I’m a pediatric nutritionist with long experience, and I wish you’d stop talking so much about food and nutrition with your kids.
That sounds crazy, I know. Food and nutrition are absolutely pivotal for your kids’ brains, behavior, growth, mood, learning… everything. No wonder then that food, recipes, and nutrition talk are all over the internet and mom blogger universe. From how to make killer bento lunches to keto for kids (mistake, BTW, unless under certain circumstances), everyone has something to say.
The good thing about this is that we are all woke now on the importance of what we eat, where food comes from, and how we grow it, whether it’s chickens, chocolate, or chard. We really are what we eat. We eat, and we turn the food into us – hair, bones, teeth, mood, and all. Period. That’s pretty much it (though a lot can go wrong along that path.. fixing that for kids is pretty much what I do).
But… there is a HUGE downside, and it’s bad for kids. It creates undue anxiety, stress, and overwhelm for kids, young ones and teens alike. It really stresses moms out too. I run into this often in my clinical practice, and I can tell you that it has gotten worse as our (justified!) enthusiasm for whole, healthy foods has exploded in the last 10-15 years. You’ll want to avoid these pitfalls with your kids. Here’s my list of Fail vs Fabulous, when encouraging healthy nutrition and food habits in your family.
It’s so easy to label a food “good” or “bad”. There’s plenty of junk out there, including organic junk. Obviously, it isn’t what kids should live on. But don’t drill these labels into your kids’ minds. What they need to learn is discernment – and they will. Eventually, ideally, when they’re out and about on their own without you, those “bad” foods should be neutral to them.
What do I mean by “neutral”? I mean that the idea of eating that food doesn’t provoke anxiety. It isn’t even compelling, because it was never forbidden in the first place. It doesn’t elicit judgment or shaming for themselves, or toward friends and peers who eat those foods.
As long as there is no safety or egregious comfort issue – as in, needing an Epi Pen, or a vomit-to-shock (FPIES) reaction, hives, migraine, nausea, bloating, burning diarrhea, disabling gas pain – then let kids have forays into junk. Not daily staples or regular snacks, mind you, but occasional dabbling.
Instead: Provide treats for special occasions (or every so often for no reason other than it’s fun) with no discussion about whether it’s “good” or “bad”. Again, safety issues and food allergens or triggers aside, simply make or buy some fun food, and let your child enjoy, care-free.
My one exception: Spoiled food. This IS bad and dangerous and kids need to learn that too. So, tell them.
2 – Don’t Expect A Young Child to Have Discernment (or even care)
Speaking of discernment, forget needing your four year old to have it. That’s your job. Children do not need to know what organic is, or glyphosate, or MSG, colors, additives, gluten or what have you. They shouldn’t care either. They’re little and they have much more important stuff going on in their little worlds. Please stop walking them through the supermarket and asking them to pay attention to labels or what you’re buying. Believe me, they are observing. They don’t need the specifics, and this will only be information overload that can lead to anxiety or meal time control battles. They need you to be chill, in charge, and happy that you’re with them (most the time). That’s about it.
Instead: Lead by example. Say less, do more. If your child accompanies you shopping, let them day dream and leave them alone; if they love chatter, join them in the randomness of it. Your child doesn’t need every moment to be teachable!
If they see something truly junky or sugary or processed that they pitch a fit for (and they will, because supermarkets place colorful cartoony packaging at your child’s eye level on purpose), that’s your call. Sometimes we can get away with floating to the next aisle with a soothing “Hmm no I don’t want to do that today” (and refrain from giving a reason why). Other days, you know the both of you don’t have it in you to make it home without giving in. Up to you, but avoid each supermarket trip rewarded with a junk treat.
If you’re in servitude to your stove or kitchen and miserable making all this scratch beautiful food, guess what – your kids know. Even your baby can tell. The most important thing here is that you get to be happy and enjoy food. Even if there are stressors, including big ones, about what can be safely eaten in your household, endeavor to find the joy in some of it. Joy is, above all else, why we’re here.
3 – Stop Explaining Everything and Stop Feeling Sorry For Your Kids with Diet Restrictions
You’re in charge. You’re the adult. If you know your child does poorly with a particular food, and they are fiendish about getting it and asking for it constantly anyway, oh well! You know best and have decided that they’re not going to have that food, period. Remember: This goes for foods that are a known danger or debilitating to your child – not for foods that are imperfect, but harmless.
Explaining and justifying your parenting choices to a young child (or even a teen) is, um, a bad idea. Doing so engenders entitlement in your child, which can make their opposition and protests even bigger. In little ones, expect tantrums, anxiety, and meltdowns when you try the “here’s why” route. In teens, expect impressive arguments, brooding, and door slamming. Most of all, don’t expect or need your kids to agree with you.
Instead: If a child asks for a reason why, offer it in the most developmentally concrete way for that child’s age. Refrain from volunteering comments like “it’s bad for you” or “will make you sick” or “your body can’t have that.” Don’t label the food or your child’s body as defective or bad.
Younger kids can be redirected with “there isn’t any more of that at the store so I found this one instead” or “I think this will feel really good in your tummy. Let’s try it and you let me know.”
Teens are reaching a point of practicing discernment on their own. Experimentation and screw ups are par for the course at this age. Let them experience the discomfort of eating the wrong food. You will decide when you have had enough as a parent: “I realize this isn’t what you want, but I am the one taking care of/rescuing you each time you feel sick from eating xyz. So, that food is no longer going to be in the house, and I won’t buy it anymore. If you eat it on purpose outside of here, I won’t be able to help you.” And then there’s always “..because I am the one buying the food, and I said so.”
4 – Stop Feeding Your Kids Like They’re Gwyneth Paltrow (or expecting them to like it)
Oh dear. How many, many food diaries I have seen that look this beautiful: Green smoothies, pumpkin seeds, sprouted Einkorn homemade bread, kombucha, fermented kvass, homemade dosa, coconut flour pancakes, avocado toast, bone broth… Or, a list of light veggie snacks all day long: Carrots, celery, nori, cucumbers, and apple slices with a few cashews. Or, a food diary that shows me 120 grams of protein and less than 60 grams of carbs (a nearly ketogenic intake).
Those are beautiful foods. Some kids really love this stuff. But, usually, it turns out this is a little dysfunctional. There are too many food rules in the house, and it’s causing tension to comply so stringently with eating only organic, perfect whole foods.
I’ll also usually discover that in these households, kids are falling off their growth patterns, experiencing stunting, or underweight. What tends to happen here is kids end up low for total calories, low for carbohydrates, and high for fats and protein. This is a great eating style for adults (who are not growing), but it can cause stunting and underweight in children.
Here is a common anecdote from my practice: I began working with a mom whose child was eating an overly restricted diet. Mom removed all processed foods entirely, based on the belief that any of them, at any time, are bad. Her child also happened to be a picky eater and refused many textures, limiting her choices more. On top of this, based on a misinterpreted blood test for a food sensitivity panel that the mom had somehow done on her own prior to our meeting, the child was only allowed to eat 7 foods, and had been eating this very restricted diet for years. She was not growing, had miserable behavior and sleep problems, and was trending toward anemia.
It turned out, right off the bat, the child could eat many foods that mom had wrongly assumed were trouble. A shift in view point on the good vs bad food mythology helped a lot. The child’s behavior improved immediately and she gained some much needed weight. Finally, her brain and body were getting replenished.
But even after a few sessions, things didn’t sound quite right. So I asked for an updated food diary. Mom shared a usual day food intake of small quantities, throughout the day, of raisins, peanuts, maple syrup, rice, potato chips, and a brownie. That was it. That was a usual day of food. This explained the re-emerging problems: No protein, no good fats or oils, too little food over all, a grazing pattern, and few micronutrient rich foods (for vitamins and minerals).
Mom said this child would sometimes eat chicken. So I asked – what if you gave a chicken nugget, would she like that, or try it?
A big silence followed. Mom was stunned. She had never done that, and wouldn’t, “because, you know, they’re so junky.” We agreed to give it a try after a quick search gave us some brand options she could live with. There are ready to heat and eat versions of this stuff that aren’t so terrible, or are gluten free too.
