Detecting a phenomenon called “vaccine interference”, a study of military personnel showed that those with prior flu vaccination had higher risk of contracting corona virus than the unvaccinated: “Vaccine derived virus interference was significantly associated with corona virus and human metapneumovirus”. In other words, in this study, having had a flu shot meant you were more likely to get sick with corona virus.
You might think Dr Hotez would be the loudest on the podium touting a shot as the single silver bullet that can fell this demon. He tried to make one just for this moment, but failed. He knows this can’t happen fast, and that we need action right now. One of the immediate solutions that he and colleagues are thinking of is “convalescent plasma coronavirus therapy.” That is, give immunoglobulin (antibodies to COVID-19) from a recovered person’s purified blood (plasma) and infuse or inject it into a sick person who is not recovering. This worked for SARS, Ebola, and MERS. Development of this biological product for COVID-19 is already underway, despite the WHO nay-saying on this strategy.
Immunoglobulin (Ig) therapy has been around since the 1950s, but not specifically for COVID-19 (no has had antibodies to it, until now). Ig is tried and true, effective, but costly; a pool of many hundreds of recovered persons is needed to extract enough immunoglobulin to treat just one person. It currently costs thousands of dollars per dose, even tens of thousands of dollars per dose, to receive Ig therapy for other conditions, so insurers are loathe to cover it. But Dr Hotez would like to see a low cost version of this made available.
Even if “low cost” means, say, $800 per dose, it sounds great – if you can manage to jump through the health insurance hoops and hurdles that will surely be raised to stop you. COVID-19 has laid bare many ills in the US in 2020, with one of the most glaring being that our for-profit health insurance and health “care” industries are a fail for consumers. There is no covered, federally coordinated access to screening to show who is infected. Millions have spotty access to health care, if they have any at all. It’s more profitable for insurers and care providers to patent and sell a vaccine, than it is to sell immunoglobulin therapy, screen everyone for antibodies, or screen everyone – before exposure – for a laundry list of risk factors like inflammatory markers or nutrients that our immune system draws on to fight infection (ferritin, ESR, homocysteine, serum iron, serum vitamin A, vitamin D, and zinc to name a few). Whether Ig works well or better than other tools isn’t relevant in our care model; whether it’s profitable is.
In Dr Hortez’ podcast mentioned above, he goes deeper into why rushing a COVID-19 vaccine is a bad idea. Among the obstacles is “immune enhancement”, a known phenomenon already seen in animal trials with corona virus vaccines (and others like AIDS) in the past. Industry scientists have long found this phenomenon to be a stumbling block that “proved to be counterproductive” in that it “renders vaccinated subjects more susceptible to infection rather than protects them.” To quote the podcast, “Vaccine trials have begun in Washington which is a positive, but we will also see immune enhancement in [the] volunteer population”. Make no mistake: Researchers know from past experience that COVID-19 vaccine trial test subjects are going to either step on a cytokine cascade landmine (potentially deadly), or suffer “immune enhancement” (potentially deadly if re-exposed), or may be just fine. Here’s how one reader put it, in the comments following Dr Hortez’ podcast:
March 17, 2020 at 4:03 am I think you heard Dr. Hotez correctly: vaccines for highly pathogenic viruses are problematic because they cause “enhanced immunity”. This is a heavy euphemism for the patient’s uncontrolled inflammatory cascade, called a cytokine storm, which causes illness and death in the ebola, MERS and SARS patient. So in a disease whose mechanism of fatality is the host’s immune over-reaction (cytokine storm manifesting as ARDS etc.), vaccines–whose adjuvants aim to “jolt” the immune system into action–can make the reaction even worse. This is one reason why a SARS-1 vaccine development was halted; although the mice survived the vaccine fine, they were dying at high rates after they were re-introduced to the virus after innoculation. For this reason, therapeutics may be the better solution to this SARS-2 virus than a vaccine.
What to do? Hopeful puzzle pieces are emerging. Persons with healthy immune systems show promise for recovering, provided that their immune systems do what they’re built to do, without going haywire.
