Which feeding strategy is healthier for kids – grazing as they please, or structured meals? I get asked this a lot. Here’s what I’ve experienced across some twenty years in clinical practice with all ages of kids, from young infants up to twenty-five year old young men who are finishing their last growth spurts. This question goes not only for meals, but breastfeeding too, especially when infants are wrapping up that first year or so, and becoming very interested in eating what they see you or their siblings eat.
But here’s the thing: The question you really need to start with is, what is best for you?
You may already know that supplying a steady stream of snacks and mini-meals isn’t nourishing for kids, and it’s a lot of work. Are you up for that? How about if you have three kids with different food allergies, not to mention different activities in different directions all day long? Or if your spouse doesn’t “believe” in all the effort you make to feed everybody, wants their own special favorites, and leaves it all on your shoulders? Mix in work schedules and budget constraints for special foods, and this becomes a fail, fast – one that I have witnessed many times in families reaching out for my help.
Usually, kids in these scenarios aren’t thriving. They’re often underweight, cranky, manipulative, poor sleepers, and picky eaters. And the chef-parent is at wits’ end. If you can’t keep up this workload, or if you plain just hate doing it, then it’s simple: Stop. Your happiness matters, period. And, happiness rubs off on your kids. And and, your kids will be healthier with discreet meal schedules, versus growing up on the non-stop graze.
As exhausting as feeding a grazer can be, it’s an easy trap to fall into. There are so many ready-to-eat packaged foods now for toddlers and children, that just handing over that pouch of organic veggie goo, paleo power bar, yogurt tube, or cup of snack crackers when you know your child probably isn’t eating enough is too tempting. But giving in to grazing has problems:
- It may worsen small intestine bacterial overgrowth (SIBO) or small intestine fungal overgrowth (SIFO), a frequent cause of picky eating, weak appetite, and poor growth and gain for toddlers in my practice. Brief periods of day time fasting help keep this under control. Toddlers can manage two to three hour stretches between meals or snacks; school age kid, up to four hours or so.
- Missing those short fasts throughout the day prevents an important thing called the “migrating motor complex“. This is what our GI tracts do between meals, when we’re on empty. It’s a housekeeping function that literally acts like a mini-cleanse broom, sweeping the intestine, and making it hard for lousy SIBO or SIFO microbial garbage to set up house.
- When the body is fasted, the muscles in the small intestine make a wave of forward motion. This cleansing wave keeps intestinal contents from getting stuck – which is better for that constipation scenario you may be dealing with (read my blog on how to get off Miralax if that’s your kid). Eating too often abruptly ends this task.
- Grazing can leave toddlers and kids hungry in the middle of the night, causing them to sleep poorly, wake up tired, or cry for a feeding when they’re old enough to sleep through – if they get the food they need during the day.
Some other points to consider
- Eating is self-care. Kids learn good self care from parents who model health and happiness habits. If you’re miserable dealing with food and preparing meals, your kids will adopt a view of food as a burdensome annoyance too. Don’t expect them to lead the way here or make it easy for you – that’s your job.
- Perhaps your toddlers (or kids) are good at grabbing what they want to eat, when they want. How independent is that, right? And maybe that makes your day easier. But, they’re toddlers. They are still dependent on adults to make wise decisions about what foods are good, and when. Left to their own devices, they’ll mostly eat what’s familiar, and not explore new foods that they may need, as they grow so rapidly.
- Up until just a few years ago, there were none of these packaged foods parents now find so irresistible: The squeezable pouches of yogurt, fruit, and veggies; the packages full of crunchy snacks designed to be held by toddler hands; the endless variety of power bars, paleo bars, protein bars, and snack bars; the mini cups of chia pudding or vegan spreadable cheese or hummus; the gummy snacks that are fruit-like, sort of. All of this has been created for one reason: You buy it. It’s profitable. Kids definitely don’t need any of this stuff to be healthy, but if a bit of it in the mix makes life easier, enjoy – just don’t make it your only food strategy.
- Learning to respond to hunger and fullness healthfully only happens when kids actually experience these things.
Avoid These Sure-To-Fail Scenarios
Recently a mom asked for my help with the breakfast routine for her three kids. One child especially did not want to eat in the morning, then went off to school semi-fed, where he proceeded to have meltdowns.
“Tell me the sequence of what happens; what is the first thing he does when he gets up?” I asked.
She explained that this one of her brood would get up, and immediately settle into Lego play before breakfast, which he would vehemently oppose leaving behind for food. He’d attempt some eating in this disintegrated state of mind, fail, and go off to school blunted for hunger but not well fed.