Instead – This child was already eating a junky poor diet. It didn’t matter if the peanuts and maple syrup were organic. Those alone don’t make up a whole foods diet. So, toss in some fun. Find some ready to serve, heat-and-eat stuff so you don’t have to work so hard cooking it all from scratch. If you hit on something, then you can make your own scratch version even better if you like.
Let kids be kids. They need different diets than adults. They shouldn’t be eating they way you do, most likely. Peruse my blog for more ideas and tips on how kids eat, what they need, and some recipes to try.
• 5 – Baby Led Weaning Is Great… For Babies
No, babies and children don’t know what they need all the time, and don’t necessarily have a keen inner wisdom that they can tap at a moment’s notice. Some babies wean because they feel eager and ready to move on. Some can’t get there, and won’t, even when it is safer and healthier for them to do so. Don’t pressure your young child to know everything. I’ve met many toddlers way past the day they needed to wean, and mom is still waiting for permission to do so. Nope nope nope. You’re in charge, mom.
Likewise, toddlers and kids need direction too. Weaned or not, presenting food all day long in a parade of choices is often just plain overwhelming and frustrating for little kids. It’s too demanding to expect that they will know what to do. This strategy can create anxiety in young kids, while mom or dad get super frustrated by the poor growth and picky appetite that this can often trigger too.
- Don’t expect them to guide you in making their food choices. Sure they will have their preferences, but it is your job to feed them.
- Don’t expect that they will always know or verbalize when they’re full or when they’re hungry. Especially when kids have used reflux medicines, appetite and its cues will be weakened over time. If you need help with this, contact me or speak to your pediatrician.
- Don’t chatter about how important food is. Just make or buy something you love to share and enjoy with your family.
- Don’t allow non stop grazing. Toddlers and young kids grow, sleep, and behave better with distinct snack times and mealtimes.
- Don’t limit texture options to just pincer grasp foods and pouches. Kids can be rigid. The longer you wait for them to reach for a new food, the longer you may be waiting. I’ve met several four and five year olds who don’t know how to chew. It’s ok to rock their world a bit and expect them to progress much earlier on.
Instead – Make food a benign or pleasant background piece. At snack or meal times, it’s just there, beckoning. Allow a choice between 2, maybe 3 foods at most. Present mixed textures and novelty, including foods that might be messy or that require mastery of a utensil. Let your child feed himself or get messy. Good help can be had with a pediatric occupational therapist if need be – let your doctor know you’d like help, and get a referral, if feeding is so stalled that your child isn’t growing or gaining well.
I really meant it …
…when I said that the most important reason why we are all here is joy. Eating and food are great paths to create it, share it, grow it. More than anything you say or do around food in your household, making food a generally positive, inquisitive, and expansive experience is what will create good self care and eating habits in your growing family. For extreme picky eaters, you may have other problems afoot that need tackling. Check out my e book here for more details on how to redirect that too.
Covid is still here, unbelievably – so what can you do to beat it?
You’ve probably heard about inflammatory cytokine storms that can trip a COVID-19 infection from mild and easily beaten, to prolonged, dangerous, or even fatal. Luckily, so far, it appears this happens to a only small percentage of those who get infected: Mortality (death) rates vary, hovering from less than 1 percent to 4-5%. The Americas are the worst place to be. What are we doing wrong?
The role of background inflammation in making COVID a riskier matter is clear. Persons with diabetes, coronary vascular disease, hypertension, or heart disease show significantly higher risk for hospitalization (asthma was at first thought to elevate risk for complications and death, but newer data have not borne this out). All these conditions have an inflammatory component. Lots of people are walking around with no idea that they have background inflammation, or the nutrition problems that go with that. For example…
- Our health care system is so bad at paying attention to food and nutrition concerns that it can take six to ten years to diagnose celiac disease, a debilitating sensitivity to gluten (wheat) that escalates to autoimmune disease. Just one simple, cheap blood test is all it takes to diagnose celiac disease; add one more to the lab order, and you can capture gluten sensitivity years before it escalates into celiac disease.
- Autoimmune thyroid disorders affect nearly 30 million people in the US, but these can go undiagnosed or misdiagnosed for years.
- Many times, I have been the first and only clinician to capture elevated calprotectin on stool testing for a child. Calprotectin is an inflammatory marker that typically attends extensive gut dysbiosis or inflammatory conditions like Crohn’s disease. It is a biomarker for colitis, enteritis, and even rheumatoid arthritis. Prior to my screening, no one knew these children – who were suffering and symptomatic – had background inflammation.
I believe undiagnosed background inflammatory conditions or processes are part of why some die so quickly from covid, including children, or young strong adults. Was there an unknown, undiagnosed background piece for inflammation that elevated that person’s risk?
Few of the kids in my pediatric nutrition practice ever had screening for inflammation, or for nutrition concerns, before working with me. This is a problem, because your immune system depends on nutrition to function.
In kids, this is very important. The lower a child’s nutrition status, the more likely that child is to get sick more often, have more complicated and longer illnesses, or even die, from infectious diseases. In fact, the single most predictive measure of how a child will fare through an illness is nutrition status, a fact that has been understood for decades. This means that a lot of folks including kids and seemingly well young adults are walking around with the ticking-time-bomb, double-whammy set up of background inflammation plus a dearth of the nutrients you need to manage inflammation and infection!
Besides finding weaknesses for critical immune-supporting nutrients (iron, zinc, vitamin A, vitamin D, protein ), nutrition screenings can pick up inflammation signals on routine bloodwork. I screen for this stuff and fix it in my pediatric nutrition practice. Parents are often pleasantly surprised when, after working with me, their kids rarely get sick (and they have more energy, sleep better, and are happier too).
I believe that part of the variation we are seeing in covid infections and deaths is directly related to nutrition. Nutrition assessment is not part of routine pediatric care, and advising families on how to navigate nutrition concerns for kids certainly isn’t either! When was the last time your pediatrician told you what to make for dinner, or how to pack a lunch your picky eater would actually finish? Lol. Never. Here are five ways to build a strong immunity-foundation for your kids:
1 – Feed Your Kids – Lots! The one factor that most determines how a child weathers an illness or infection is nutrition status. And, the single most important nutrition parameter for a child is growth pattern. This is the single most important nutrition parameter for a child, period. Not whether they eat fermented food, follow a GAPS diet, or never eat sugar. Nope. In children, when it comes to fighting infection, it’s all about body resources and nutrient stores. So, make sure that your kids maintain a healthy weight before illness strikes. Underweight children as well as overweight kids are more likely to get sick more often, stay sick longer, and have more complications than children in normal weight status. This fact is based on decades of global data on childhood illness and child mortality. Because the immune system pulls on stored nutrient resources during illness, and because some of those resources are stored protein and energy in our own tissues, even slightly underweight children can have higher risk for infections and poor outcomes. Your child does not have to be visibly emaciated or even below the 5th percentile for weight for age, in order to be clinically underweight. Your doctor may not have noticed a growth impairment, so visit my blog on underweight in children to see if your child falls in this category.
- Don’t fear carbs or over-restrict them. Instead, load up on healthy vegetable source carbohydrates like sweet potato fries, plantain chips, squashes, chick peas, berries, apples, mango, carrot, pea pods, cassava tortillas (if corn is a fail), sprouted grains or seeds, or legumes; or allow whole grains and GF grains as tolerated. Carbs help kids gain and grow, and a healthy gut will readily and comfortably use them. Recipes from my blog that fit the bill: Portuguese Kale Soup, Spicy Chick Pea Curry, and Pumpkin and Lentil Dahl.
- Too much protein can be as ineffective as too little protein in a child’s diet. Generally, children need anywhere from 35 grams (toddlers) to 50-60 grams (bigger school age kids) or as much as 70-80 grams (big high school athletes with rigorous work outs) of protein daily, depending on their growth status and activity levels.
- During illness, protein losses can increase. Use two extra servings daily for protein rich foods like bone broth, collagen, fish, legumes, meats or poultry, any safe nuts/seeds or their butters.