Immune systems are complex with lots of opportunity for “haywire” to happen. The good news is, we can minimize the haywire and build functional, meet-your-COVID-exposure-safely immune performance with nutrients, food, supports for inflammation and detoxification, and with better monitoring and management of our own risk factors. So far, policy and practice in the industrialized world around infectious disease mostly disregards all that. On a policy and practice level, we haven’t looked much into how to enhance our own immune response so that it is balanced and effective, or why some immune systems do it right while others get it wrong. We’ve focused on drugs to control symptoms during infection, on vaccines, and on drugs to kill infection. But COVID-19 is shaking these foundations to the core. These 20th century strategies are failing us with this one. This is grim, but it means there is opportunity to pivot and integrate some cool new stuff. Practitioners in the functional medicine realm have been doing this all along. Some pearls have already emerged, more are sure to follow.
One shockingly simple finding may be right under our noses: Severe COVID19 patients can have dramatically high levels of ferritin, even exceeding a value of 1000 ng/mL. This is a very high level that reflects intense inflammatory process underway. Ferritin is a means to make iron safe in the blood. It scoops up free iron when iron, a powerful oxidative stress element when free in the blood, gets too high. This high level of iron will set off inflammatory cascades in itself and slowly poison patients. It’s possible COVID19 is doing this by knocking iron off of the hemoglobin on red blood cells, so it to floats free in the bloodstream. No iron on hemoglobin means no oxygen can attach to your red blood cells, and you will essentially suffocate while the inflammatory cascade is encouraged from too much iron.
A simple way to oppose iron is to supplement zinc. COVID19 patients who report a sudden loss of taste and smell are reporting one of the classic textbook signs of zinc deficiency. They may be rapidly depleting zinc to meet demands set off by infection. This may be just one of the trip-wires that sends some patients into a rapid decline, while others muddle through. It’s not exotic, but it’s worth exploring. It would be a lost opportunity if it were true but instead we took a detour into how COVID19 might affect olfactory nerves.
COVID-19 is ruthless and devastating for the vulnerable among us, and incidental for most of us. If we follow our own hallowed tenets of epidemiology and herd immunity, according to Scott Atlas MD, a health policy expert at Stanford University, the most protective-for-all thing to do is to “stop the panic and end the total isolation”. That is, go back to work, come out of hiding, and build population immunity naturally, while identifying and supporting those who are at risk. We have tools at hand right now, and they may be deceptively simple. From tapping older less profitable drugs (less profitable because they are off patent and available generically) to engaging essential tenets of the nutrition / immune interface, we have a lot to work with already.
About The Author: Judy Converse MPH RD LDN is a licensed registered dietitian nutritionist. She holds a master’s degree in public health with nutrition major from University of Hawai’i / Manoa and a bachelor of science degree in human nutrition from University of Vermont. She has lectured widely and authored several books on pediatric nutrition and specializes in nutrition intervention, monitoring, and support for children in her private practice. She has worked with health insurers on nutrition service delivery and with industry partners on medical foods.
Yup, GAPS can fail. And it’s probably not your fault.
Gut and Psychology Syndrome Diet has a lot success stories… But what about the kids who fail on GAPS?
I have met a lot of those kids. After GAPS has just plain not worked (or worse – traumatized the family and injured the child, which can unfortunately happen) – I’m often the next stop.
These are smart people who followed the GAPS protocol carefully, and engaged lots of on line support; some worked with GAPS certified practitioners. But still: Fail. Their kids withered on bone broth; vomited or bled in stool on probiotic foods; and had bloating, rashes, and irritable stools with egg yolks, avocados, and nut butters. Their parents pressed on, for months or even longer; some moms have described to me the intense pressure they felt to stay with this protocol, and the deep sense of failure they internalized about it not working.
Okay, here’s the thing: There is no one diet for everyone. There never is. All children with autism, FPIES, or gut issues do not benefit from or need GAPS. I have met many who failed on it. GAPS works well for some. It fails for others. If it isn’t going well, odds are it’s not your fault. Your child just needs something different.
So, what can go wrong? Why not just try it?
Besides the possibility of wasting a lot of money and effort preparing scratch foods that may be wrong for your child, you’re going to waste time too – which some children simply can’t afford. The younger they are, and the more undernourished they are to start, the harder this can be on a child, if it isn’t the right measure.
And a mom’ s worry is no small thing. Chronic, strong apprehension and anxiety about anything is hard on parents. It changes your chemistry, and ups your cortisol. Sensitive children will sense your strain, and this will strain them. If you’re breastfeeding, altered cortisol levels are in your milk too. Cortisol changes blood sugar metabolism and endocrine function; it can disrupt sleep, appetite, feeding, and immune response. If implementing GAPS (or any special diet measure) is exceedingly stressful, pause; relax and enjoy your children; and secure professional guidance so you don’t have to carry the nutrition-flip project on your own shoulders.
