Not at all to diminish the important work and skills of occupational and physical therapists. They work hard at helping kids learn to chew, swallow, touch, and tolerate the act of eating – kids who are tube fed, kids who’ve never mastered chewing by age four or six years, kids who only drink but can’t eat, kids who gag and vomit to different food textures, kids who stop eating at the slightest interruption or sudden sound, kids who are in growth failure because they can’t eat. This is important work.
But there are important underlying triggers for these feeding problems to rule out and repair, before you spend thousands on sessions in which you sit behind a two way mirror and watch your child try to touch whipped cream, corn chips, and broccoli with peers, before the rigorous home sensory protocols before each meal (trampoline, Nuk massage, Wilbarger protocol), not to mention stringent food routines at the table.
If your child has had a traumatic brain injury, a spinal cord injury, began life on a feeding tube, or has a physical or developmental disability that impedes feeding skills, then of course rehabilitative therapy is in order.
And, after you’ve been through challenges unimaginable when you became pregnant – that is, the challenge of your kid actually not being able to eat, gain, and grow – and your child has suffered, you’ve been to every specialist, and you know your local children’s hospital hallways backwards and forwards, it can feel downright offensive, insulting even, that there may be something simple, overlooked, that could fix this. Wouldn’t your team have told you?
A lot of parents get stuck right there. They outright reject that a solution as simple as correcting nutrition and digestion first could be a thing. Unless this is a complex, inscrutable drama that requires ivory tower specialist care, and week after week with an occupational therapist, a lot of folks feel like bad parents. So they turn away from the simple.
Don’t!
Forgive yourself for not knowing. Forgive your care team. Occupational therapists, GI doctors, and even pediatricians are not nutritionists. This isn’t their purview. If they had known, they would have told you, of course!
For kids who go from infancy to preschool with a mysterious lack of progression for feeding skills, screen for underlying physiological triggers that can keep your child from being able to swallow, chew, and eat normally. Even for kids with physical disabilities and complex conditions who benefit from feeding therapy, footwork on these underlying interlopers can make eating work even better.
Also, know this: I had one of these kids. Been through it, seen it, worked with OTs and PTs (some fabulous, others not so much). I know the trauma, cost, and stress that accompanies this situation. And, yet another mom just left my office today, telling me with deep exasperation what a waste of time (and money – thousands of dollars, not covered by insurance) it was to send her young son to a renown feeding clinic, for months, carefully following instructions for the home plan too, only to get feeble progress out of it at all. Is this you?
Before you go through costly, strenuous therapy that may inch your child forward, but not quite produce the progress your child deserves to grow, thrive, and just plain enjoy food – investigate these problems. Your child will be healthier, because they will be able to digest and absorb food more comfortably.
Nutrition and digestive problems turn kids into picky eaters
Fix these, and their appetites can quite abruptly improve. If you need help fixing these, schedule an appointment with me. You may see changes in as fast three to four weeks, depending on your child’s condition at start, and your compliance with a nutrition and gut health care plan tailored to your child. Here we go:
1 – Fungal Dsybiosis: Your child may have had thrush, you may have had a C section, maybe there were antibiotics in the mix for you while pregnant or breastfeeding, maybe you have a lot of yeast infections in your past, or maybe your child needed antibiotics early, often, or both. Whatever. Somehow, your child may have been left with a fungal burden somewhere in the digestive tract. What this does is (a) buffer the stomach so it is less acid, which makes you never feel that hungry (b) constipate you so you never feel like eating because you are always full of ______ (c) give you serious cravings for very few foods, namely, starchy sweet stuff, or dairy food and (d) bloat your belly. Solution: Screen for fungal dysbiosis with stool or urine testing; ideally include Candida and Saccharomyces antibody testing too (blood tests). Give a protocol to drop the fungal burden and restore healthy gut bacteria balance. Your kid will feel more hungry, poop more regularly, and will want new foods, usually in about 3-4 weeks. Other nutrition measures may be needed, but this is a foundational piece that can relentlessly dog kids’ appetites. Note: Probiotics can help, sort of. The stuff on store shelves is usually too low potency to make a dent for kids who truly have a significant fungal burden in the gut. If you’ve used them and your kid is still picky, they’re not working, and you need a deeper strategy.
2 – Bacterial Dysbiosis:Your child may have a bacterial imbalance in the stomach, upper small intestine, or colon. This can make eating very uncomfortable. The small intestine normally harbors little bacteria; when too much is there, kids can have a lot of trouble eating. This will continue until these infections are treated. This is called Small Intestine Bacterial Overgrowth (SIBO), and your doctor may need to prescribe antibiotics to treat it. Some herbal treatments work well also; probiotics can make it worse. Kids with bacterial dysbiosis feel full quickly. They may gag, or vomit violently, even to the point of shock (they go limp, become pale, you may have even rushed them to the ER where they needed IV fluids – this is FPIES) if they eat the wrong foods. Pressing children to eat when an infection is active in the gut is truly unnecessary and will be unsuccessful too. Solution: Talk with your GI doctor or pediatrician about possible SIBO. And, do functional stool testing such as GI MAP (one of the tests I use in my practice) to identify what microbes may be interfering. This test can give detail on what your child needs to balance bacteria in the digestive tract, so they can eat and digest food more normally.