- Immune (and lung) helpers like vitamins A and D need to be eaten with fats or oils, to be absorbed and stored. Let your kids eat plenty of healthy fats like olive oil, grass fed butter or ghee, organic grass fed meats, coconut milk or oil, egg yolks, avocado, nuts/seeds and their butters, or fish oils.
- Eat mineral rich foods for zinc and iron; both are immune-critical helpers that are often low in kids’ diets and are readily spent when we get sick. Go for nuts, seeds, vegetables, legumes, juiced greens, bone broth, egg yolks, pork, lamb, or beef; unsweetened cocoa or dark chocolate is zinc rich too! If some of these don’t go in your kids’ mouths every day, use a supplement. 30 mg zinc daily is a start; kids may need more depending on their status. Iron is toxic at high doses, so ask your doctor what dose to start with in your child’s case. Fun fact: A clinical sign of poor zinc status is losing your sense of taste and smell. Sound familiar? This is also a key feature of covid infection, indicating that the body is ripping through whatever zinc it has on hand to fight.
2 – Probiotics Help Lungs Too
- Lactobacillus rhamnosus GG, Lactobacillus reuteri, and Bifido lactis have been shown to help lung tissue protect itself from invading pathogens. If a probiotic isn’t in your child’s regular rotation, consider adding one that includes these strains, such as Allergy Research Group Lactobacillus or Klaire Labs Therbiotic Factor 6.
3 – Use Antioxidants During Illness
- Vitamin C as sodium ascorbate in high doses is a strong antioxidant that may help beat viruses. Use doses in the multi gram range, not milligrams, eg a 50 lb child can use 5 grams of Vitamin C daily if this doesn’t upset stomach. Split doses throughout the day for better tolerance.
- N-Acetyl Cysteine (NAC) is an amino acid we use to make glutathione, our body’s top go-to for detoxification and antioxidant actions – especially for lung tissue. NAC also helps break down mucus in lung tissue. In my practice, I have used 600-1200 mg NAC daily in school aged children. It can be used in multigram doses as well (a common support for anxiety or OCD).
4 – Use Immune Modulating and Virus-Killing Herbal Supports
- Houttuynia cordata herb (available as drops from Nutramedix) showed anti-corona virus activity in this animal study from 2016.
- Cilia are tiny hair like cells that beat debris and mucus up and out of our lung tissue. Corona viruses target these delicate structures, causing more fluid and debris to build up. Protective herbs for cilia include olive leaf extract and berberine. See Barlean’s Olive Leaf Extract liquid and Core Berberine from Energetix; you can also use a glycerite based goldenseal tincture as a berberine source.
- Corona viruses attack by attaching to a key protein on cell surfaces called ACE-2, which has the important job of regulating vascular constriction. Once ACE-2 is disrupted, fluid can enter the lungs more easily… and fast. The body responds with strong inflammatory cascades, but this can make the infection worse. Chinese Skullcap, horse chestnut, elderberry, cinnamon, and licoriceroot make it harder for the virus to attach. Resveratrol can reduce inflammatory cytokine response. All of these products are available in various formats easy to give to children (tinctures, drops, powders, and in some cases, chewables).
5 – Give Direct Immune Support
- Immunoglobulins are immune proteins that we make to protect ourselves. They are found in breast milk and in colostrum, and are quite effective at protecting newborns and babies! You can also now purchase a dairy free, hypoallergenic, bovine serum derived immunoglobulin supplement and use it daily to boost immunity. See Orthomolecular Research brand for SBI Protect. I use this often in my practice for children of all ages, with good results. This is a tasteless powder that mixes readily in soft foods or liquids.
We may be facing the reality that there is no safe or effective vaccine for covid for a long time, if ever. As we learned before from the SARS virus, corona virus vaccines are exquisitely challenging to create.Two-thirds of those polled expressed that they would not take a covid vaccine, due to safety concerns. In the meantime, take action to support your kids’ immune systems so they can be as ready as possible. Bonus – they may breeze through winter with no colds or flu bugs at all!
I’ve been in pediatric nutrition practice for some 20 years, but these health and nutrition myths just won’t quit. They can keep kids sick when they could be enjoying better health. Here are 7 myths I encounter week after week. They’re powerful enough to steer your kids away from health and into being more sick, more often. Change your mind about these myths, and your kids may enjoy more health, more often.
Myth #1 – It’s normal for toddlers to be sick all the time …Um, not quite. Common? Yes. Normal? No. A toddler who rides a roller coaster of colds, infections, stuffy noses, coughs, diarrhea, or malaise every month, for more than 5 or 6 times a winter, with or without fevers, or who needs antibiotics over and over before age 2 or 3, gives me pause. So does a child who never gets a fever, but isn’t thriving either, and is often fatigued. Kids should not be sick more often than they are well. Yes, little tykes are vulnerable; their immune systems are developing, and if they were not breastfed, they haven’t been given that powerful foundation from mom’s immune system to protect them.
A cold or virus with a vigorous response – like a fever to 103 or so – that drops your child for a few days is a healthy and necessary challenge for the immune system to develop. But toddlers should bounce back, and resume a hearty eating pattern to restore depleted nutrients burned up during illness.
Nutrition and food make it possible for the immune system to work. When we’re sick, we make big withdrawals out of our nutrition bank accounts. For growing toddlers, this is especially costly – like borrowing money on a 25% interest rate! They need a lot of strong nutrition for growing, and for fighting illness, when they’re sick. We store nutrients for these occasions – especially iron, zinc, vitamin A, and vitamin D. We also use our own protein – which we store in functional structures like our organs, bones, muscles and flesh – to help fight infections. So if a child has a weak growth pattern to begin with, or is even just a little bit underweight, there won’t be much to work with if illness keeps knocking him down. A downward spiral of malnutrition and infection can ensue, and this is dangerous for tots.
PSA: Here we go with everyone’s favorite topic… The shot schedule. My 2p? It’s overloaded, fails often, and creates opportunity for mutation into more virulent strains of the viral and bacterial material in the shots. Vaccines can also cause the infections they are meant to prevent, such as in this case. The medical community understands overuse of antibiotics and has made big efforts to cut this back. Not so with vaccines. There is a mania that more are better. Believe me, my public health master’s degree gave me full indoctrination into immunization theory and practice. But these practices are not working, and after 20 years in clinical practice, I’ve had an about face. Despite having many more vaccinations than ever, kids are more sick and disabled than ever in US history, and not a single “vaccine preventable” disease has been eradicated. It is not because your neighbor opted out. It is because natural, long lasting, robust immunity from actual infection has all but vanished, and because vaccines can spread infection too.
When vaccinated people shed and spread infection from recent shots, this is called “secondary shedding”. Evidence of this is documented for flu vaccines, chickenpox, measles, polio, and many others. If you’re seeing your kids get sick when school starts…. it may be because everyone just got vaccinated and is shedding infectious material. Check out this sign at my neighbor’s condo association pool, barring anyone with recent vaccinations:
Dilemma: Your pediatrician’s bread and butter is giving vaccinations, and prescribing drugs. That’s about it. Since their degree required little to no depth in nutrition, they may not recognize nutrition problems that drive frequent infections.
If your child is sick more often than well, if colds and infections just won’t quit, what to do?
- Have your child’s levels of quantitative immunoglobulins checked. Low immunoglobulin means low defenses. Good nutrition and food build this back up eventually, but other special measures may be needed.
- Improve your child’s growth pattern. Are they underweight? Are you sure? Even being modestly underweight may drop immune response and defenses.
- The immune system needs iron. When it’s depleted, infection fighting is harder.Check iron status with a full iron study, not just with hemoglobin (Hgb) and hematocrit (Hct). Hgb and Hct are crude measures that capture only profound anemia. Ask your doctor to do a full iron study to see if your child is pre-anemic. An iron study includes ferritin, serum iron, transferrin, and saturation. Don’t start iron supplements without guidance – iron can be poisonous at the wrong dose.
- Get your child’s vitamin D level checked. It should be well above 30. At our office at Flatiron Functional Medicine, we look for levels in the 50-80 range for good immune protection.