Meanwhile, here’s what can go wrong, when GAPS is the wrong tool for the job:
Fungal Failure – Recently an old study jumped out at me. It examined how children in weaker nutrition status can’t control Candida (fungal) species very well. They have more Candida, and different, more irritating strains of Candida in their intestines, compared to children in good nutrition status. The study found that for children, simply being in better total nutrition status meant better control of Candida colonization.
What exactly does this mean?
For kids, nutrition status = growth status. It is the single most potent predictor of how well a child will manage any illness or infection.
Nutrition status in kids is not a measure of how many vegetables or probiotic foods they eat. Not whether they’re gluten free, GAPS, or Paleo. Not what supplements they’re on, not whether they drink raw camel milk. No matter what a child eats, if growth pattern has wandered below that child’s innate trend, all body systems struggle more.
Even when children eat lousy processed food, if they are in robust growth status, they still have more reserve to tackle a disruptive biome. Whether it’s a fungal load in gut, mycoplasma in lungs, MARCoNs in nasal passages, or a viral story in brain tissue, there is simply more energy and building material around to throw at it, in a kid with a strong growth pattern. This is such old news in nutrition science! Learn more about the cycle of malnutrition and infection in children here.
This does not mean that the quality of your child’s diet doesn’t matter. But it does mean that even if your child eats beautiful food, if they’re in a weak growth pattern, they are going to struggle more in every way – sleep, mood, infection fighting, learning, behavior – and, detoxifying a bum biome and healing the gut.
In the study mentioned above (from 1974, back when there were no GMOs, and less processed food available than is now fed to children worldwide), the groups compared were well fed white Australian children, poor aboriginal Australian children, and poor Indonesian children. The underfed children had weak total diets, meaning they had too little protein, too few total calories, insufficient vitamins and minerals, and sparse nourishing fats. They also had more Candida.
What does this have to do with GAPS? Read on.
A small child’s immune system will sputter when s/he’s underfed – like when eating just broth for more than a week. (Or when exclusively breastfed or formula-fed, with no solid foods, past the first year. Or when on deep dietary restrictions for healthy carbohydrates – which are fundamental to steady growth in children). There simply is not enough protein, energy (calories), and nutrients around to manage, balance, and fight. If an already weak, underweight child attempts GAPS, it may fail, because s/he was too depleted for multiple immune-essential nutrients and energy (calories) in the first place. A more recent study illustrates this well known tenet in infant and child nutrition: Just by not having enough food around, the gut barrier is disturbed, and tissue damage occurs. It doesn’t take long for this to happen in young children. Adding probiotic can hasten recovery, but only when an adequate total diet is also in place.
Hence the susceptibility to Candida – and quite likely, other bad actors in a gut biome, tissues, or organs. So although this first phase of GAPS may clear out some disruptive species from the gut, it can also drop your child’s total body immune response further, and permit other bum bugs to flourish. For kids who are underweight or have marginal iron stores to start, or who have deep total body dysbiosis, this can set up for failure. The detox is too fast, and the re-build fails, because the foundation was too weak to begin with.
Even mild nutrition deficits impact immune response in children. This is one of the reasons why GAPS fails. GAPS can be too restrictive for too long to help these kids recover. Just the introduction phase of this diet can take three weeks; this is an eternity for an already underweight toddler struggling at the bottom of the growth chart. Though broths, probiotic foods and egg yolks are fabulous, this may not be enough sustenance for a growth-impaired small child whose immune system is already straining. Yes, probiotics are critical to immune maturation – but, so is food itself, to nourish the gut tissue –> that harbors the biome –> that helps the immune system “learn”.
Carbs are especially essential for children. In infancy and toddlerhood, they are the fermentable food that normal gut flora require to thrive. Healthy gut flora make fatty acids like butyrate, which in turn fuel cells building your child’s gut tissue. I’ve met many parents who fear carbs, and over restrict them in their kids. This can fail too. Non-sugary, unprocessed carbs are a cornerstone to fuel the tutorials going on in a young child’s gut, between gut flora and the developing immune system. They also fuel growth and gain, and protect the lovely fats and proteins needed for other functions. The trick is finding which ones work best for your child’s circumstance. This is something I work with closely in my practice, for each individual child.