First step: Lose the Legos. Morning on school days is self care time, not play time. It’s get-ready-for-your-day. It’s fuel-up and settle-down for the tasks ahead. Toys should be nowhere in sight. This may sound hard, given the absurdly ubiquitous nature of branding for toys on everything from pillowcases to toothbrushes (not to mention snack food!). But it’s a self care routine that must be learned. Kids will not become good planners when toys, snacks, and whatever else they desire is within reach at any moment.
Another very common fail I encounter is prolonging breastfeeding. Don’t get me wrong: We all know how amazing breastmilk is. But, as infants age out toward their second year, they need some solid food too. I have met countless moms afraid to wean, for a variety of reasons. It’s misguided to think that breast milk will continue to be the solution as their babies become toddlers. Their kids sip sip sip. They want feedings at midnight, 2 AM and 5 AM even though they’re 13 months old. Fail. This is a kid who needs to start eating food.
Continuing to breast feed is fine – but it should not be the only or primary source of sustenance at this age.
Even if your youngster is doing great at 14 months on just breast milk, I’ll bet you haven’t had a full night’s sleep in a long time. No good. You need sleep. Baby needs food. Solid foods needed for the baby’s higher demands get displaced with constant sipping on breastmilk, which can stop being adequate to meet all of a baby’s needs by about age 10-12 months. This can vary with circumstances for the baby, so finding the fit for you and your baby is key. It might be different from someone else.
If your child is fiercely picky for just breast milk, sleeping fitfully, waking for feedings, and failing to progress with introducing foods after age 15-18 months, it’s time for some intervention and redirection – call me for an appointment.
Ok, one more: Just like toddlers, older kids need guidance and modeling for healthy self care habits when it comes to food. Teens who skip breakfast, breeze through lunch with a power bar, chow hard at dinner, then eat big again at midnight are setting themselves up for a bunch of challenges for mood, energy, attention/focus, and sleep. If they’re struggling, and combative about food, let’s talk. Most teens I’ve worked with are relieved to be offered options that lift this burden and give them strategies they feel better with quickly. The trick may be hearing it from someone other than mom or dad.
Need help? Work with me to sort out what food your kids need, when, and how!
Is your child underweight? Your doctor would have told you, right?
Maybe not. In fact, I am often the first person to capture this finding in a toddler, child or teen who has seen multiple providers, from the pediatrician to gastroenterologist to allergist and so on. But this is really important for kids. Why? Because once kids slide into growth impairments, it throws a lot of other stuff off kilter for them. One, their immune systems don’t work as well. They can get sick more often, stay sick longer, and have more complications from infections than kids in healthy status. Two, they struggle more to behave, learn, focus, or sleep, and will often experience more anxiety, less self regulation, and more mood swings. This can happen even with mild or moderate growth impairments. In other words, kids don’t have to be severely underweight for this stuff to go wrong. When kids finally hit bottom with that failure to thrive (FTT) status, this will create a leaky gut – something many parents ask me about – because there aren’t enough nutrients and energy from food for the child’s gut wall to maintain its integrity. And, the younger a child is, the more vulnerable they are, when dropping off channel.
Pediatric providers generally won’t intervene on or even mention a lagging growth pattern unless your child is really, really underweight, as in – heading for the very bottom of the growth chart. Why not? There are several reasons why this can be true:
- Your insurance may not pay your doctor to intervene on any growth impairment other than failure to thrive (FTT), a severe and entrenched problem in which a child has fallen to below the fifth percentile for weight for age.
- Your doctor may not know that dropping just fifteen percentile points off expected growth pattern, for either weight or stature, actually means your child is underweight or undernourished.
- Your pediatrician may not know how to calculate your child’s ideal body weight, expected weight, or expected height, or doesn’t have time to do it.
- Your doctor doesn’t have time to scrutinize, integrate and explain all the growth data in that brief fifteen minute visit, including all the things that impact growth, from your kids’ food intakes to energy level to genetics.
- Your doctor isn’t sure how to help you fix the problem, or why it’s happening in the first place, if they notice it.
Because I work with kids with problems like allergy, autism, FPIES, inflammatory bowel conditions including Crohn’s disease, or all sorts of circumstances in which they can’t eat regular diets, it’s common for me to find that a child is indeed underweight. Many parents who contact me have placed their kids on special diets on their own, and don’t realize their kids are underfed and malnourished, even with all the best efforts at feeding well. But it can be a relief to know exactly what and how much food your child needs to grow, feel, and function better.