- Get your child’s vitamin A level checked (also called serum retinol). Vitamin A is crucial for immune function, and upper respiratory infections, measles or chickenpox in particular. Unless your child likes to eat liver, cod liver oil, lots of fortified dairy food or grass fed butter, and/or orange and green vegetables, a marginal or even deficient vitamin A level may ensue. Marginal or deficient vitamin A places your child at higher risk for complications from measles or measles vaccine.
- Don’t vaccinate a sick child.
- Breastfeed as long as you can.
- Camel milk is a good source of potent immunoglobulin. Consider using a few ounces daily. If that’s just too weird, consider using a bovine serum derived oral supplemental immunglobulin like this one, or colostrum, if your child tolerates milk protein.
- Keep your child home after vaccinations if they don’t feel well. Avoid recently vaccinated peers just as you would avoid a sick child.
- Balance your kids’ meals and snacks so they get about a third of all their food as fats or oils, about half as clean, non-processed, non-sugary carbs, and about 10% as high value protein. Vary the protein they eat, so it isn’t always the same source.
- Use as much organic food as you can afford. Pesticides in food burden the immune system further.
Myth #2 – Picky Eating Is A Willfull Behavior Choice ….Followed by “your kids need feeding clinic” (maybe they don’t) and “they’ll grow out of it” (I have many kids in my caseload in their teens who …didn’t). Nope nope nope.
Picky eating is a downstream effect of three things: Gut dysbiosis, mineral imbalances, and exogenous opiate peptide formation from wheat, dairy, soy and pea protein (like Ripple milk, or plant based protein powders). Watch this short video for a fast explanation.
What sets this up? Reflux medicine, C section delivery, antibiotics (for mastitis, at delivery, during pregnancy, for your child, or a long history of your own yeast infections and dysbiosis prior to pregnancy), early vaccinations… That’s where it begins. This parade of interventions and pharmaceuticals from birth insidiously but profoundly change the gut biome away from a healthy early profile and toward disruptive microbes like Candida, Rhodotorula, Klebsiella, Prevotella, too much Staph or Strep, or even Helicobacter pylori. Sometimes I will see a protozoan pop up on DNA screen stool studies too. These in turn usurp minerals out of the diet and make them harder to absorb too, due to subtle shifts in pH in the digestive tract that these microbes create. Ultimately, appetite can drop, the poor diet begets more poor diet, because weak zinc and iron status tend to trigger pickier eating. Next, this scenario also degrades digestion of proteins. When proteins like wheat, dairy, soy and pea are poorly digested, they become “dietary exorphins” or “food derived opioid peptides” that trigger effects on the nervous system.
Once this is in play, your kid is indeed addicted to that white diet (Goldfish crackers, yogurt, noodles, milk, milk, Pediasure, milk, more milk, cheese, pizza, mac and cheese, pasta, bread… and of course sweets). Other foods will be absolutely refused even if you let your child go hungry – because other foods don’t give that opiate-like kick. There is literally addiction chemistry here working against your child. Sure tells that this is happening to your child, besides the fierce picky eating, are hyperactivity, behavioral volatility, dilated pupils after meals, and/or delays in expressive language or socialization.
Breaking this pattern can be done. I’ve helped hundreds of families break it, and it has nothing to do with convincing your child to like something else, or sitting through agonizing feeding clinics where your child is pressed to place different foods to their lips against their will.
Full disclosure: The only thing that makes a nutrition intervention, and not a behavioral one, for this fail is when parents bemoan how hard it is. Yep, it’s hard. But it can be done through a methodical reboot of your child’s gut environment, with individualized strategies for supplements and new foods. Start with this e book if you want to break picky eating. Spoiler: Probiotics alone won’t fix this.
If your child has mechanical issues with swallowing and feeding, then of course they need feeding therapy. For other kids, unless the underlying nutrition and gut biome problems that cause picky eating are professionally assessed and corrected, feeding clinic may not be necessary or helpful.
Myth #3 – Kids Get Constipated Because They Choose To Hold Stool – Gaining potty skills is a process for sure, and some kids do get flummoxed around it to the point of trying hard to withhold stool. In 20 years, I have had one legit case of this. For all the hundreds of other kids, they were constipated because of (a) disrupted gut biome and (b) dietary exorphin formation.
Most of these kids had Candida or fungal microbes flourishing in their intestines. How did we find out? We did urine and stool studies to show it. These are not yeast infections that their pediatricians noticed – because the kids didn’t seem outwardly sick, didn’t have immune suppression, and didn’t even always have white flecks in stool, white or grey coated tongues, flat or concave nails, or ringworm rashes (all tell tale signs of fungal dysbiosis). What they did have were bloated bellies that wouldn’t quit, fierce cravings and picky eating for starchy processed food or sugar, behavior challenges, lots of Miralax in their histories, and, constipation. Some of them also had epic battles with bedwetting into their tween years, which turned out to be a Candidiasis of the urinary tract.
Clearing the dysbiosis does the trick. This takes thoughtful intervention with probiotics, antimicrobial herbs, or in some cases, prescription anti fungal drugs, as well as some upgrades in what these kids eat. I choose all this stuff based on each child’s history, labs, and presentation.
The other constipation trigger here is the opiate peptide business (See Myth #2). Casein digested into casomorphin, or gluten digested to gliadorphin, are both powerfully constipating – after all, they have opiate-like effects, and if you’ve ever needed pain killers for a surgery, you know the drill. In some cases, the constipation doesn’t quit til those proteins are 100% strictly removed for at least three months. Because soy and pea protein concentrates do the same thing, swapping out milk or wheat protein for pea or soy can fail. Ripple milk, Vegan Orgain, and any plant based protein powder may have pea protein concentrate or soy in it and will continue the constipated pattern in some cases. Digestive enzymes may help, but this isn’t as effective as removing the offending foods. If you use enzymes, buy one that has dipeptidyl peptidase IV in it (DPPIV) at a high concentration. After some gut repair and good nutrition replenishment, wheat and dairy may be fine once again, but don’t expect results from a reduced intake of these foods – they may have to entirely vanish to get your child pooping again.
Myth # 4 – If my pediatrician didn’t say so, it’s not real – The American Medical Association and the American Academy of Pediatrics don’t require rigor with respect to nutrition, for those getting MD degrees with specialty in pediatrics. Only about a third of doctors routinely discuss nutrition at clinic visits, and most report they don’t feel adequately trained in nutrition (they’re not).There are big knowledge gaps for pediatricians when it comes to nutrition. So when you go in with questions about foods, supplements, or special diets, you may come out empty handed at best, or chastised at worst. Don’t stop there, or assume there isn’t a solution, if your pediatrician can’t answer your questions or tells you there’s no evidence that a nutrition measure might matter.
Odds are, there are some very good data on whatever your question may be. Nutrition is a thoroughly pedigreed science that has been around for well over a century. There is so much possibility to engage information, research, and clinical experience from it that your pediatrician may not know about. Naturopathic doctors have more training in it, as does a pediatric nutritionist/dietitian (that’s me). Adding these resources to your care team can give your child better odds for better health.
Myth #5 – Cavities? #ThisIsFine – Cavities are no fun for anyone. Even kids who have good oral hygiene can end up with repeat visits to the dentist, for drilling, filling, capping, or extractions. It may seem entirely usual that everyone gets them. Well, not everyone does, and no, cavities are not a necessary childhood rite of passage.
Cavities are a canary-in-the-coal-mine scenario. They can be thought of as a flag for a disrupted oral microbiome, and/or a shortage of the strong nutrition that helps build teeth and enamel. A healthy mouth will harbor friendly microbes that do a good job of intervening on your behalf, and don’t let an overly-acidic environment erode enamel. And, a baby who gets to breast feed a long time will have a better shot at less crowding of the teeth, and thus less chance for cavities.
If your child has a frequent flyer punch card with your dentist, start with gut. Your child’s gut microbiome may need an overhaul away from Candida, yeast, Helicobacter pylori, or other disruptive species. These are fed by simple carbs, sugary food, and processed foods. If your child is picky, see Myth #2 above, and set a goal to bust that pattern. Ditch the reflux medicine if possible (if you’re using it), because this reduces absorption of both protein and minerals – two key components of teeth. If children have optimal nutrition during the time that teeth develop, they can avoid cavities. Vitamins A, D, K, and C along with healthy fats and protein, with wholesome vegetable sources of carbohydrates, can accomplish this task. For more on nutrition and cavities, visit the Weston-Price Foundation.