So even though GAPS aims to eradicate fungal load by restricting all carbs for a while and by adding extremely high potencies of probiotics with fermented foods, it can backfire. I often see disrupted stool cultures in kids coming off GAPS attempts, showing weak beneficial flora and ample dysbiotic bacteria, and even yeast in some cases.
When Leaky Gut Begets Leaky Gut – Some GAPS mainstay foods are renown suspects when it comes to intolerance or allergy. Eating broth with probiotic foods for three weeks is not long enough to clear pre-existing food antibodies, which circulate for months; in some kids, for years. If a child starts GAPS with hidden food allergy or sensitivity to egg or nuts, using these daily can exacerbate leaky gut, even when using that beautiful kraut or other probiotic food. I often find strong egg and nut reactions on IgE and/or IgG panels children who have used GAPS for several months. Even yolks can trigger immunoglobulin reactions that may not show on the “drop on wrist” test suggested in the GAPS protocol.
Better move: The “dot on wrist” test may not be enough. Do some food antibody testing before you start any special diet. Identify what foods are safest to work with before you begin. Check for both allergy (IgE) and sensitivity (IgG) to several foods, and work from there. If eggs and nuts light up your child’s panel, GAPS is not for you – or, it will be a bumpier road – consider easier paths than GAPS to gut healing in this case – there are many options.
In my practice, I find that ALCAT testing is less useful. It tends to show too many reactive foods, which makes menu planning really difficult. Even when IgG and IgE panels are alight with multiple foods, in young children, it is not practical or healthful to remove them all. I will remove the top four or five offenders, rotate others, and dial in gut restoration tools suited to that child. This can include anything from simple organic aloe to direct herbal antimicrobial measures to products like Apex RepairVite to arabinogalactan, butyrate, glutathione, or a low FODMAPS + SCD compliant meal plan for a few weeks to start.
FODMAPS Meltdown – Many kids have difficulty with foods that are high in FODMAPs. Another GAPS mainstay, avocado (which is indeed a great food) is a moderate FODMAPs food that is poorly tolerated by many in my practice, especially babies and toddlers with FPIES. I am encountering many FPIES families who turn to GAPS, with poor results (vomiting to shock, blood in stool, lagging growth). Learn why FPIES may be as much about carbohydrate fermentation in the gut than it is about food protein reactions here. Meanwhile, if your child has FPIES, I would hesitate to recommend GAPS, because FPIES reactions can be severe and dangerous. I am seeing success with FPIES in my practice with other strategies, so if you need help, contact me for an appointment.
Dairy Dilemma – Dairy yogurts are another wonderful food that are simply wrong for some of us. If these have worked for your family, that is good. In my house, I can eat dairy while my husband and son cannot. I love raw goat milk. I have occasional organic yogurt binges. I eat ice cream, goat cheddar, sheeps yogurt, and whatever I want. My family can’t. I have countless children in my practice who show clean lab findings for any sort of dairy reaction from opiate formation to IgG, IgE, and ALCAT – but who still disintegrate terribly on dairy. Usually this is a “behavioral” reaction – anxiety, impulsivity, rage reactions, stilted social processing, or poor sleep. For those moms who took my advice and tried the three month, uber strict, zero tolerance dairy free diet, and your kids got inexplicably way better, got off psych meds, and started to eat better, don’t thank me – I thank you. It’s hard to go out on a limb and try something that seems to make no sense. But, sometimes, a meticulous elimination trial is the only way to know if your child really can manage a food.
Are dairy yogurts okay for your child? If you really want to know what is going on, consider doing a Cyrex Array 4 for cross reactivity testing. Your child may react to dairy foods when eaten with other foods, and this panel will find if this is true for you child. This test plus sensitivity and allergy tests (IgG and IgE) can guide you before you begin.
Did GAPS Work For Your Kids? Great! Share your success stories here, I’d love to hear them. If it failed, don’t despair. Get individualized expertise for your child’s gut healing (and thus total body healing) journey. Your child deserves to visibly trend toward thriving. If you’re still struggling, get help, give me a call, set up an appointment. There are many ways to replenish, restore, and heal the gut; it’s okay if every kid is different. Honor your instincts as mom, because they are good as gold.