Usually, parents are downright surprised at what a difference something as simple as the right food intake makes for their kids. This quote is straight out of clinic today from a mom regarding her fifth grader, who had severe attention and focus issues for which he’d used medication, difficulty with independently toileting (constipation, stool accidents), frequent infections, and felt unhappy or frustrated often:
“Looks super healthy, I’ve never seen him this healthy. He seems more like a regular kid. He is thriving. He is growing like a weed. He is happy.”
This boy is off stimulant medication, using the bathroom independently and not having accidents, and has not had any infections for months, for the first time in his life.
What would your pediatrician do for these problems?
He would do what had been done for this child, and failed: Give methylphenidate (stimulants like Focalin, Ritalin, etc) for inattention and hyperactivity; Miralax for the constipation; antibiotics for the infections; and a “he seems fine” shrug for the moderate drop off of expected weight for age.
Nutrition care is not a replacement for medical care – and vice versa: Medical care is not nutrition care. They do different things, and require different skill sets. Strong nutrition in kids makes them healthy; prescription drugs mostly avert acute problems. Neither replaces the other, both are important for kids – but, unfortunately for kids all across the US, nutrition is not a big player in pediatrics nowadays.
Is your child underweight? Is it impacting their health? It’s easy to find out. There are well established criteria for determining things like expected growth pattern for a child, and how to restore it if lost. There are many tools at my disposal too, to sort out what foods would best serve your child, what foods you might really need to avoid, and what foods you really may not have to worry about. If you’re not sure, schedule an appointment and we can just find out!
Ezekiel and sprouted wheat breads are taking off in the ancestral diet department – but does this work on a gluten free diet? Spoiler alert: Sprouted grains, while containing less or different gluten from modern wheat, are not gluten-free. And even old land-race or ancestral strains of sprouted, organic, fermented wheat may be poorly tolerated in a modern-day injured gut. We have different wheat nowadays, and different guts!
First things first: What is sprouted wheat? Sprouted wheat bread is simply bread made with the seeds of wheat that have been soaked in water until, you guessed it, they sprout. Then the sprouts are ground into “sprouted flour”, used to make bread. Sprouting breaks starches down so they are easier to digest. Sprouted seed flours contain less gluten, but aren’t gluten free.
You can sprout all sorts of grains or even legumes, including barley, beans, brown or white rice, amaranth, lentils, millet, spelt, and more. “Ancient” grains – those cultivated millennia ago – include farro, spelt, quinoa, amaranth, chia, sorghum, freekeh, teff, millet and eikorn.
By comparison, non-sprouted grain breads simply use flour made from grinding seeds into flour.
In the case of wheat, grinding and refining non-sprouted seeds retains a lot of gluten – great for that doughy elasticity we so enjoy in stuff like dinner rolls or doughnuts, but bad for gluten-sensitive people.
We Eat Different Wheat Now
As you may have heard, wheat has changed a lot in the last sixty or so years:
- Wheat crops grown in the US today were modified through cross breeding in the 1960s to have even more gluten
- Decades before that, modern milling techniques stripped wheat of much of its nutritional value.
- Pesticides weren’t used at all on crops until the 1940s; now US wheat is one of the most heavily pesticide-laced crops on earth, because glyphosate (RoundUp) is doused on it just days before harvest, to ease harvesting and processing.
- Soils today have become depleted by modern farming techniques, leaving wheat even more bereft of nutritional value.
Besides the fact that modern wheat is now more refined, less nutritious, and higher in gluten, all of which make it harder to digest and more inflammatory for the human gut, the pesticide part really matters too. If you haven’t already heard, glyphosate damages the human gut biome, is suspect for exacerbating the autism epidemic, and may even trigger gluten intolerance or celiac disease itself, by virtue of its synergy with other toxins in our food and environment.
We Have Different Guts Now
So this means that the “can-you-eat-old-timey-wheat” question has two parts: While humans enjoyed organic, sprouted, fermented or even just plain ground wheat from ancient seed strains for centuries without injury (part 1), humans have not used glyphosate, exposed themselves routinely to heavy metals and industrial toxins, or repeatedly injected viral antigens into themselves year after year ever before (part 2). These can conspire to damage a gut beyond tolerance for even the loveliest of ancient or sprouted grains.
For the first time, we are eating and exposed to hundreds if not thousands of toxins that we never have been before, from pesticides like glyphosate to artificial ingredients in medicines and food to environmental pollutants. These all have potential to injure gut health and trigger inflammation. Glyphosate has been found in just about everyone, in breast milk and urine samples.