Myth #6 – Measles and chickenpox are deadly diseases. The short answer here is, yes, and, no.
So much has been said about this in recent years – most of it counterproductive – that it’s hard to consider bringing this up at all. As a senior practitioner who has been credentialed in my field for over 30 years, I can say the sea change in this has not been worthy. It has not translated into better health for children. The conversations now afloat, where anyone questioning vaccines is pilloried and branded insane, would have been shocking during my graduate studies the late 1980s. We were allowed, and encouraged, to question and investigate, as were our mentors and instructors. This was not forbidden in that day, as it is now. And yes, I studied immunization, epidemiology, and nutrition as a graduate student. Yes, I know of deaths from these diseases. Among my classmates were physicians and health professionals from Taiwan, Indonesia, Africa, Egypt, Pakistan, Vanuatu, Guam, and the like. For our graduate practicum rotations, we were flung to all corners of the globe, including underdeveloped locales where poverty and malnutrition were common. My classmates went on to positions in clinical practice as well as in policy, including for WHO, USAID, and the CDC.
Measles can kill a child in poor nutrition status. So can chickenpox, flu, or a common cold. Here is the lost part of the conversation: Nutrition, not vaccination, makes or breaks this for a child. For decades, the World Health Organization (WHO) has emphasized nutrition protocols for controlling infectious diseases, and for measles in particular (see Table 1 here for just one example and Table 2 here for another). Why? Because the immune system only works if it has nutrients to draw on to make immuglobulin, white blood cells, NK cells, a thymus gland, and so on. It can’t work from just a poke in the arm with a bunch of antigens and toxic adjuvants in it. It needs the body’s nutrients to respond. My classmates in public health knew this, witnessed this, and applied it. They did not go on caterwauling about vaccination, condemning people who deferred, or indulging emotional, religious-fervor, carte-blanche approval to using vaccines without limits. We understood that nutrition status was, and still is, the primary driver of whether or not a child may die from an infectious disease, have complications, or survive it handily. Whether you derive it from an injection or a natural infection, there is no immunity without nutrition to build it – period.
This is now so polarized a topic that effective discussion is impossible. Young parents have succumbed to relentless fear mongering and misinformation from the pharmaceutical industry (via its alliances at the AAP, FDA, and CDC) while actual science has fallen by the wayside. Millenial parents are in lock step out of fear of becoming social pariahs, willingly submitting their children without question, lest they be accused of being “unscientific”. At the same time this generation can grasp that the oil industry has lied about climate change since the 1960s, it is somehow lost on young parents that the pharmaceutical industry is, likewise, lying to the public about the safety (and efficacy) of its single most profitable sector. As long as pediatricians remain poorly informed on nutrition, they too will readily believe that an ever growing vaccination schedule is the only way to have immunity to anything. It isn’t.
For kids in strong nutrition status, measles and chickenpox are survivable and beneficial infections. Not only do these infections give effective immunity that lasts into adulthood, having had acute fever inducing infections in childhood like measles may lower risk of certain cancers later in life. Strong nutrition status means robust stores of iron, zinc, vitamin A, protein; access to clean whole foods and the appetite to eat them; and a body mass index somewhere between the 25th and 80th percentiles.
Nutrition and infection is a vast and complex topic. Our pediatric physician community is tragically not well versed in it. Hence, we have a nationwide army of pediatricians believing that only vaccines can prevent infection, while at the same time depending on giving them for their livelihoods. The truth is, not a single disease has been eradicated by vaccines so far, and like any other pharmaceutical product, it may not suit everyone. The strong arm tactics afoot to force vaccination are highly suspect – if a product truly works well, no one would object and no one would need to be forced to use it. In fact, vaccination itself may have loosed more virulent strains of several previously mostly benign infections, besides destroying the natural immunity that humans developed over eons of time.
If your child contracts either measles or chickenpox, consider these guidelines from Mayo Clinic. If your child has been growing well, eating well, and not picky prior to illness, odds are they will have the nutrition reserves to weather this successfully and will be gifted with robust immunity for many years. Vitamin A is crucial for fighting measles. Supplementing it during this illness may be necessary. If your doctor doesn’t know how to do this, see these WHO guidelines (Source – see page 45):
Myth #7 – Elimination diets will make my kid different and there’s nothing to eat anyway – When I became a mom, despite my degrees in nutrition, I knew virtually nothing of elimination diets or food allergy. I soon found myself on a steep learning curve. This was in the mid 1990s. No internet, no online support groups, no other moms in this boat. I was isolated, and cracking into my training, texts, and visiting medical libraries all over again, just like in graduate school. My son needed to eliminate gluten, soy, egg, dairy, and nuts back when nobody did this. Nothing could be bought ready made, including bread (we eventually found Kinnikinnick bakery in Canada, but that was the only one for years). I was often quite unwelcome at school events, family gatherings, or birthday parties because I would show up with “weird” food that my son could eat. I always made enough to share. I always asked hosts ahead of time if this was okay. Eventually, it was …fine.
We didn’t talk a lot about this in my house. We just made food. It wasn’t my son’s problem, it was mine. I was the adult, and it was my job to give him the freedom to eat and feel good, rather than eat and feel sick, like any other kid. If anyone had a problem with that, well, insert expletive here. He gets to be well and happy too. This was my mantra.
This made me learn a lot about food, cooking, and baking that I didn’t know. I learned how to make really good food and really fun and delicious treats for holidays and birthdays. It made me do a better job than I would have, of feeding my family.
If I could do it in the dark ages, you can do it now. There is so much awareness for food allergy now, not to mention thousands of food products out there ready to buy, mix, cook, bake, or just eat. Get to it. If you need help, let me know.
How do you get your kids a decent lunch at school? You’re over the top with beautiful Bentos, containers, and boxes for all the best snacks and sandwiches you can think of, you’ve tried every healthy power bar, fruit, carrot sticks, rolled up turkey, hummus… You’ve resorted to the junk: Cheddar Bunnies or Goldfish, pretzels, chips, sugary granola bars… and it comes back barely touched at the end of the school day, right? Or you’re buying school lunch, but have no idea what it is, whether your child eats it, or why they come home and melt into tantrums day after day (hunger, maybe?) Here’s five tips to help this go a little better.
1 – Let yourself off the hook – and your kid too. You’re not the problem. Neither is your child. The school is. Lunch is too short, too chaotic, and too impersonal. Incredibly, some children literally don’t get to eat lunch at all, as they spend too much time lining up to get it and finding a table. Here is one example of a school where children actually dumped untouched trays of food in the trash because it was time for recess by the time they’d gotten their lunches – they never got to eat at all. No amount of curriculum is worth this. You can stuff curriculum into kids’ faces all day if you like, but guess what? It won’t work. Because when children are hungry, attention and learning drop. Hmm maybe this is why we hear that US kids are falling behind compared to other countries?
By contrast, check out this story and video about how school lunch is served in France. Imagine how differently children learn to value food, community, self worth, and social interaction, when they get to eat this way. Oh well. We are probably not going to get there anytime soon in the US. But I share this to illustrate how absurd it is to expect children to function well in our version of a school lunch system. It does not engender health, good digestion, or appreciation for food, self, or how to contribute to a positive group experience. Our system is downright competitive, and anxiety provoking, as kids must worry about what they’ll get, when they’ll get it, if they can eat it, how fast, where to sit… and must do it in a cacophony that could make your ears bleed. So give in to the fact that how your child eats at school is something you can’t likely change, at least not this week. Make up for it with family meals at home as often as you can, whether it’s breakfast or evening meals. Having family meals together on a regular basis has been shown to boost kids’ vocabularies, grades, and intakes of nutrient-dense foods.. and it lowers high risk behaviors in teens like drug use and drinking.