Another measles outbreak made the news this week as nearly fifty cases (so far) were counted after an outbreak began at Disneyland in California. Even though “patient zero” – the individual who was the source of the outbreak – has yet to be identified, the usual scare-mongering was in force with grim reminders of deaths from measles: 123 to be exact, in the US, over a three year period from 1989-1991. What we never learn is whether these deaths happened in vaccinated or unvaccinated children, or what background health problems or nutrition deficits they may have had to make them vulnerable. We don’t know if patient zero was vaccinated, but odds are strong that s/he was – see below. We are simply (mis)led to believe that because somebody wasn’t vaccinated, somebody died, or will die. The “anti-vaccine movement” is blamed, again.
But here are the facts, straight from the CDC’s mouth:
• Nearly 95% of US children are vaccinated against measles (2014 measles vaccine coverage data)
• Deaths from measles in the US dramatically dropped to fewer than 2 per 100,000 by 1945 (see page 93 here), nearly twenty years before a vaccine existed.
• Measles vaccine has been failing since the early 1980’s, with dramatic outbreaks spreading through fully vaccinated populations. Despite this investigation being published by the CDC itself, media outlets today keep telling us that this only happens because of people who don’t vaccinate. Earlier this year, even Science Magazine made this very gaff, with a headline so dramatically wrong it’s almost comical: “Measles Outbreak Traced To Vaccinated Person For First Time “.
Even though these periodic outbreaks continue despite nearly every child in the US getting MMR shots, the CDC, your pediatrician, school principal, neighbor, auntie, and everyone else will tell you it’s your fault there’s an outbreak, if your child didn’t get an MMR shot. Even if your child is well while all the vaccinated kids are getting sick with measles, they will still believe this to be true and will still blame you for it.
That’s when you might whip out this pearl: “This outbreak demonstrates that transmission of measles can occur within a school population with a documented immunization level of 100%” (see 1980’s link above). There you have it: Every kid in the school where this outbreak occurred had been fully immunized. Every. Single. One. And this is not an unusual scenario.
If that doesn’t seem crazy enough, here’s how the CDC explained this disconcerting fail of MMR vaccine, in the carefully investigated and documented 1983 outbreak: “…this outbreak may have resulted from chance clustering of otherwise randomly distributed vaccine failures in the community.” Of course, this missive wraps the topic by saying it’s important to get vaccinated. Meanwhile, acquiring measles infection from vaccination itself has been documented.
Obviously, MMR vaccination is not eradicating measles. It may even be spreading measles. And risks from this vaccine are real. Personally, I have worked with many families who are certain that the descent into autism that their children experienced was due to an MMR shot. Reviewing their medical charts carefully, I can’t disagree. What’s a parent to do?
This is a huge topic, and I can’t begin to tackle it in a single blog. For more on why measles vaccines may be failing us more than we know, start here.
Still, I would say this: Fear not. My siblings and I grew up in the era when your pediatrician was worried if you didn’t get measles, not the other way around. Measles, chickenpox, and mumps infections were regarded as beneficial childhood milestones that developed a vigorous, healthy immune system. Measles infection was so benign for healthy children that our lexicon created the word “measly” from it – meaning, insignificant, or “contemptibly small“. How times have changed! Pediatricians today who are under forty years old may never have seen a healthy child with measles in the flesh, and may be ill-prepared to nurture and nourish that child through it.
Food and nutrition support children in having an uncomplicated course of infection. While a well nourished child who gets measles is going to be sick for a week or two, complications from measles are what can be life threatening, more so than measles itself. These can include pneumonia or encephalitis. But these are extremely rare in children who are healthy and in strong nutrition status, before exposure. This doesn’t mean that sprinkling a poorly nourished child with supplements during fever and illness will do the trick (though certain ones may help). Here’s what that means:
– Measles infection and measles vaccination as MMR both present vigorous demands for the immune system. Your child’s nutrition status before, during, and after exposure can determine the severity of illness/reaction and whether or not there are complications. While sick with measles, your child probably won’t feel like eating, will have a fever, and may have diarrhea. Measles exposure (natural or injected) triggers changes in gut tissue and immune function, causing children to lose protein in stool during this illness, when the immune system most needs it. Replenish your child daily with good food during this infection. If they feel too nauseous to eat, feed organic beef broth or bone broths that are not low sodium – your child needs electrolytes here. Stir a half teaspoon of ghee or grass fed butter (a vitamin A source) into the broth. Give electrolyte drinks and any protein rich foods they will accept. Lactose intolerance is a documented effect for some children exposed to measles, so if dairy foods that your child usually loves suddenly feel awful during this illness, switch to non-dairy protein sources like egg, meats, chicken, homemade broths, or any tolerated legumes/beans/peas. Elemental amino acid formulas and supplements are available too. Contact me if you need more information on these products.