3 – Reflux Medications: These drugs, which are not approved for use in children by the way (with one exception), diminish digestion by reducing acid in the stomach. Great for an initial reprieve from what may (or may not) be a painful reflux, but bad longer term. The more stomach acid is reduced, the less your child is able to digest food, and the more food will sit in the stomach and – you guessed it – reflux up to the throat. Many kids in my practice end up on highest allowable doses of these drugs, but still have feeding problems with weak appetites and texture aversions. Reflux medicines also exacerbate fungal infections in the digestive tract, creating even more dysbiosis and difficulty with feeding and eliminating. Solution: Unless your child needs “mercy” dosing of a reflux medicine to ease pain, talk to your doctor about weaning off of it. For more help with that process, check this blog and contact me for an appointment.
4 – Weak Iron and Zinc Status: These minerals have a lot to do with what we feel like putting in our mouths. Even adults with poor iron or zinc status will do weird things like hang around, sniff, or even lick gas pumps, chew on paperclips, or refuse to eat vegetables. If your child is mouthing objects beyond early toddlerhood, or insists on eating non food items into school age years, it’s time to straighten this out. It could help normalize eating “behavior”. Solution: Have your pediatrician run labs for ferritin, serum iron, transferrin, iron binding capacity, and serum zinc. These should be solidly in the middle of the lab range – not near either end. If these labs come back looking a little weak, get guidance on supplementing these minerals. Iron and zinc won’t be well absorbed, by the way, if your child takes a reflux medicine – so this is another reason to get off that stuff. It reduces absorption of minerals and B vitamins. Not what your child’s developing brain needs.
5 – Opiates: Wow, what WHAT? Yes, your kid might just be a little high on opiates all day long. Common signs: Do they wake up from 1 to 3 AM all silly or active? Are they constipated? Do they have a crazy voracious appetite and a big head (above 90th percentile)? Are they verbally delayed? Do they bang into stuff and never cry about it? Do they really, really seek proprioceptive input, to the point of endangering themselves? Are they hyper? Do they meltdown fiercely when hungry, or if you don’t hand over that favorite mac and cheese, yogurt, or noodles and butter STAT? Addictive, opiate-like neuropeptides can form from wheat, dairy, and soy protein in a gut with certain digestive impairments. This will make a child relentlessly, extremely, fiercely picky for wheat and dairy food (maybe a little soy too). Yes, food proteins can be misappropriated into compounds that look like opiates to the brain. This happens when digestion is weak and the gut is too permissive; that is, the intestinal wall lets bigger-than-it-should molecules across into circulation, something a healthy intestine won’t do. These opiate-like compounds have various names: Dietary peptides, polypeptides, casomorphin, gliadorphin, or exogenous opiates. Urine screening is available to identify these. These will cause a lot of problems, including stunted language development, social delay, some crazy, even violent or aggressive behavior – and, uber picky eating. Feeding clinic will go nowhere if your child is swimming in opiate like peptides from milk, yogurt, Pediasure, bread, pudding, crackers – any wheat or dairy food. It’s all your child will want to eat, and anything that looks or feels different will be a non-starter. Solution: Start with my e book on milk addicted kids. If you need help getting your child out of this hole, set up an appointment to get started. Your child may need a strict gluten, casein/dairy and soy free diet (the prime opiate offender foods).
Get your kids clear of these five physiological problems and you may be amazed at how swiftly they graduate out of feeding clinic. Ignore any one of them and it is going to be a longer haul. Check out my quick video recap, click here. Thank you for stopping by.
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
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!
I’m now serving my second generation of clients, working with moms who where were not even born when I finalized my credentials as a dietitian/nutritionist. Recently I did a double take noticing that a young mom I was working with was born on my wedding day – Wow!
It has been quite a journey. I’ve watched earlier clients’ kids, and my own son, grow up to be more functional and able, after rocky and uncertain beginnings. But I have some bad news for you young moms: It is a lot worse out there than it used to be. It’s very different for you than it was for my generation. There’s a whole new normal, and it ain’t pretty.
During my graduate years in public health nutrition, this was unthinkable. CDC goals we worked with then have not come close to being met. We’ve not only fallen short, we’ve actually violated the very first goal to “prevent morbidity and disability “- ! Both have increased dramatically for US children in the 21st century.
Type 1 diabetes has quadrupled. Children under age 10 are now getting diagnosed with Type 2 diabetes – actually unheard of when I was trained in the late 1980s; this was only diagnosed in overweight, middle-aged people at that time. At least 80,000 kids in the US are diagnosed with Crohn’s disease, a severe and chronic inflammatory bowel disease, and its incidence in children is increasing. I meet kids each month who have similar symptoms but have never been diagnosed, and I just worked with my first toddler diagnosed with Crohn’s disease this spring. During my training, this wasn’t even mentioned as a condition that a young child could have. Even the phrase “toddler diarrhea” didn’t exist (diarrhea is not a developmental phase!). Babies and toddlers were not diagnosed with, or given medications for, GERD (reflux drugs like Nexium came to be so overprescribed, they were called “purple crack“). Asthma, cancer, allergies, and of course – autism – are all increased far past their 1985 levels, with no signs of slowing down. And are you tired of hearing yet that autism has shot up nearly 150-fold since 1975, and that some estimate that half of US children will have it by 2025? How will this country function, populated by sick and disabled adults? How will we pay for their care?