2 – Let your child eat what is easy during the school day. Literally, anything is better than nothing. Pack high protein finger foods, starchy snacks (yes, you read that right), and comfy favorites. Don’t worry about the carrots and celery that come home. They’re not going to help much anyway during the busy school day. Your child needs high density food. Their brains use nearly half the total food energy they eat every day, just to be and learn (adult brains use about half that amount). Starchy snacks give fuel quickly and while we can argue all day about why they’re bad, they are better than nothing. Think of it this way: You’re flight was delayed and your stuck in an airport terminal at 4 AM with nothing open for food. You never had dinner the day before or breakfast this morning. But wait: You found some crackers in your purse. Eat them, for God’s sake! Yes, it’s junk, and, it will give you a little help til you get to your destination. It’s not what you’re going to eat every day, but you’re glad to have it in that moment. Likewise, don’t sweat it if your child is eating some low value starchy snacks during the school day sometimes. Avoid processed high sugar or corn syrup snacks – but a blondie brownie (gluten free if necessary), made with strong organic ingredients, coconut sugar or maple syrup instead of cane sugar, and some awesome ghee or coconut oil for a brain boosting fat isn’t at all that bad. If allowed at your kids’ school, throw in some crushed cashews or other safe nut. A dense homemade or store bought bar every day with clean ingredients isn’t all that bad.
Lunch at an Iowa school, 1939 (courtesy Library of Congress)
3 – Fast finger foods are an obvious help. Expand on the starchy goodies by including some protein and fat rich options, like olives, hard boiled eggs, jerky or meat sticks, or collagen bars like BulletProof, Dr Axe, BonkBreaker, Caveman, or Perfect Bars (some from this brand have peanut). Other bars may source the protein punch from dairy, using whey or casein; you’ll need to skip those for a dairy free child. You might also see soy, rice, hemp, or nuts as protein sources. Scrutinize ingredients to fit your child’s needs. Generally, grass fed collagen is a good protein source that is non-allergenic for most kids. Another great option: Fat bombs, bite size power packed snacks that are easy to make at home with a few ingredients, and are beginning to appear on store shelves in various forms. Here is just one site that offers a cache of 45 fat bomb recipes. Look around the web for more from sites like Paleo Hacks, Paleo Plan, or under names like Paleo Energy Balls. Those recipes use nut butters often; some schools have a zero nut policy while others only limit peanut or have a nut free table. Lastly – macadamia nuts, if allowed at your child’s school, have the highest fat and calorie content of any nut. Even a few nuts give high octane fuel that can make the day’s journey easier. Ten nuts yields about 200 calories. Throw in a few organic, stevia sweetened chocolate chips if you want to make it a treat that skips sugar.
4 – Make the liquids count. Instead of juice pouches or boxes, consider a midday meal replacement power shake that adds fat, protein or micronutrients. Options abound for ready to drink stuff you can pack in your child’s lunch. Orgain drinks are widely available (even at Costco) in both vegan and dairy protein source versions. The vegan version is gluten, dairy, and soy free. I also love Rebble Protein Elixirs. A little pricey, but they are dairy, gluten and soy free, with big protein boosts from pea, sunflower, pumpkin seed, or hemp. They are less sugary, more nutritious, and cleaner than stuff like Boost or Pediasure, which are high corn syrup and low nutrition value with only GMO fed cow casein and GMO soy as the protein sources.
Many kids with severe allergies need an even more specialized product. One example is Splash ready to drink elemental formula for children. Though many in the integrative nutrition communities love to hate this stuff, in certain cases, I have seen it be quite successful for children with feeding difficulties and multiple food allergy. Downside: High cost, but may be covered on insurance for kids with documented multiple food allergy.
You can of course also always make your own smoothie and send it to school in a single serving container, but keep in mind that this makes more work for you, and it may take more steps for your child to eat it than products that come with a straw or easy open cap.
5 – If all else fails and your child is simply not eating lunch, meet with your school principal and teacher to troubleshoot. Ask if you can observe a lunch period, volunteer during lunch, or work with an advocate to observe for you, so your child isn’t seeing you at school to watch lunch (they will most likely behave differently in your presence). Is your child last to get to the table, struggling to know where to sit, klutzy with the tray tasks, overwhelmed by noise, too excited to socialize to eat? Identify what is not working. Solutions might be quieter seating with a lunch bunch rather than in the cafeteria en masse, leaving two minutes sooner to get to cafeteria with a peer, or reliable seating at a regular spot. Further ideas are talking to your principal about aligning recess before instead of after lunch, expanding the lunch period by a few more minutes, or creating conduct rules at lunch for noise or behavior for the whole school. In my son’s elementary school, lunch included clear conduct rules that meant no one left the table until everyone had finished eating and had cleared their trays/lunch sacks and trash. This meant that at the end of the half hour (yes, they had 30 minutes), twelve little angels were usually seated quietly waiting for the signal for the whole table to go out and play. Rather than bench seating or loose chairs, the cafeteria had tables with single circles integral for each little behind, like this. These omitted crowding or jostling for space. Find power in numbers with other parents for these larger changes.
When I was a kid, we actually got bussed home in the middle of the day for lunch. My school did not have a cafeteria. We were picked up, brought home, I had lunch with my mom and siblings, and got back on the bus to go back to school. I had a full half hour to eat once home. I never felt rushed or worried about lunch. It’s hard to believe this is how it used to be in an American public school. Times have changed, budgets are squeezed, moms aren’t home to serve lunch. Maybe someday our school system will reboot how it does lunch time to something more conducive to learning, but until then, give your child these options to at least get through the day on more than fumes – they deserve it!
Functional medicine is all about resolving the root cause for chronic conditions, by giving the body tools to repair and heal itself beyond just prescription drugs to mask symptoms. The idea is to be well to potential, not just un-sick. But there’s a problem, when it comes to babies, toddlers, kids and teens: Those people are not little adults. The functional medicine model that works for grown ups sometimes leaves out critical pieces for kids – and I see these mistakes in my pediatric nutrition practice, regularly!
If you know me, you know I work in an office with a fabulous functional medicine doc, author, and speaker Jill Carnahan MD. Before moving into our new office digs in 2015, we shared space with Robert Rountree MD, another renown educator, author, speaker and founding IFM member (here’s just one of his fabulous pearls of wisdom). Just being in the same room with those two is a joy, as both are fonts of knowledge and experience!
I meet many kids who have come into my practice having already worked with a functional medicine practitioner elsewhere in the US – but often, these kids are still sick, not getting better, or even getting worse. Does this mean functional medicine doesn’t work for kids?
Nope. It means a few key pieces got left out. I see this a lot. Work these bits into your child’s care with your provider, and things might go a lot better. Here’s the top 3 goofs that I encounter, when working with families who tried functional medicine care for a child, but didn’t see great results.
1 – Your Doctor Forgot About The Food
Sounds crazy, but it’s true: The most important piece for children of any age to feel better with a chronic condition (or even leave it behind) is food. How much? What protein sources are safe? How much fat? What carbs are okay? What do you make for dinner? What goes in the lunch box? How many ounces of formula, and what formula is best for the baby? How much breast milk? Should mom be on an elimination diet too? Which foods should she remove, which foods can she replace those with? Should your child eat fermented food, GAPS, ketogenic diet, Autoimmune Paleo (AIP), gluten, low oxalate foods, avoid nightshades, low FODMAPs foods?
All those questions need specific answers and specific instructions.
But… What I often see is that parents are just told what not to feed their kids, without details about what to feed them instead. This often leaves kids over-restricted, not eating enough. I also find that foods are eliminated without a good reason (“aren’t carbs bad for you?” … “I was told potatoes are inflammatory, so we cut those too.” … “I don’t want to feed yeast – the doctor said to go ketogenic just to be safe.”) Or, sometimes, a food that is not a fit gets over-used, like daily high oxalate juices with spinach, kale, and beet juice; or coconut everything, when we find coconut to be a high IgG trigger food or too high FODMAPs for that child. Long short, you really gotta know what food is right for your child, and how much. That is based on lab studies, signs, symptoms, and history – not on any dogma about the “best” diet.