Our Viral Exposures Have Changed Too… A Lot
Viruses have long been suspect as a trigger for inflammatory bowel diseases including celiac disease. Meanwhile, viruses and heavy metals can synergize each other – that is, the two together can injure gut microbiota or worsen viral infection more than either alone (as in this example and this one). Like it or not, we have tinkered with these exposures with immunizations over the last six or seven decades too, by blending viral antigens in shots with metals like aluminum or mercury to “irritate” the immune system so that the shots work better. How these metals actually work in shots and what their cumulative toxicity may be, especially for infants and children, are not well studied.
Besides introducing vaccination in the 20th century, we also introduced exposures to toxic metals and pollutants from other types of pesticides besides glyphosate, and from large scale, mechanized extraction and manufacturing processes like strip mining, fracking, drilling, the use of plastics, and more.
So what this all means is that returning to ancient grains may not work for gluten sensitive kids, especially if they’ve had usual vaccinations (which gives multiple viral exposures in quick succession early in life with toxic metals), antibiotics, stomach flu bouts, or other potential disruptors to healthy human gut function and gut microbiome.
Ok So NOW WHAT?
Some gluten sensitive kids may be able to incorporate sprouted grain breads into their daily diets without an issue. Here’s how to sort it out:
- Find out which grains your child is most sensitive to before stocking your kitchen with sprouted or ancient grain options, especially if there has been a diagnosis of eosinophilic esophagitis (EE) or food protein induced enterocolitis syndrome (FPIES). I use ELISA IgG food antibody testing for multiple grains in my practice, including spelt, millet, oat, barley, and gluten.
- Run a urine test for glyphosate. This is available here. Work to reduce it by switching to organic foods as much as possible, while improving your child’s detoxification capacity. I work on this piece often with parents in my practice.
- Run a stool test for microbiome profile. Several options exist for this, from extremely detailed genetic analysis for microbes found, to simpler cultures, to panels with or without inflammatory bowel markers like calprotectin or lysozyme. I offer these in my pediatric nutrition practice. Include the inflammatory markers if your child has been symptomatic for a long time, if s/he isn’t growing well, or if s/he has had multiple rounds of antibiotics or frequent infections.
- Give your child upstream work first – a strong, nourishing, replenishing diet without any gluten (or grains if possible) for a good six months. You should see weight gain, strong nails, good dental health (no cavities), no rashes, and comfortable daily eliminations. Constipation, eczema, dentail cavities, or frequent sniffles are signs that you have more work to do. Don’t sacrifice growth or gain – kids need to follow their expected patterns for these, so don’t over restrict.
Need help? Get in touch, set up an appointment and let’s get started. Thanks for stopping by.
I spend hours each week researching products, recipes, and meal strategies for my very special pediatric clients. I also live in Boulder, Colorado – ground zero for foodie start ups (even my son’s baby sitter started a food company whose products are now in Whole Foods and other store shelves!). Just about every time I go to the grocery store, there is an interesting new product to check out around here.
Whatever I can find on store shelves right down the street, you can find on line. There’s no excuse to miss out on healthful, real food for your kids, even if you’re short on time and your kids have special diets or food allergies. Here’s my latest favorites for parents who don’t have time to bake, cook, or prepare scratch snacks. I often post new finds on my Nutrition Care Facebook Page too, so be sure to follow me there!
Tres Pupusas – Years ago I ate these delicious pupusas hot and freshly made at our Farmers’ Market. Now they are on store shelves, in the freezer section. Gluten free, organic non GMO masa (corn) flour pockets, with options from vegan (dairy and gluten free) to meaty (carnitas) or with cheese. Nicely sized for little kid hands (there’s even a bite sized mini pupusa), they make good finger food. Throw in a dip for your kids’ snacking, like avocado, hummus, or salsa.
Feel Good Foods – This is a good go-to for teens or college kids who have a microwave or hot plate and big appetite. This company’s egg rolls, potstickers, and other good stuff are gluten free, with several dairy free options too. Tasty if you have time to heat in your regular oven too. The pot stickers even come with their own gluten free dipping sauce. Have them ready when your starved kids come home from school starved, mad, and ready to kill you because they didn’t eat all day.
Capello’s Foods – Here’s an interesting line up of products: Gluten free, grain free manchego pizza, pastas, and… cookie dough?! If you can’t scratch-bake those lovely hypoallergenic cookies for the classroom party or your kids just like eating cookie dough, you have that option. And pizza – so missed by kids who don’t do dairy – can often work with manchego cheese (sheeps’ cheese), which some kids tolerate when they do poorly with cow’s milk or even goat cheese. Capello’s pizzas are the real deal – delicious, and you can build in more toppings if your kids like – chopped olives, basil or spinach leaves, bell peppers, or pepperoni. Almond flour is the base for these products.