Those are big questions. But here is the question that has had me scratching my head for the last twenty years: What are our pediatricians doing about it?
Are they even thinking about reversing these trends, in any meaningful way?
If they are as young as you are, it’s doubtful they know how miserably we failed at reaching the CDC’s goals from the late 20th century, for population health. Or that they’ve had much of a deep dive into child nutrition and its role in development, learning, behavior, and immune strength. I also do wonder if they know what it’s like to see kids who never need any prescription drugs, because they’re just …healthy.
Being sick repeatedly throughout the year, needing multiple rounds of antibiotics, being developmentally delayed, having an impacted, inflamed, or ulcerated colon, being unable to eat anything but milk, yogurt, or Pediasure, or having only loose, burning, foul stool or impacted hard stool may be common nowadays, but it isn’t normal.
Your kids should be healthy, comfortable, vibrant, eating, eliminating daily, sleeping well, growing, playing, and thriving! If they can’t because of a chronic condition, then they still deserve to reach their fullest potential, enjoy their highest well being, and feel good as often as possible.
From my perch as a pediatric nutritionist/dietitian, I have watched it get harder and harder to restore kids’ health, away from the chronic gastrointestinal, feeding, growth, developmental, and allergy/immune problems they have. Kids bodies seem more compromised, their immune systems more confused, their intestines less functional. The work is more complex than it was in 1998 or 2000. Diagnoses like FPIES (which my own son had in 1996, before there was a name for it), milk protein intolerance, food allergies, intolerance to breast milk, and EoE are not unusual now, but they earned no mention during my training in infant and child nutrition in the late 1980s.
I often wonder how pediatricians of my generation reconcile this. Do they notice, like me, that children are sicker, as government data show?
Moms under 35 have it rough. You are..
The first generation to grow up with more antibiotics, vaccine doses, psychiatric medicines, and just plain more prescription drugs than any other.
The first generation to grow up eating GMO foods.
In the years you were conceived, patent and marketing laws for drugs changed – and dozens of new drugs flooded the market, whether we needed them or not, and regardless of non-drug options that may have worked as well or better.
Environmental protection laws are either being stripped or unenforced, allowing more toxins into air, water, and food.
You are now bearing children with more toxic burden than any parents before you in America’s history.
In short: It’s a lot harder to have healthy kids these days. Your bodies were exposed to more toxins, sooner, than people of my age. And now your children are exposed to all of this even before they’re born, in utero.
So now what? It’s simple: Remember that your kids get to be healthy.
That is their birthright, and their normal. Expect them to be healthy, not chronically sick. But you have to do some serious footwork, even before pregnancy, to help them get there. If your kids are already here on the planet, there is a lot you can do to diminish their odds for chronic disease, developmental injury, and psychiatric conditions. If your kids are already affected by these problems, there is still plenty to do with food, nutrition, and good support for immune function and detoxification – you might be surprised to see how well your kids can be.
Here you go:
Eat organic whenever you can. It matters. I actually did some work on this during my graduate studies (eons ago) and found that yes, organic foods are more nutritious, and have fewer toxins (though not toxin free, thanks to widespread use of pesticides and GMO crops in the US).
Don’t eat GMO food, period. Minimize it as much as possible. Here’s why.
Find out if your kids have food sensitivities or allergies; feed them foods that nourish deeply, not foods that chronically inflame.
If your kids need antibiotics, restore healthy flora – you will know it worked by appearance of a daily, comfortable elimination (no bloat, hiccups, burps, picky eating, straining, watery stuff, mucus, dry pebbles, or foul odor – just formed easy to pass stool and healthy appetite).
Drink filtered water, not tap water. Put filters on shower heads. Or, consider a whole house reverse osmosis water filter.
Don’t use plastic containers for food. Avoid plastics, xenoestrogens, and xenobiotics in lotions, shampoos, soaps, or foods.
Eat more vegetables, more plant foods, and less meat and sugar than you want.
Eat loads of ancestral, organic fats and oils.
Don’t have a C section if you can help it. If you can’t, seed your baby’s gut biome with probiotics or your own flora.
Don’t get vaccinated while pregnant. It can increase your risk of miscarriage, and it delivers toxins like aluminum, mercury, and rogue viral or human DNA into your body. Effects of vaccinating pregnant women on their unborn children for asthma, allergies, or other immune mediated conditions are unstudied.
If you need antibiotics during pregnancy, delivery, or breastfeeding, take all precautions to restore your baby’s gut flora with probiotics and a healthy diet.
Read this 2017 study on the health of vaccinated versus unvaccinated kids. Choose soberly what you want to do.
