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!
I’m now serving my second generation of clients, working with moms who where were not even born when I finalized my credentials as a dietitian/nutritionist. Recently I did a double take noticing that a young mom I was working with was born on my wedding day – Wow!
It has been quite a journey. I’ve watched earlier clients’ kids, and my own son, grow up to be more functional and able, after rocky and uncertain beginnings. But I have some bad news for you young moms: It is a lot worse out there than it used to be. It’s very different for you than it was for my generation. There’s a whole new normal, and it ain’t pretty.
More than half of US children are now chronically sick or disabled – meaning that it is now more common for kids to have chronic conditions or developmental delays, than it is for them to be healthy, growing strong, and developing or learning normally.
During my graduate years in public health nutrition, this was unthinkable. CDC goals we worked with then have not come close to being met. We’ve not only fallen short, we’ve actually violated the very first goal to “prevent morbidity and disability “- ! Both have increased dramatically for US children in the 21st century.
Type 1 diabetes has quadrupled. Children under age 10 are now getting diagnosed with Type 2 diabetes – actually unheard of when I was trained in the late 1980s; this was only diagnosed in overweight, middle-aged people at that time. At least 80,000 kids in the US are diagnosed with Crohn’s disease, a severe and chronic inflammatory bowel disease, and its incidence in children is increasing. I meet kids each month who have similar symptoms but have never been diagnosed, and I just worked with my first toddler diagnosed with Crohn’s disease this spring. During my training, this wasn’t even mentioned as a condition that a young child could have. Even the phrase “toddler diarrhea” didn’t exist (diarrhea is not a developmental phase!). Babies and toddlers were not diagnosed with, or given medications for, GERD (reflux drugs like Nexium came to be so overprescribed, they were called “purple crack“). Asthma, cancer, allergies, and of course – autism – are all increased far past their 1985 levels, with no signs of slowing down. And are you tired of hearing yet that autism has shot up nearly 150-fold since 1975, and that some estimate that half of US children will have it by 2025? How will this country function, populated by sick and disabled adults? How will we pay for their care?
Those are big questions. But here is the question that has had me scratching my head for the last twenty years: What are our pediatricians doing about it?
Are they even thinking about reversing these trends, in any meaningful way?
If they are as young as you are, it’s doubtful they know how miserably we failed at reaching the CDC’s goals from the late 20th century, for population health. Or that they’ve had much of a deep dive into child nutrition and its role in development, learning, behavior, and immune strength. I also do wonder if they know what it’s like to see kids who never need any prescription drugs, because they’re just …healthy.
Being sick repeatedly throughout the year, needing multiple rounds of antibiotics, being developmentally delayed, having an impacted, inflamed, or ulcerated colon, being unable to eat anything but milk, yogurt, or Pediasure, or having only loose, burning, foul stool or impacted hard stool may be common nowadays, but it isn’t normal.
Your kids should be healthy, comfortable, vibrant, eating, eliminating daily, sleeping well, growing, playing, and thriving! If they can’t because of a chronic condition, then they still deserve to reach their fullest potential, enjoy their highest well being, and feel good as often as possible.
From my perch as a pediatric nutritionist/dietitian, I have watched it get harder and harder to restore kids’ health, away from the chronic gastrointestinal, feeding, growth, developmental, and allergy/immune problems they have. Kids bodies seem more compromised, their immune systems more confused, their intestines less functional. The work is more complex than it was in 1998 or 2000. Diagnoses like FPIES (which my own son had in 1996, before there was a name for it), milk protein intolerance, food allergies, intolerance to breast milk, and EoE are not unusual now, but they earned no mention during my training in infant and child nutrition in the late 1980s.
I often wonder how pediatricians of my generation reconcile this. Do they notice, like me, that children are sicker, as government data show?
Moms under 35 have it rough. You are..
- The first generation to grow up with more antibiotics, vaccine doses, psychiatric medicines, and just plain more prescription drugs than any other.
- The first generation to grow up eating GMO foods.
- In the years you were conceived, patent and marketing laws for drugs changed – and dozens of new drugs flooded the market, whether we needed them or not, and regardless of non-drug options that may have worked as well or better.
- The goal posts have moved for what counts as valid published medical “science” – much of it is now ghost written by the pharmaceutical industry.
- Environmental protection laws are either being stripped or unenforced, allowing more toxins into air, water, and food.
- You are now bearing children with more toxic burden than any parents before you in America’s history.
In short: It’s a lot harder to have healthy kids these days. Your bodies were exposed to more toxins, sooner, than people of my age. And now your children are exposed to all of this even before they’re born, in utero.