– Your child’s weight relative to his height should be in a healthy range. Body mass index should be above 10th percentile. Underweight children, especially those with a body mass index or weight-to-height ratio below the fifth percentile, are at higher risk for infection in general and for more complications from infections. Though we often hear about childhood obesity in the US, most children in my practice are struggling with gaining weight and growing – and these are kids who get sick more often, stay sick longer, and have more complications.
– Iron status should be robust. The best way to measure this is to check a child’s ferritin level. It should be at least 30, though reference ranges drop to 10. Signs of weak iron status include pallor, veins visible through skin, shiners at eyes, penchant for chewing ice or other non-food items (sticks, rocks, sand, pens, paperclips, fabric), fatigue, intermittent hyperactivity, depression or mood swings, or poor sleep. Teen girls may have heavier menses when iron deficient. Iron is the single most commonly deficient nutrient world wide, including in US children.
– Vitamins A and C should be strong in your child’s diet every day. These are specifically protective for measles virus and will be depleted by the demands made on the immune system if your child is exposed. Cod liver oil, whole milk or butter, brightly colored vegetables and fruits are all good sources, and can add omega 3 fats also, which help modulate immune function.
– Zinc status should be strong. Eat zinc rich foods daily – raw cashews, nut butters, pumpkin or sunflower seeds, pork, lamb, beef, mushrooms, or legumes and beans are good sources. You can also use a supplement to 15-30 mg daily for children in most cases.
– Give your child strong protein status so his immune system has the building blocks needed to make globulins and other immune molecules to mount a defense. Your child should be eating at least 35-60 grams protein daily depending on age, from varied sources (that is, not just milk, cheese, and yogurt – see my blog on dairy addiction if that is your kid).
The role of nutrition in preventing measles and lessening the impact of this infection is legendary in public health circles, and has filled volumes for decades – from vitamin A status as a predictor of measles deaths, to how fish oils modulate certain immune proteins in our bodies. Your child can have marginal status for any of these nutrition factors without your pediatrician’s notice – a scenario I routinely find in my pediatric nutrition practice. Pediatricians have little training in applied nutrition, and even less time to use it in clinic, where they must turn over dozens of patient visits per day. If you’re not sure what your child needs to build strong immunity, contact me for an appointment.
How was your child’s school physical, did you talk about upcoming flu season and how to use nutrition and food to stay healthy?
Probably not, but you likely were encouraged to get a flu shot for your child, even though they have a fairly poor record of success. Plenty of not so subtle efforts are afoot to pit parent against parent and doctor against parent, sadly. Increasingly, parents come to my office with anxiety over pressure felt socially, at school, and in the doctor’s office to “just do it” – vaccinate to the CDC’s specs – regardless of a family member’s medical needs, history, ethical or efficacy questions, or existing laws that protect choice.
How bad can it be? Well, it has gotten grim. In Africa, a report has been made of children have been vaccinated at gunpoint. In 2007, Maryland schoolchildren were rounded up into a courthouse and forcibly vaccinated under watchful eyes of armed officers and police dogs. And in 2011, a Chicago mother was held in a gunpoint stand off with police after she refused to continue Risperdal for her daughter, a medication that the girl tolerated poorly.
School physicals are where the pressure may be at its worst. Many parents believe if they don’t vaccinate their children, school access is denied – a fallacy not upheld by existing laws nationwide. Most states have exemptions to permit individual needs around vaccination. Your child can go to school without following the CDC vaccine schedule, in most states. This may not be easy, but your child’s health and safety are too precious to risk, if any possibility exists that a vaccine may trigger a reaction – which I have witnessed many times, in my twenty odd years in pediatric nutrition practice.
There are many reasons to individualize vaccination schedules, like any other medical treatment. Some children have allergies to ingredients in shots (click here for vaccine ingredients, and here for information on traces of nuts in vaccines), or family history of adverse reaction. Every parent should know the eight questions to ask before giving any vaccine to a child.