Those are good starts – a big effort, yes; harder perhaps, but the upstream work is well worth it if there is a chance it can prevent burdensome chronic conditions in your kids. If you need more specific guidance for your own child’s situation, contact me for an appointment and we can get started.
Miralax is one of the most commonly prescribed drugs for infants, toddlers and kids. It was available by prescription only until 2006. Even then, it wasn’t FDA approved for use in kids. Despite this, the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) heartily endorses its use in babies, toddlers, kids and teens. It contains ingredients found in anti-freeze. Concerns for its toxicity have mounted – which is warranted: One child in my practice slipped into a coma during an in-patient, closely monitored procedure to give high doses of the laxative ingredient in Miralax (polyethylene glycol 3350) to clear a fecal impaction. So many parents have voiced concerns for reactions to Miralax that there is even a Facebook group just for this, a class action lawsuit, and consumer advocates who have pressed the FDA for answers on how often and freely doctors place children on Miralax.
The label states it is only to be used by adults for up to seven days – but children have entered my practice who have been on it, with their gastroenterologists’ blessing, for years – which is not unusual. And when I meet these kids, they are still constipated, still unable to move bowels without drugs or suppositories, still picky eaters, and they don’t feel good. Their parents want them off Miralax, and so do I. Having messy, uncomfortable “applesauce” stools every day – or none, not to mention side effects like bloating, gas, or psychiatric changes – is not healthy.
Get More Help! Jump to my Peaceful Pooping e-book to tap deeper and more detailed strategies to quit Miralax. Includes access to my top performer supplements, herbs, and probiotics that I have used in practice. To jump right to my product picks, click here.
The Truth About Miralax Use
The truth is, besides reaching a dangerous level of toxicity for some children, Miralax does not treat causes of constipation. What it does do is turn stool into mush, by pulling more water into the intestine. Children can go from being impacted with hard dry feces – which is indeed uncomfortable or painful, and important to resolve, since this encourages toxins from stool to be reabsorbed – to expelling some mushy stool regularly. Even still, kids can be left with blobs of sticky festering fecal matter throughout the colon, despite using more, more, and more Miralax.
For kids on Miralax for a long time, a common problem that I’ve encountered in my pediatric nutrition practice is “overflow diarrhea”. In this scenario, blow outs of loose stool happen every few days, with or without firm, hard, or dry plugs of stool. This overflow seeps around impacted stool matter, causing staining in pants that kids (and even teens) can’t control. For toddlers, it can explode up the child’s back and and down to ankles. Many moms have described to me the daily chore of stripping kids down, bathing them, and getting fresh clothing because this pattern covers their toddlers or babies in stool. Older kids experience embarrassing stool accidents with this pattern. Needless to day, this is exasperating and concerning for parents – and miserable for kids.
There are other solutions! They are non-toxic, safe, and effective. My top three interventions for constipation are…
1 – Assess and clear fungal infections in the gut.
Prevailing thought in gastroenterology today dictates that fungal infections rarely warrant attention, unless a person is showing clear outward signs – like thrush at tongue, persistent itchy dry patches on skin, vaginal yeast infections, and so on. Even then, a topical medicine may be the only offering. People who are immune suppressed may also need anti-fungal medication. It’s hard for them to fight off any infection, and having a fungal burden makes this even harder. In that case, an oral dose may be prescribed.
It’s rare for a gastroenterologist to regard fungal infections in the gut as a problem or to prescribe an oral medication for it. A pediatrician usually won’t either. The belief is that fungal microbes (yeast, Candida, mold) are normal residents in human intestinal micro-biomes, and relatively harmless.
True enough – if there is little to no fungal growth in there. A lot of fungal microbial overgrowth is not healthy, and can cause problems like constipation, leaky gut, bloating, gas, sugar cravings, picky eating, or behavior issues especially in kids. Without testing stool specifically for fungal burden, this problem can continue unaddressed. Kids can have fungal infections in the gut while not otherwise showing signs like recurring rashes or thrush. Antibiotics, C-section delivery, prior thrush, and long term use of reflux medicine or steroids are just a few ways that a fungal burden can take a commanding posture in a child’s gut microbiome!
If your baby or child has had thrush – that is, a white coated tongue, or a diaper rash with white patches in stool – an anti-fungal medication may be offered, because thrush is a kind of fungal infection. But fungal load can persist deep in the GI tract, which, don’t forget, is several feet long. There is plenty of space between mouth and anus for fungal microbes to thrive. Yeast and fungal microbes can occur in the small intestine under certain circumstances, as well as in the colon. Just because the white coating on the tongue is gone, and the diaper rash too, does not mean the fungal infection is all gone. A lengthier course of medication can clear the problem, if it is lingering in colon or intestine.
Stool tests that screen for fungal dysbiosis are not routine in pediatric gastroenterology, but many functional medicine providers offer this test. I often use these in my pediatric nutrition practice too. Why? Because fungal overgrowth in the gut can be very constipating. A simple but thorough treatment with anti-fungal medicine may fully resolve years of Miralax-dependent constipation. I have observed this many times in cases where a patient’s prescribing MD was willing to give it a try. Anti-fungal medications like Nystatin or azole antifungals can do this.