So now what? It’s simple: Remember that your kids get to be healthy.
That is their birthright, and their normal. Expect them to be healthy, not chronically sick. But you have to do some serious footwork, even before pregnancy, to help them get there. If your kids are already here on the planet, there is a lot you can do to diminish their odds for chronic disease, developmental injury, and psychiatric conditions. If your kids are already affected by these problems, there is still plenty to do with food, nutrition, and good support for immune function and detoxification – you might be surprised to see how well your kids can be.
Here you go:
- Eat organic whenever you can. It matters. I actually did some work on this during my graduate studies (eons ago) and found that yes, organic foods are more nutritious, and have fewer toxins (though not toxin free, thanks to widespread use of pesticides and GMO crops in the US).
- Don’t eat GMO food, period. Minimize it as much as possible. Here’s why.
- Find out if your kids have food sensitivities or allergies; feed them foods that nourish deeply, not foods that chronically inflame.
- If your kids need antibiotics, restore healthy flora – you will know it worked by appearance of a daily, comfortable elimination (no bloat, hiccups, burps, picky eating, straining, watery stuff, mucus, dry pebbles, or foul odor – just formed easy to pass stool and healthy appetite).
- Drink filtered water, not tap water. Put filters on shower heads. Or, consider a whole house reverse osmosis water filter.
- Don’t use plastic containers for food. Avoid plastics, xenoestrogens, and xenobiotics in lotions, shampoos, soaps, or foods.
- Eat more vegetables, more plant foods, and less meat and sugar than you want.
- Eat loads of ancestral, organic fats and oils.
- Don’t have a C section if you can help it. If you can’t, seed your baby’s gut biome with probiotics or your own flora.
- Don’t get vaccinated while pregnant. It can increase your risk of miscarriage, and it delivers toxins like aluminum, mercury, and rogue viral or human DNA into your body. Effects of vaccinating pregnant women on their unborn children for asthma, allergies, or other immune mediated conditions are unstudied.
- If you need antibiotics during pregnancy, delivery, or breastfeeding, take all precautions to restore your baby’s gut flora with probiotics and a healthy diet.
- Read this 2017 study on the health of vaccinated versus unvaccinated kids. Choose soberly what you want to do.
Those are good starts – a big effort, yes; harder perhaps, but the upstream work is well worth it if there is a chance it can prevent burdensome chronic conditions in your kids. If you need more specific guidance for your own child’s situation, contact me for an appointment and we can get started.
Has anyone on your child’s care team done lab tests, only to tell you they’re all “normal” and there is nothing more to do? Or worse, you’re sent to a specialist for more tests and invasive procedures, when you still don’t understand what is going on?
This is such a common story in my pediatric nutrition practice that I had to address it. The truth is that any lab test result has two interpretations: Lab range, and functional range. Anyone, including babies and kids, can have test results that fall within the lab reference range (considered “normal”), when they are in fact teetering on health disasters. Functional range means your lab test results fall into a more narrow range, and this is where you actually feel good. You’re not just not sick, you’re well!
If your pediatrician is using only lab range to interpret your child’s results, then a lot of opportunity for well-being is missed. And, you may end up doing more invasive and useless diagnostics, when improving these initial findings is all that your child might need.
Establishing what is considered “normal” ranges for lab test results is difficult to do. Groups of individuals who have no known health problems are tested, and a range is created from their findings, for each lab test that exists. These ranges can be wide. But functional lab test results fall smack in the middle of the lab reference range. The lab range is wider than this, and may include findings for people who are not so healthy. This is why it’s good to look closely at your child’s findings and ask questions.
Here’s what to do:
- Always get a copy of your child’s labs, after any visit where your doctor presents them, including emergency room visits. Keep these in an organized file.
- Use your doctor’s secure on line portal (if they have one) to view your child’s labs. Download these and save them as pdfs if you like, so you can carry these into other provider visits with you, and get second opinions.
- Scrutinize your child’s lab test results yourself. If you notice results that are close to being out of range, ask your doctor about this.
- Don’t assume your primary care doctor or pediatrician always or immediately sees lab test findings done in an emergency room visit, or at a specialist visit. Always maintain your own files of these and share other providers’ test results with your pediatrician or primary care provider.