Manage the pressure at your child’s next physical by presenting some of the information below. If your doctor won’t discuss it, consider finding a pediatrician who respects your concerns. A naturopathic doctor or osteopath are often informed on options beyond vaccines for preventing and treating infectious diseases, such as how to use food, nutrition, and herbal tools to support the immune system. Chapter 6 of this book explains how to find different types of providers; another chapter explains how to use nutrition to stay healthy and avoid infections. Here are points to discuss with your child’s health care provider:
(1) Vaccinations can spread disease. They are supposed to prevent disease, but disease transmission from vaccines has been repeatedly documented. If your child just started school and just got sick, proximity to newly vaccinated peers may be a factor. Here are examples:
– Flumist vaccination showed a 2.5% rate of transmission from recently vaccinated to unvaccinated persons. Meanwhile, getting no vaccine for flu at all showed only a 4% risk of flu – which means that getting this vaccine not only makes an arguably insignificant difference in protecting you from flu, it may actually spread the flu as well.
– Polio vaccine is a documented source of polio infection. According to the CDC, cases spread by polio vaccine are essentially identical to wild type cases – meaning that the “protection” from vaccine was just as dangerous as actual infection.
– Prevnar vaccine has been shown to worsen the virulence of pneumococcal bacteria strains in sputum of vaccinees – meaning that children given Prevnar can spread more virulent bacteria than unvaccinated children.
– Chickenpox (Varicella) transmission after vaccination has been documented, and is most likely if a rash develops after getting the shot. Even MedLine Plus states that vaccinated children can still get and spread chickenpox. Chickenpox outbreaks continue to occur even in highly vaccinated populations.
– In recent pertussis outbreaks, many of the infected were vaccinated. Click for another study that showed the same finding. Some speculate that vaccination has triggered a new more virulent strain. Meanwhile, pertussis continues to circulate at the same level as it did prior to use of any vaccine. Boosting preschool children with pertussis vaccine has correlated with an increase in cases in adults and teens. Pertussis vaccines (DTaP) are the most frequently reported for injuries they cause to infants.
(2) Vaccines can fail. They can fail to protect entirely, or may create a weaker, false, or transient immunity – meaning that it may be easier, not harder, for diseases to spread in vaccinated populations. Flu, pertussis, pneumococcal infections, measles, mumps, and chickenpox have occurred in highly vaccinated populations. In spite of this, health officials still believe vaccines are successful, still insist unvaccinated persons in good health spread disease, and still urge us to get vaccinated! Examples:
– A study in Canada found measles outbreaks occurring in populations with over 90% vaccine compliance but sill blamed measles cases on unvaccinated persons.
– MMR vaccine failures are documented; waning immunity to measles caused by use of MMR is a frequent concern in the medical literature. Teens vaccinated as toddlers may be especially vulnerable.
– This study in the Marshall Islands decided MMR vaccine was a success even though, once again, an outbreak occurred with high vaccination compliance. Giving extra doses of vaccine was touted as the cure for the epidemic – it may have run its natural course anyway. Poor sanitation, poor nutrition, and crowding – all known factors in disease severity and transmission – may well have caused it in the first place.
– Chickenpox (Varicella) vaccine failures are noted above. Another pitfall introduced with chickenpox vaccination is the rise in shingles, a more severe and painful infection with Varicella virus that afflicts older persons. Without frequent boosting from naturally circulating chickenpox in children, older persons may suffer waning immunity to the virus, thus becoming more susceptible to shingles.
– Some argue that when data on infectious disease are juxtaposed with timelines for when vaccines were introduced, it’s noticeable: Vaccines may not have prevented much of anything. Infectious disease may have dropped mostly due to vast improvements for hygiene, nutrition, and advent of antibiotics in the twentieth century. Some infectious diseases indeed trended downward in a dramatic way, well ahead of widespread vaccination.
(3) Vaccines don’t reliably protect the herd. The mainstream medical community believes that you have been “immunized” once you develop antibodies to a disease, and that if enough people are vaccinated, “herd immunity” kicks in – that is, there are enough people with immunity to keep an outbreak from occurring. But outbreaks are documented in highly vaccinated groups – proving that vaccines don’t reliably confer herd immunity.
Flu shots are especially encouraged for anyone with a health condition that might make them more vulnerable to infection. But this may be more wishful thinking than reality, according to a prospective cohort study of 263 children that found that “children who received flu vaccine had three times the risk of hospitalization, compared to children who had not received the vaccine.” For children with asthma, the risk was worse.