CauliPower – This cauliflower crust pizza has taken the media by storm. Several topping options, with a crust based on cauliflower, and crazy good. All have cheese, but you can buy just the crust and build your own (try this cheeseless combo: Tomato sauce, salami, chopped olives, fresh basil leaves, scallions, oregano sprinkle and olive oil drizzle). Throw it in the oven 15 minutes before kids get home from school and you’re good to go.
Chebe – This product has been around for years. For Paleo, grain free, or gluten free diets, it’s a winner for giving your kids a sense of “bread”. It is basically tapioca flour, boxed as a mix, to which you add an egg, some vegetable oil, and liquid (water or almond milk). Period. I know a few noses will wrinkle at the thought of tapioca flour as Paleo, but the fact is, one of the biggest mistakes I see when kids go Paleo or GAPS is that they are underfed, their growth slows down, and they get cranky – usually because they’re eating too much fermented food, too much protein, and not enough good carby stuff. Kids do need carbohydrates to sustain normal growth patterns, sleep, focus, and to not feel anxious all day. So try this fast-to-prepare item and shape it into rolls, breadsticks, buns, or focaccia. Mince in some peppers or scallions. Plain, with herbs, slather on butter, ghee, olive oil, nut butters, or cut into awesome sliders and stick in a slice of prosciutto with mustard.
There you go – Five mostly heat-and-eat goodies to get your kids fed easily when you can’t prepare much of anything. Be sure to check each of these manufacturers pages for recipe ideas with their products too. Enjoy!
This will make a lot of people mad:
Feeding clinic may be a waste of time and money
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.
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.
Getting your kids’ annual physicals this month? Take this check list with you to your appointment. There are straight forward, nutrition-focused solutions to all of the problems on this list. No drugs, no therapy, no ongoing visits to behavior clinics. Simple measures may resolve these problems without drawn out drug trials or therapies that leave your family frustrated and exhausted. If your pediatrician is stumped about how to use real food and nutrition tools, let’s talk soon!
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, schedule an appointment for integrative nutrition with me today.
2 – The most important thing for fighting infections is strong nutrition
Forget the vaccine debate. 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.When kids do get sick with serious bugs like flu or measles, well nourished kids fare far better, with a less complicated, shorter course of illness and 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 your kids’ tissue stores of vitamin A, to total protein intake, growth status, iron or zinc status, inflammatory chemistry, and more! 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 – just be sure to tailor these to what your child needs, not a 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 things that are classically measured in children to assess how healthy they really are. These are not all included in a standard well check or school physical, but some may be added on if you ask your doctor. Strong nutrition status is evident in:
- Solid growth pattern in your child’s expected channels for weight, height, and body mass index. Your child can be expected to proceed at percentiles achieved at birth, unless s/he had a special circumstance that needed support very early, such as low birth weight or premature birth; even this can be expected to improve some as your child grows. Though pediatricians generally won’t address growth regression until children fall way down the chart, drops of more than fifteen percentile points that persist for more than three months warrant investigation for cause.
- 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.
- Infrequent illnesses with short duration and full recovery.
- Strong clinical signs for healthy hair, skin, teeth, and nails; no or few cavities in the child’s lifetime.
- Ability to play, sleep, learn, and eliminate comfortably.
3 – Your child may need iron when s/he is not anemic
It’s common at annual physicals to check hemoglobin and hematocrit for kids, which is done with a finger stick blood test. These are two tests to check if your child is anemic. The problem with this is that these are low sensitivity tests that don’t pick up pre-anemia. Pre-anemia is a thing! It is a state in which iron stores are depleted, but hemoglobin and hematocrit are still in the normal range. These kids need iron support, and depending on diet, food intake and other factors, the fix may be just the right food, or may require the right iron supplement (there are several) or even an iron prescription. Kids in pre-anemia will have any or all of these features:
- shiners under eyes, pallor
- more frequent infections and colds; may take longer to recover
- irritable; crabby one minute, happy the next
- hyperactivity with fatigue – “crash and burn” pattern
- math may be most difficult subject (iron is related to math learning!)
- difficult sleep pattern, insomnia, 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. You can also view this free lecture on nutrition 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 companies tightly control what topics can be addressed 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, he essentially won’t get paid for his time. And, they need to have a high volume practice to make money – 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 much more profitable. Drug companies now 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 (scroll down) to download your free Sensory Nutrition Checklist – begin today with some easy tricks to help your kids function better!