There are few anti-fungal drugs available, which is one reason why doctors are hesitant to use them unless they really have to. They don’t want resistance to develop against these drugs. But if a child is so constipated that they’ve spent years unable to eliminate normally or painlessly, they suffer side effects from Miralax, or they can’t eat well, grow, or thrive, and quality of life is greatly compromised, then your doctor may be willing to help.
Herbs can help keep fungal infections cleared out too. Common tools include tinctures or capsules of oregano, thyme, grapefruit seed extract, goldenseal, berberine, uva ursi, caprylic acid, black walnut, garlic, undecylenic acid, and many others. Capsules and liquid tinctures are available – these are best used with guidance. See my e book Peaceful Pooping for more details, and set up your own access to my nutrition dispensary here to browse.
Olive leaf extract has activity against fungal strains like Candida albicans.
Probiotics can often resolve milder constipation. But for kids with a longer history of constipation severe enough to require clean outs and medication, I have not found probiotics alone to be effective. Combining a probiotic regimen with herbal or prescription treatment can work best.
Here’s a clinical pearl: A popular probiotic used for intestinal fungal infections is Saccharomyces boulardii (“Sacc B” for short). I see most success in my pediatric nutrition practice when using this short term, that is, for 2-4 weeks. Sacc B is itself a yeast species. When used for longer periods, in my experience, it starts to act like more of a burdensome fungal microbe than a helper. An ideal product for this is Klaire Labs ABx Support. You can join my professional grade FullScript dispensary here to view this product.
While Miralax is not FDA approved for youngsters, anti-fungal medicines like Diflucan and Nystatin are. They can do a good job of clearing constipation from fungal infections. Explore this with your doctor if your child has been constipated for a long time.
Like Miralax, reflux medicines are widely prescribed for babies and kids – some say over prescribed. Prilosec (omeprazole), a proton pump inhibitor (PPI) reflux medicine, is one of the top ten drugs prescribed in the US. The FDA has not approved PPIs for use in infants or children, unless a diagnosis of erosive esophagitis has been made (this requires endoscopy). Still, I routinely encounter infants and toddlers in my pediatric nutrition practice who are given reflux medicines with no diagnostic testing. As is often the case with Miralax, kids stay on these drugs for months or even years. This will worsen constipation and exacerbate fungal infections while lowering digestive function overall. Using reflux medicine long term reduces absorption of many nutrients, especially minerals, protein, and B vitamins. I have had some cases in my practice in which children who used reflux medicines for over a year suffered fractures, and others have experienced stunting and delayed bone age. They were not absorbing minerals or protein normally, and could not grow bone as expected. The FDA has issued a warning about elevated fracture risk in adults using reflux medicines. The same problem has been noted in children.
Talk to your doctor about weaning off reflux medicine if your child has used it for more than a month. There are many ways to improve digestion and diminish reflux without drugs. Changes in foods and use of herbs can gently enhance your child’s digestion while you wean off a reflux medicine. Correcting the gut micro-biome will help as well. Do this with guidance for better, faster results.
3 – Use Magnesium.
This one is so simple. Magnesium is an easy way to pull water into the gut without toxic effects from peculiar ingredients in products like Miralax (dyes, gluten, polyethylene glycol). Magnesium oxide is a stronger laxative than magnesium citrate; magnesium citrate is stronger than magnesium glycinate. There are other forms of magnesium besides these three, and depending on your child’s presentation, there is probably a magnesium option that can help wean off Miralax. A product called Mag O7 is easily available. It’s ozonated form of magnesium that has worked well for some of the most constipated children in my practice. But take note!! The label instructions are intended for adults. This dosing is too high for most children. Safe upper limit dosing of magnesium for a 40-80 pound child is only 350 milligrams (mg) of magnesium. For smaller children, even less may be all that is needed. Check with your health care provider and pharmacist before using this product, to make sure it can be safely used.
Besides drawing water into the colon, magnesium is calming. It can help with sleep, mood, muscle cramps, or may even fix heart palpitations or arrhythmias. This is great, but too much is sedating and may slow heart rate. It’s best to use magnesium with guidance, especially for infants or young toddlers. I choose which product and what dose, based on each child’s case. There are liquids, powders, and capsules of various magnesium products. One of the most popular is Natural Calm, available on many supermarket store shelves. A two teaspoon gives 350 milligrams of magnesium citrate. This is too much for a baby or toddler, but may be perfect for a school age child weighing more than 40 pounds. More than two teaspoons daily is not likely to be necessary and may be too sedating for any child. If you have any questions about using these products, especially if your child takes other medications, ask your pharmacist or pediatrician.
These three ideas are only the beginning. From foods to herbs to drug-free options, there are many ways to clear constipation that are not only non-toxic, but more effective than Miralax – and they create better overall health by replenishing nutrients, building a healthier gut microbiome, and eradicating the cause of constipation. For even more help, check out my e book on Milk Addicted Kids (another constipation situation!) and stay tuned for Peaceful Pooping, my upcoming e book and protocol on getting off Miralax. Thanks for stopping by!