The flip side of looking in detail at what and how much your child is eating daily is growth pattern. Growth is the single most important measure of a child’s nutrition status, especially in children under age five. It can be assessed in great detail, to include stuff like Z scores for body mass index for age, velocity, regression, or level of malnutrition. This is a big blind spot in the functional medicine model, which was borne out of how to manage chronic conditions for adults – who aren’t growing!
Growing dramatically changes how we use energy (calories), protein, fats, carbs, and even some micronutrients like folic acid, zinc, or iron. Just your kid’s brain uses more energy per ounce daily than yours does! Not to mention all the other stuff going on in a growing person.
I request a food diary with each new patient intake, and often at follow up appointments too. This isn’t about watching what parents are doing right or wrong (it’s not about you!). Food diaries reveal a lot about a child’s body, what they feel like eating, what they are absorbing well, what nutrients they may be losing, why they are fatigued or hyper, or what sort of dysbiosis may be active.
Matching this info up with a growth analysis is a gold mine of information about why a child isn’t feeling well. Growth impairments can be subtle or even invisible, without a skilled assessment (which pediatricians generally don’t do either – they don’t have time). Even mild growth impairments matter – they are costly for children. They affect sleep, behavior, mood, self regulation, timing of puberty, and stamina.
And.. Guess what: That Holy Grail of healing leaky gut? It can’t and doesn’t happen when a child has a growth impairment. Just being even a little underweight can, in itself, make a child’s gut leaky. The functional medicine community often overlooks this. You can eat all the kombucha and bone broth you like, but if you’re five years old and off your expected growth pattern, it won’t work so well. There won’t be enough energy and construction material to manage the demands for growth, and the demands of tissue repair and restoration. These heighten a child’s macronutrient needs (protein, calories, fats, and carbs) dramatically – and they have to be the right macronutrients for your child… Or, you guessed it, all your efforts can flop.
I often find that a child will be sprinkled with supplements for toxicity and neurotransmitter support, when all they needed to function better was the right food in the right amounts, consistently, day to day. The only way to find this out is by looking at detailed food diaries and making a deep dive into growth data – including life long growth pattern from birth. This helps identify what the expected growth pattern is in the present day.
2 – Your Doctor Ran Too Many Fancy Lab Tests
…that didn’t really add up to an action plan for the family.
There’s no shortage of super interesting lab tests available now, that broaden our understanding of how the immune system is managing food, how we manage toxic exposures, or what our microbiome is up to. But what do you do with it all?
Sometimes this information isn’t actionable. That is, there isn’t going to be anything you can do with it.
For example: A Cyrex Panel 3 for Wheat Proteome Reactivity and Autoimmunity is as detailed as you can get, to see what an immune system “thinks” about gluten. It costs about $300, out of pocket. But if you’re just trying to figure out if a gluten free diet would help, all you need to establish that is deamidated gliadin antibody test. Your pediatrician or PCP can do that, and bill your insurance. (Your pediatrician will tell you it’s “normal” if the result is less than 20. But I will tell you to withdraw gluten if your child has any suspect symptoms for gluten intolerance, with a value above 10). Even if you pay cash for this simple test, it isn’t likely to cost more than about $50.
Or you might see a test for red blood cell toxic and essential metals, like this one. I like this test because it captures a lot of information in one sample. But, in children especially, iron needs more detailed digging than this test can show. If iron is marginal, it’s easier to absorb toxic metals like lead. The only way to know if iron is truly marginal is to do some standard stuff that, once again, your pediatrician can do very inexpensively or on your insurance. Include ferritin, CBC, transferrin, saturation, and serum iron to get this picture. Plus, kids show signs of mineral deficits clearly in behavior, sleep pattern, mood, hair, or skin. For children, a nutrition focused physical exam should be included in assessment too, not just lab tests. And by the way, here in my practice and in the practice of Jill Carnahan, we don’t use hair testing for mineral analysis, because we don’t find it to be terribly accurate or useful.
Another popular (and costly) test is the NutrEval by Genova Diagnostics, which runs close to $400 out of pocket. Some insurances may cover this test; in my own practice, this is rare. Many functional medicine docs rely on this for nutrition assessment. While it does do several tests for one fairly decent price, it does not assess children as well as it does adults. Nutrition assessment in children must include growth and food intake data, as well as clinical signs and symptoms. No one lab test can do this, even a comprehensive panel like the NutrEval. Because it is sold as a comprehensive, complete tool, it tends to mislead into thinking that all solutions lie in the supplement protocols that come with your test results. How often I have seen this fail!
The NutrEval also includes an analysis of essential fatty acids. I think you can skip that: It’s easy to see things like essential fatty acid deficits in kids, based on their food records (are they eating any?), behavior, and clinical signs that relate to essential fats. You don’t really need a blood test for this in my opinion, unless you are revisiting how to dose a fatty acid supplement protocol that doesn’t seem to be working. Even then, you can check other parameters in signs, symptoms, or other less costly labs to find out.
Another common misunderstanding I encounter with parents who have done a NutrEval is they believe that their kids’ protein status has been assessed, because there is an amino acid profile in it. Amino acid profiles don’t assess protein status or intake, which is crucial for kids. The amino acid profile rules out inherited metabolic disorders, another common and often insurance-covered test that you don’t need a functional medicine doctor to order for you. Protein status in kids is assessed with a metabolic panel (a common and cheap LabCorp or QuestLab test that your pediatrician can do), and by looking at clinical signs, growth, feeding, and elimination patterns.
For more cost saving tips on what lab tests to start with, without spending thousands out of pocket with a functional medicine doc, see my e book on 5 Essential Lab Tests For Kids With Autism. Goes for any kid, with a chronic condition! Any practitioner skilled in Nutrition Focused Physical Exam for children can save you a lot of time, trouble, and money – and help you avoid a care plan that backfires.
3 – Your Child Has Been Over-Treated, or Treated Too Aggressively
There are so many cool tricks and tools for wellness potential that insurance doesn’t pay for. These are the things that your functional medicine doctor is trained to use – cutting edge stuff that includes everything from far infrared saunas and nutritional or immunoglobulin IVs, to highly specialized supplement protocols and ozone suppositories, or novel ways of using prescription drugs off label, for special circumstances. It’s hard to hold back, when we want to help people heal!
But here’s the thing: Children are delicate little creatures. Especially really young ones, like, babies. Or kids of any age who have been overwhelmed with mold toxicity or Lyme disease, or who didn’t tolerate the vaccine schedule. Their bodies are overwhelmed. Don’t overwhelm them all over again, with a barrage of treatments, all at once.
I have seen children go from bed-ridden to literally jumping, enjoying school, and playing normally again simply by suggesting a family stop treating their child for all these found problems, and by helping to re-boot with nourishing, gentle foods that fit that child’s needs. Then we pick and choose which “layer” the child might successfully address first. Are they anemic, or are there other mineral imbalances? Can they absorb foods and nutrients in the first place, or is there achlohydra, SIBO, SIFO? Are they pooping comfortably? Can they detoxify ….anything? Where can we gently support some detox?
When children are over-treated, they get sick, tired, weak, anxious, fatigued, depressed; they don’t eat right; they can’t play, they’re weepy or more angry, with volatility; they have rashes, fevers, or get every cold and bug more easily. It’s not necessary to go through this. It can be easier, gentler, and work better.
Functional medicine is the way health care is trending. We all want to feel really good, not just live “meh”, without sickness. Kids deserve it too. If your child is not playing, sleeping well, eating well, and enjoying activities they love, take a look at whether these mistakes are in the mix with your functional medicine provider. Re-boot the plan, and your child can feel better.
Let me tell you the five most helpful to-do’s I have seen parents use for their children’s health, as we start a new year.
These come from my twenty years’ experience working with families in my pediatric nutrition practice – with mostly complex, difficult cases who couldn’t find improvement elsewhere. In other words, even if your child is really challenged with feeding, growth, chronic illness or disability, developmental trials, allergy or more, I can tell you that these five tips are still my top picks, for setting up the healthiest foundation possible for your kids.
You might think I am going to talk about stuff like picky eating, junk food versus organic, gluten, food allergies, eating more vegetables, probiotics, vitamins, the latest autism protocol, whether or not you should do GAPS, gut biome… Nope. I definitely do cover all that and more in my clinical practice and in my blog, so have a look around.