Some typical examples of “lab range” problems from my practice…
- Gluten sensitivity may bet the most frequently missed diagnosis I see. Many doctors run celiac panels, which can be normal, even when a child has a gluten reaction. The problem here is that many celiac panels do not check for gluten reactions – they only check for celiac serology. It’s possible to have debilitating reactions to gluten, without having celiac disease. This is called non-celiac gluten sensitivity and it can really wreck your kid! Definitely get a second opinion if your child continues to grow poorly, have stomachaches or headaches, or experiences ongoing gut or even psychiatric symptoms.
- Iron and Anemia Screening: You may have seen a normal hemoglobin and hematocrit at your child’s annual physical, but this can miss other problems concerning iron. The hemoglobin and hematocrit test is done with a finger prick drop of blood. This will only fall out of lab range if your child has entrenched anemia. Read this blog on iron screening to learn what to do next – prevent complications from marginal iron status that don’t show up with the fingerstick test.
- Ferritin (the storage protein for iron) has a very wide lab range, and labs vary on how they report it. Some labs report a ferritin level as low as 10 as normal; others say it’s okay for it to be as high as 400. Either way, ferritin is so important for your child’s immune function, learning, behavior, sleep and more that more investigating is worthwhile if this lab finding is not somewhere between 40-85.
- White blood cells (WBC) fight infection, and the lab range may sound small: Anywhere from 4.0 to 14.0 for kids is considered “normal”. But if your child’s WBC count jumps from its usual level of 5 or 6, to say 11 or 12, then it’s possible your child is fighting a new infection – even though it’s still “in range”. Or if it always hovers at the low end, say 3.8 to 4.0, then your child may have an undetected chronic infection that keeps him tired, cranky, or inattentive. Is your child having any fevers, intermittent malaise, frequent colds and bugs, tired all the time, unable to shake off a cold or virus? Go back to your doc and ask about it. By scrutinizing the blood count further, your doctor can discern if your child is fighting a bacterial infection, a virus, or struggling with a moldy environment, and may be able to help you more.
- Vitamin B12 can be a red herring if it your child’s serum level is reported above range. This may mean B12 is hanging out in serum instead of getting into red blood cells, where it is needed, so those cells can function normally with normal size and shape. Further scrutiny of a complete blood count will show if B12 is needed, as will a test called methylmalonic acid. Serum B12 level alone can’t give the whole picture. Simple changes in nutrition protocols can fix this.
- Lyme disease antibody may report as a false negative if your child got exposed to this infection long ago and you didn’t know. If Lyme disease is at all suspected, ask your doctor to be as thorough as possible. Do both the Lyme antibody test, as well as all the “reflex bands” and a co-infection panel. Undiagnosed, old Lyme infections can impair immune response to other infections, so the co-infection screening is important.
- Blood tests for heavy metals are not terribly useful. Blood tests can “see” recent or active exposures to heavy metals, but won’t show you about past or old exposures. If your child’s mercury or arsenic screening came back ok, this doesn’t show whether or not those metals are hiding out in places they really like – like kidney, brain, or nerve tissue. Mercury, lead, arsenic and other heavy metals like to avoid watery spaces (like blood) and migrate to fatty tissues, where they tend to stay put. If you really want to know about heavy metals in your child, some other tools are necessary.
These are just a few examples of how your doctor might miss opportunities to really help your kids feel good. If you have questions, always ask. I maintain continuing education credits in functional blood chemistry, and enjoy helping families with using nutrition supports to help kids feel really well. Make an appointment with me today if you need extra help!
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Yup, GAPS can fail. And it’s probably not your fault.
Gut and Psychology Syndrome Diet has a lot success stories… But what about the kids who fail on GAPS?
I have met a lot of those kids. After GAPS has just plain not worked (or worse – traumatized the family and injured the child, which can unfortunately happen) – I’m often the next stop.
These are smart people who followed the GAPS protocol carefully, and engaged lots of on line support; some worked with GAPS certified practitioners. But still: Fail. Their kids withered on bone broth; vomited or bled in stool on probiotic foods; and had bloating, rashes, and irritable stools with egg yolks, avocados, and nut butters. Their parents pressed on, for months or even longer; some moms have described to me the intense pressure they felt to stay with this protocol, and the deep sense of failure they internalized about it not working.
Okay, here’s the thing: There is no one diet for everyone. There never is. All children with autism, FPIES, or gut issues do not benefit from or need GAPS. I have met many who failed on it. GAPS works well for some. It fails for others. If it isn’t going well, odds are it’s not your fault. Your child just needs something different.
So, what can go wrong? Why not just try it?
Besides the possibility of wasting a lot of money and effort preparing scratch foods that may be wrong for your child, you’re going to waste time too – which some children simply can’t afford. The younger they are, and the more undernourished they are to start, the harder this can be on a child, if it isn’t the right measure.