(4) Vaccines contain highly toxic and highly allergenic ingredients. Read vaccine product inserts (available on line) before you go to the doctor’s office – these are lengthy documents that you might want some time to understand. The prevailing belief is that the small amounts of toxins and allergens in vaccines are safe to inject. But would you let your child lick even a tiny amount of formaldehyde? How about mercury? Many are concerned that industry interference has kept safety standards dangerously low for vaccines, and no review had been made of the cumulative effects of repeat injections.
Children who are allergic to egg or pork may need to skip flu shots, since several brands contain these. Nut oils are a controversial ingredient that manufacturers have not had to disclose to the public, under current laws protecting proprietary formulations. Mercury remains in about half of flu vaccines brands, and other shots given to kids. MSG (monosodium glutamate) is in some vaccines, so if this is an ingredient you avoid in food, you won’t want to inject it. Vaccines may also contain formaldehyde, aluminum, genetically modified viruses, yeasts, and bacteria, along with antibiotics, human tissue components (from aborted fetal tissue), and proteins or tissue components from monkeys, chickens, pigs, and cows.
(5) Deciding to defer shots? Then it’s important to keep your child’s immune system healthy. This is where nutrition can play a starring role. Children need varied diets. They should be amenable to accepting many fruits, vegetables, protein sources, and healthy fats and oils. All of these contain nutrients essential for good immune function. If your child is a picky eater who sticks to starchy processed stuff – like Goldfish crackers, sweetened yogurt, breakfast cereal, bread, and milk – you have your work cut out for you. You may need to supplement to add protective nutrients, though foods are the best sources.
– Vitamin A’s protective effect against measles and other infectious diseases is legend in public health nutrition circles, and was recently revisited in British Medical Journal. Cod liver oil at ½ to 1 teaspoon daily is an adequate amount for children in normal nutrition status. Vitamin A rich foods (or foods with lots of vitamin A precursors) are easy to get if you have a juicer or good blender. Try tomatoes, carrots, kiwi, papaya, spinach, kale, or peaches if you’re juicing. Cooked pumpkin, yams, beets, or butternut squash are good sources if you’re cooking. A pressure cooker makes this job fast and easy; baking is easy if you can plan ahead.
– Zinc and iron keep key detox and immune proteins functioning normally. Organic grass fed beef, pork, nuts, seeds, pumpkin seeds, lentils, and spinach are good sources. If your child’s diet is void of these, have your doctor check ferritin level to see if an iron supplement is needed. Iron supplements can be poisonous, so use them only with supervision. Zinc is safe to supplement, and can be purchased in kid-friendly chewables, liquids, or teas. For children eating poor diets that lack mineral-rich foods, give 15-30 mg of zinc daily.
– Underweight children may get sick more often. If your child’s body mass index is below 13 or 14, or below the tenth percentile for his or her age, s/he may be healthier with more weight. Allow liberal servings of healthy foods and fats/oils like avocado, organic eggs, ghee (clarified butter), organic butter, olive oil, flax oil, nuts and seeds, sesame tahini, or coconut milk curries. You can check your child’s body mass index here.
– Vitamin D has an excellent track record for preventing flu and reducing incidence of complications from upper respiratory infections. Give children 1000-3000 IU daily in drops, or allow time in the sun, to get healthy doses of vitamin D.
– Remove foods that trigger wheezing, runny/stuffy nose, itchy rashes, or other signs of inflammation. Your child’s immune system will be more organized to fight true infections if allergens are off the table.
– Add a high potency probiotic – at 15 billion colony forming units (CFUs) per dose or higher. In my practice, some children do best at very high doses – up to 250 billion CFUs/day. This varies widely, but don’t give up on probiotics until you’ve tried a high potency blend for at least 2-3 months for your child. These not only improve digestion and protect the intestine from invading pathogens, they can help fight colds, reduce eczema, prevent flu, and lessen respiratory infections too. One of my favorites is Klaire Labs’ Prodegin, a high potency, soft chewable for children. You can order Prodegin from this link, or directly from Klaire Labs (authorization code is required; use 825).
Poor outcomes happen to children from vaccines on a daily basis. In fact, the government has been compensating families for vaccine-triggered injuries and deaths for over twenty years. So before you let your children join the millions of students getting vaccinated for school, talk through these issues with family and health care providers. Find solutions that gift your child with good health.