These tips are about you – and how subtle shifts in your approach to health and what your family eats can cause unexpected benefits to unfold in everyone’s health.
1 – Get fierce about this: Adopt the mantra that health – not illness, disability, endless doctors’ appointments, or dependence on prescription or over-the-counter drugs that bring unwanted side effects – is your child’s birthright. It’s the baseline they are entitled to. Picture them at their healthiest and happiest. Imagine the unimaginable, if that is what it takes. Start with that picture of the joy good health brings.
If they’re not there, if your children are saddled with chronic illness, don’t lament, and definitely don’t feel sorry for them – they have you as their advocate and model, and they need positivity and possibility. Hold that image of total health that they need and deserve. Assume they have it already, and lead the way toward it, quietly and persistently. Expect a good outcome. Their bodies are built to grow, heal, and restore. There is always potential for healing.
2 – Chill out about food. Robyn Obrien’s 80/20 rule is a comfortable sweet spot. Her suggestion is to work for “progress not perfection”. Unless you know your child will sustain severe injury or consequences from eating certain verboten foods which must be avoided, don’t pathologize food. Don’t judge. Don’t chatter about how horrible this or that food is.
I encourage parents to use empowering language, even with small children. I discourage labeling food as “bad” or something that will “make you sick”. This can burden children – even teens – with unnecessary anxiety.
Instead, use words that show the power to choose. If your child eats something that backfires into discomfort or behavioral disintegration, ask which food might feel better next time, if they’re old enough to consider that question for themselves. If not, tell them what you will do next time: “Next time I’ll have xyz ready to eat instead, and you can see if that feels good”. Or “I’ll give your teacher a new snack for you at school. Maybe that will feel good instead.” Don’t harp on what a mistake a transgression was, especially if your child made the choice or if the choice was beyond their control. That is too easily internalized into feelings of powerlessness or failure by a child.
Notice your phrasing, demeanor, and tone when talking about food and health. Leave out the dark, judgmental stuff and emphasize food feeling good, tasting good, or being fun to share or experiment with.
3 – Read food labels? Now try this. If you’re like most parents I work with, you read food labels ad nauseam. You scrutinize every ingredient that passes your child’s lips – especially if you faithfully eat only organic food, avoid corn syrup or dyes, or if your kids ever needed an Epi Pen for eating the wrong thing!
Great. Now try this: Read a vaccine package insert. Read the whole thing, including the ingredients (often listed under the word “Description”). If you care about what’s in your child’s food, you will definitely want to know what is injected into them.
This is a great resource to see the full insert for each vaccine in the schedule. To see ingredients, search for the word “description” (which – as you may wonder – does not necessarily disclose all the ingredients, some of which are allowed to be proprietary, per the FDA).
I’ve met many a mom worried about letting their kids eat, say, corn chips or dairy (because they heard either was “bad” for everyone) – but never knew that Prevnar 13 – just one of dozens of shots on the schedule – has GMO soy fragments in it. Or that Recombivax has yeast, soy, formaldehyde, dextrose, and aluminum in it.
Recombivax is given to newborn babies. If you wouldn’t let even traces of GMO soy, formaldehyde, or aluminum touch your newborn baby’s tongue, why would you let these be injected? Note that eating any protein – or toxin for that matter – is far safer than injecting it, especially if your child is prone to any sort of reaction.
No need to dwell on what a contentious conversation anything with the V-word is, or indulge the drama and emotional reactions to this topic (I’ll delete comments that do). I get it. My graduate training in public health was full-on pro vaccine. I don’t need any instruction here, thank you very much.
It’s just that it’s high time for common sense. We talk a lot about food ingredients, including traces of glyphosate in GMO foods. Nobody talks much about ingredients in your kids’ shots. The “trace amount” argument loses traction once you see that kids receive anywhere from 70 to 100 doses in their first five years, when they are the most vulnerable to the burden of toxic exposures.
It would be fabulous if there was a pharmaceutical or biological product that actually was reliably, equally safe and equally effective for every kid or baby, every single day. But that is just magical thinking. There is no such thing, anywhere. Not a food, not a medicine, not even a fragrance. Can you imagine if it were mandated that all public school children eat Adderall every day, because some kids are too hard to manage in the classroom due to ADHD?
So this is why my Number 3 is for you to learn exactly what’s in your kids’ shots (or yours, if you’re planning on getting pregnant). They are potent. Don’t take them lightly. They may be helpful, or like anything else, they can be harmful. Too many may overstimulate the immune system to cause problems later on. Learn what is in vaccines, when they’re given and how often, and scrutinize if your child really needs them all.
For example: Your child won’t need boosters if they retain immunity from a prior dose – more may not be better.
If you’re upset because someone gave your kid a bag of Skittles at school, then wig out about the kid next door who skipped chickenpox vaccine, I think you’ve got it backwards. Just my opinion.
Besides, don’t you believe your own kid’s chickenpox shot worked – ?
In this scenario, the candy may be the lesser of two evils. Chickenpox vaccine is made with human fetal DNA, guinea pig embryonic tissue, sucrose, glutamate and MSG, and fetal bovine serum. Check out page 6 under “Description”.
4 – Heed your intuition. It’s a powerful healer, guide, and protector for your kids. And at the same time, remember that intuition is not a mandate for you alone to know everything!
In all my years as a clinician, I can’t tell you how many times I’ve heard a mom say “I just had a feeling” …and how often that feeling was right. I’ve certainly had that moment many times myself as a mom.
It can be tough to go against the advice of the expert specialist at the Mayo Clinic, but you can do it if you simply feel you must, even if you don’t know quite why just yet. You know your child best.
Don’t confuse intuition with fear, or with the egocentric idea that only you can help your child. While I’ve often seen a mom’s intuition impressively steer a child to a good outcome, I have also seen families withhold good care options or block alliances with good providers, out of fear that they shouldn’t trust anything, or a belief that only mom can know what to do. Neither approach is very successful.
Look for your allies and resources, know your own strengths as well as spots where you could use help, allow the help in, and remember – you do know your child best.
5 – Drop the drama. When we have kids with struggles, it’s so easy to be seduced by the drama of what it takes to be their parent.
It’s easy to over-identify with the tasks of caring for kids with learning disabilities, developmental concerns, feeding and growth delays, allergies, and more.
Don’t do that. It messes up your kids. They’re not here to fulfill you in some way, or address your needs. They’re just here. Pretty much, to be themselves.
I meet traumatized families. Families who have had too many trips to the ER for severe allergy reactions from an accidental walnut, for seizures because a medication keeps failing, for passing out because of FPIES reactions and non-stop vomiting. For these families, a plain old broken arm sounds pretty good. Families isolated by too many dietary restrictions, by developmental disabilities including autism, anxiety disorders, or processing disorders.
I meet families who have been verbally battered or treated with great insensitivity by doctors, teachers, neighbors, or even friends or family members. Trusting becomes hard. As a parent, it’s hard at times not to feel victimized, to feel like the hardship with your kids may never end, and to lapse into the trap of believing that this whirlwind of medical/developmental/educational crises is… your whole and sole self.
But this isn’t about you.
Underneath and in between all that, there is your child, endeavoring to just be. Like any other kid.
The kids who come out of these tempests with the best outcomes, in my experience, are the ones whose parents can remain aware of this. These parents do not attach their own pain, ego, fears, sadness, disappointment, frustration, or feelings of inadequacy to the child, or to the outcomes. They don’t focus on diagnostic labels, whether it’s eosinophilic esophagitis, PANDAS, autism, Crohns, FPIES, or whatever. They rarely if ever use the labels around their kids, because they know their kids are not the labels. They obtain the labels as a path to health and wellbeing as is useful – that’s it. They don’t spend too much time on Facebook groups devoted to their kids’ labels. They focus on actionable solutions. They trust the fact that as parent, they are doing the best they can.
You’re in charge. You set the tone. Your kids will follow suit, even if they have seemingly insurmountable challenges on their plates. I used to hate it when my mother advised, “don’t complain, don’t explain” …but, she was right.