Can a baby have a fungal infection? Yes – and undiagnosed, untreated fungal (yeast, thrush) infections could be one of one biggest failures of pediatrics today. How could this be?
I have often seen untreated thrush/fungal/yeast infections in babies, toddlers, and kids persist, then shift, into deeper, entrenched problems. Then the prescription drug parade ensues, usually in this order, with only limited or modest success: Prilosec (or other reflux medicine); Pediasure; Miralax; Ritalin, Concerta, or other stimulant, followed by something for anxiety or depression, like Straterra, Zoloft or Seroquel. Is this health care, or drug dependency? And are the kids feeling great, or lousy?
Most children who come to me for nutrition intervention only get to me as a last resort. They’ve been to gastroenterologists, neurologists, psychiatrists, feeding therapists, occupational therapists, behavior therapists, speech therapists. The last thing their parents want to do is change up the food in the house – especially when specialists don’t help them do that, and they tell parents it won’t do any good anyway (as most of them have told my patients). Too much work, right?
But eventually parents are at wits’ end. They have a picky child who eats poorly, grows weakly, or has reflux. Or they have an enthusiastic but still picky eater (read: stuffs food in mouth to choking) who loves starchy, sugary food like bread, chips, cheese crackers, candy, carbs, dairy junk (yogurt tubes or sugary milk substitutes). Their kids have big behavior problems: Tantrums well past toddler years. They can easily melt down, overstimulated, in public places, like restaurants, supermakets, or malls. They struggle at school, for being aggressive, combative, inattentive, or oppositional. All before they are five or six years old…. Uncle! Time to try that crazy nutrition stuff.
You’ve probably heard of Candida, or yeast infections, or thrush. And we’ve all heard a lot about gut biome, and how crucial it is for many aspects of health. This burgeoning area of research may not make the pharmaceutical industry very happy. Turns out that nearly any chronic condition – from Alzheimer’s, asthma, and autism to anxiety, depression, rheumatoid arthritis, and much more – may be treatable through improving the microflora (bacteria) in your gut.
How do you do that?
Easy. You change what you eat. You use the right probiotics, tailored to your stool testing or your history. You clear out nasty gut microbes that don’t help you, and there are many fabulous herbs that can do that. You do this as a lifestyle, not as a ten day course of a drug. And, your body begins to restore itself from the inside out. That is the “crazy nutrition stuff” in a nutshell – and it’s not what your pediatrician is primarily trained to offer.
Recent reports indicate that you can even improve conditions like these through a fecal transplant – using a healthy donor’s poo to reboot your own colon with microbes that know how to run a clean shop in there. Good gut bugs communicate intimately with the immune system, and help it “learn” – learn what is friend, what is foe, what to react to, what to ignore, what to kill and pull apart, what to leave alone.
The pharmaceutical industry only makes hay when they can sell a patented product (as in for example, hundreds of millions of dollars in a single year from just one vaccine). But they can’t get far with … your poo. That stuff is yours. It’s definitely not patentable. Pharma also can’t get far with food, which is not patentable either. If you eat better, they lose money. Food isn’t patentable unless it’s processed beyond recognition or engineered genetically by Monsanto (patenting everything you eat is their business model, which is why they really don’t want you to learn about how bad GMO foods are for your gut, or to even know they’re in your food – hence the labeling battles). Probiotics are naturally occurring organisms. Not patentable, because they simply already exist. But food, probiotics, and even someone else’s poo may be better for kids than many of the drugs they are routinely given.
I digress a little here, but to a point: These addled kids tend to have really disrupted gut biomes. And, they are very often full of yeast. This can be like thrush throughout the GI tract, whether or not it’s visible in the mouth. That means there is too much Candida, Saccharomyces or other fungal strains in charge of the gut biome – and hence, your child’s digestion, absorption, and eliminations.
We find this out with stool testing that looks beyond the basic horrible microbes your insurance company pays a gastroenterologist to check for. We look for beneficial species like Lactobacillus strains, Bifido strains, and others. We also screen for annoying microbes like Klebsiella or Citrobacter species that may well be usual enough to find in a human gut, but not to excess. They shouldn’t be in charge of the conversation in there, so to speak. And if a child is underweight or in weak nutrition status, these microbes can have a pervasive negative impact.
And, we find yeast. Lots of yeast.
This is how untreated thrush can situate itself and make your child miserable
Now, here’s the thing. Fungal microbes are somewhat usual members of our micro biome. But, they are normally kept in check by a healthy immune system. Mostly, they only raise an eyebrow for your doctor if your child has (a) florid thrush, in which white fluffy fungal stuff is literally coming out both ends – mouth and anus; or, (b) very serious immune deficiency problems, like leukemia or AIDS or neutropenia. If a child has a fungal skin rash, usual practice is to give a topical anti fungal cream. Other than that, pediatricians and gastroenterologists are generally unconcerned about yeast overgrowth in the body, because they are trained to only manage it for immune suppressed people.
But thrush can indicate yeast is a player even after an oral medicine like gentamicin clears it from the mouth. It’s easy to find out. Besides checking stool cultures or stool DNA analysis for yeast, I may also request a urine microbial acid test that looks for the “trash” that yeast cells make. Finding loads of this trash in urine means that yeast is present somewhere in body, possibly to a degree that is disruptive for mood, behavior, stooling, appetite, or more. It may even mean that a child’s repeat urinary tract infections are from yeast, not bacteria – in which case, antibiotics will not only do no good but will actually worsen the infection.
You can look at yeast (or mold for that matter) in many other ways with other lab tests, but the bottom line is this: A lot of children seem to be walking around with a lot more fungal and mold microbes in them than is healthy. What does this do? Typical symptoms are:
– Constipation severe enough for kids to be Miralax or enema-dependent, or to have had hospitalizations to clear fecal impactions
– Bedwetting well into school age years or even later
– Aggressive, rageful, violent, or oppositional behavior severe and frequent enough to impede learning, socializing, or ordinary tasking; abates if favorite foods are given, flares when hungry
– Appetite rigid for sweets, starches, dairy foods, and wheat (pizza, bread, pasta, crackers, mac and cheese, cookies)
– Refusal of protein foods (meats, fish, eggs, legumes, nuts, nut butters)
– Extreme pickiness for textures; easily upset by mixed food textures; refusal of fresh foods especially vegetables
– Dependence on reflux medicines (fungal infections can cause reflux, and reflux medicines cause fungal infections!)
– Allergies or sensitivities to many foods (which may be undiagnosed as well)
– Chronic fatigue, frequent malaise, with intermittent hyperactive bursts
The incredibly simple thing is this: Clear these fungal loads out of a child’s gut or body, and you have a different child. Behavior, appetite, everything starts to improve. The constipation ends. Gradually, given the right food and the right tools, the gut will start to heal up too.
But we haven’t even talked about the real problem here. Candida albicans, one of the most common yeast microbes found in our intestines, can shape shift from its initial “bud” form to a more debilitating “mycelial” form (see the pictures above). In this case, it grows little threads called hyphae that penetrate the gut wall tissue. It uses these to suck in nutrients for itself. It literally sends out little fingers that puncture your gut wall, in order to anchor itself there, eat and grow more, and hide better from your immune system. Watch the video to see what I mean:
Once in this mode, yeast and thrush infections are harder to clear. They create “leaky gut”, which creates more food allergies, more food sensitivities, and more susceptibility to other infections – including yeast infections in other locations. Many children start life susceptible to this scenario from birth. How? By receiving antibiotics directly or indirectly through mom, by getting a hepatitis B shot (made from a yeast strain called Saccharomyces cerevisaie), by arriving via C-section (in which case they miss getting mom’s vaginal flora on the way out), or by getting formula instead of breast milk (which favors undesirable microbes over beneficial ones).
Given that we know all this, we can do better for our kids. Many drugs prescribed for children – from Ritalin to Reglan – may become unnecessary, if underlying Candida infections are cleared, better food is in the mix, and the gut biome gets to work as intended. This can be straightforward to manage with the right non-prescription tools. Click the appointment tab above if you’d like to work with me on strategies to clear problems caused by untreated thrush or yeast infections. I look forward to hearing from you!
If your baby or toddler is using reflux medicine, maybe it’s time to quit. Here’s why, and how.
This is one of my least favorite findings in a little one’s history. Why? Because the longer reflux medicines are used, the weaker a child’s digestion becomes. The weaker your baby’s digestion becomes, the harder it is to absorb food and nutrients. This creates a domino effect of trouble! Just click through this FDA powerpoint presentation to the Pediatric Advisory Committee to see what I mean. From fractures to fecal impactions, it’s not pretty. A
Most parents report to me that reflux medicine seems to help a little at first, especially for quelling colic and crying. But soon, the benefit fades.
Then the baby becomes more picky, appetite more sluggish, stools more constipated and slow, belly more bloated. Feeding gets harder, not easier – and the reflux medicine dose goes up. After a few months, we have a fussy eater who is having tantrums about feeding, who is dependent on Miralax to have bowel movements, and growth pattern has slowed down. After a few years on reflux medicines, it’s common for me to be looking at a stunted child who is barely getting taller; who is epically picky, cranky, or anxious; who is struggling to learn, behave, or develop normally; and who is so stuck on Miralax even at ever increasing doses, it doesn’t work so well anymore.
The whole point of these medicines is to weaken stomach acid – presumably because too much acid is irritating the esophagus. Reflux medicines (“proton pump inhibitors” or PPIs) are the second most prescribed drug for infants and children, behind antibiotics. Does your baby even need it?
These medicines were created and approved for use in adults who may actually have too much acid gurgling up from the stomach into the esophagus. But this may not be what is happening in a baby or toddler’s digestion. Reflux medicines are not FDA approved for use in infants (kids under a year old) but are routinely prescribed anyway. Even if actual reflux was the issue, the only way to know for sure is to put the baby through an invasive procedure with something called a pH probe. A probe is stuck down the baby’s throat in “dip-stick” fashion so that a reading on the stomach’s acidity can be taken. Infants may need sedation and hospitalization to get through this procedure. Obviously, it’s all too easy for your pediatrician to hand you a prescription instead and say “try this”.
Before you try that, you should know that there are many drug-free options that work well, and leave your child’s digestion in tact. Try these instead – because reflux medicines have been found to have these negative side effects:
Yuck! Imagine all this going on in a tiny infant’s gut, which is just getting started in learning to digest and absorb food.
Basically, these medicines weaken stomach acid – and thus, make the stomach less capable of digesting anything. The ability to digest and absorb food is gradually weakened. Effects from using these for more than a few weeks? Examples from my own practice include linear growth grinding to a halt (kids can’t grow taller), delayed bone age (kids’ bones are not growing normally), and fractures of hip, wrists, or spine – in kids. Other nutrients become harder to absorb too, especially vitamin B12. Anxiety becomes prominent – and this is not surprising, as we learn more about how gut bacteria are linked to mood and anxiety.
But that’s not all. Changing the acid level of a human digestive tract means you change which microbes can grow there. The microbes we carry in our intestines do a lot for us. They help us digest food, communicate with our immune systems, and help fight off invading infectious microbes that can make us sick. Using reflux medicines favors microbes that are not ideal – such as Clostridia difficile (linked to seizures and autism like features in tests on rats) and fungal infections (Candida or other yeast species). These definitely do not help your baby or child. A healthy gut has a pH that will favor helpful species, like Lactobacillus strains or Bifido strains.
So what to do? Try these steps – and learn more detail in my book Special Needs Kids Go Pharm Free. The first chapter is all about babies, from feeding to colic to sleep, reflux, and more.
1) If you’re breastfeeding, trial a diet without the usual suspects. Remove dairy, gluten, nuts, eggs, or soy. Some babies fare better when brassicas are removed (cauliflower, broccoli, Brussel sprouts). Don’t remove all these foods at once. Experiment with rotations. Always put back in a strong, nutritious replacement for any food you take out. Use ample organic fats including eggs, ghee, meats and poultry, legumes, and vegetables. You may need to use alternate protein supplements to keep you strong and energized while your own diet is restricted. A gentle whey protein like ImmunoPro Whey may be well tolerated for you. Or, you may need a collagen protein support. You can find these in my practice supplement dispensary here.
2) Change up the feeding routine. Cow’s milk, pea or rice protein concentrates, and soy proteins are not what your baby was built to digest. So, if you’re using a formula based on those proteins, change it. This alone may ease reflux symptoms. Use a partly digested (“hydrolyzed”) formula instead. This one is organic, with lactose as the carbohydrate (just like breast milk), and hydrolyzed whey protein instead of whole cow’s milk protein – very gentle! Formulas like Nutramigen or Alimentum are made with hydrolyzed casein protein and may work too. These aren’t organic and may contain GMO ingredients, but may be better tolerated than a standard whole milk protein infant formula. For toddlers, plant based options exist. I don’t like using pea or rice protein concentrates in my practice – these seem tough on baby and toddler bellies in my experience. If almond is safe, give this organic option a try. Your baby may also do just fine with a goat milk formula option (which I’ve only found here so far – see all their options for ages and stages), or even a camel milk formula recipe (not commercially available …yet!).
3) Switch to organic, GMO-free formula and foods as much as you can. GMO ingredients in conventional formula and foods are injurious to your baby’s gut biome. Read here for why I tell my patients to avoid GMO foods. More scientists are expressing concern that GMO foods alone may be triggering autism in our children. This simple step can help your baby’s gut.
4) Use probiotics. Lactobacillus retueri is a strain that has been shown to reduce colicky symptoms and crying. Bifido bacteria are crucial for healthy gut biome development, as are other Lactobacillus strains. Consider starting with a simple product like ProBiota HistaminX probiotic. To order, tap my practice supplement dispensary here, set up an account, and order. You can also start with a product that only contains Lactobacillus called Primadophilus L. reuteri, also available in my dispensary.
5) Use an herbal tincture designed for babies and toddlers, in a glycerite base, that supports digestion. These are often called “digestive bitters” – there are many brands – and they can gently support normal stomach acid secretion and digestion. Here’s an example of one of my favorites. For a baby under one year, 1/8-1/4 teaspoon is plenty before or just after a feeding.
6) Put Epsom salts in your baby or toddler’s bath at night. This is calming, and delivers both magnesium and sulfur via absorption through skin. Sulfur is a key mineral for many digestive functions. Dissolve one half cup in the bath and soak for twenty minutes.
7) Clear fungal infections. If your baby had thrush, he may need some stronger medicine to clear any lingering fungal load from the digestive tract. Fungal infections alone can alter the acidity of the digestive tract, and keep it sub-optimal – thus causing more reflux! See my blog on fungal infections and how these affect the GI tract.
These are so easy to do. Use these steps to prevent ever getting on a reflux med, and to help your baby or toddler wean off. Let me know how it goes!