And a mom’ s worry is no small thing. Chronic, strong apprehension and anxiety about anything is hard on parents. It changes your chemistry, and ups your cortisol. Sensitive children will sense your strain, and this will strain them. If you’re breastfeeding, altered cortisol levels are in your milk too. Cortisol changes blood sugar metabolism and endocrine function; it can disrupt sleep, appetite, feeding, and immune response. If implementing GAPS (or any special diet measure) is exceedingly stressful, pause; relax and enjoy your children; and secure professional guidance so you don’t have to carry the nutrition-flip project on your own shoulders.
Meanwhile, here’s what can go wrong, when GAPS is the wrong tool for the job:
Fungal Failure – Recently an old study jumped out at me. It examined how children in weaker nutrition status can’t control Candida (fungal) species very well. They have more Candida, and different, more irritating strains of Candida in their intestines, compared to children in good nutrition status. The study found that for children, simply being in better total nutrition status meant better control of Candida colonization.
What exactly does this mean?
For kids, nutrition status = growth status. It is the single most potent predictor of how well a child will manage any illness or infection.
Nutrition status in kids is not a measure of how many vegetables or probiotic foods they eat. Not whether they’re gluten free, GAPS, or Paleo. Not what supplements they’re on, not whether they drink raw camel milk. No matter what a child eats, if growth pattern has wandered below that child’s innate trend, all body systems struggle more.
Even when children eat lousy processed food, if they are in robust growth status, they still have more reserve to tackle a disruptive biome. Whether it’s a fungal load in gut, mycoplasma in lungs, MARCoNs in nasal passages, or a viral story in brain tissue, there is simply more energy and building material around to throw at it, in a kid with a strong growth pattern. This is such old news in nutrition science! Learn more about the cycle of malnutrition and infection in children here.
This does not mean that the quality of your child’s diet doesn’t matter. But it does mean that even if your child eats beautiful food, if they’re in a weak growth pattern, they are going to struggle more in every way – sleep, mood, infection fighting, learning, behavior – and, detoxifying a bum biome and healing the gut.
In the study mentioned above (from 1974, back when there were no GMOs, and less processed food available than is now fed to children worldwide), the groups compared were well fed white Australian children, poor aboriginal Australian children, and poor Indonesian children. The underfed children had weak total diets, meaning they had too little protein, too few total calories, insufficient vitamins and minerals, and sparse nourishing fats. They also had more Candida.
What does this have to do with GAPS? Read on.
A small child’s immune system will sputter when s/he’s underfed – like when eating just broth for more than a week. (Or when exclusively breastfed or formula-fed, with no solid foods, past the first year. Or when on deep dietary restrictions for healthy carbohydrates – which are fundamental to steady growth in children). There simply is not enough protein, energy (calories), and nutrients around to manage, balance, and fight. If an already weak, underweight child attempts GAPS, it may fail, because s/he was too depleted for multiple immune-essential nutrients and energy (calories) in the first place. A more recent study illustrates this well known tenet in infant and child nutrition: Just by not having enough food around, the gut barrier is disturbed, and tissue damage occurs. It doesn’t take long for this to happen in young children. Adding probiotic can hasten recovery, but only when an adequate total diet is also in place.
Hence the susceptibility to Candida – and quite likely, other bad actors in a gut biome, tissues, or organs. So although this first phase of GAPS may clear out some disruptive species from the gut, it can also drop your child’s total body immune response further, and permit other bum bugs to flourish. For kids who are underweight or have marginal iron stores to start, or who have deep total body dysbiosis, this can set up for failure. The detox is too fast, and the re-build fails, because the foundation was too weak to begin with.
Even mild nutrition deficits impact immune response in children. This is one of the reasons why GAPS fails. GAPS can be too restrictive for too long to help these kids recover. Just the introduction phase of this diet can take three weeks; this is an eternity for an already underweight toddler struggling at the bottom of the growth chart. Though broths, probiotic foods and egg yolks are fabulous, this may not be enough sustenance for a growth-impaired small child whose immune system is already straining. Yes, probiotics are critical to immune maturation – but, so is food itself, to nourish the gut tissue –> that harbors the biome –> that helps the immune system “learn”.
Carbs are especially essential for children. In infancy and toddlerhood, they are the fermentable food that normal gut flora require to thrive. Healthy gut flora make fatty acids like butyrate, which in turn fuel cells building your child’s gut tissue. I’ve met many parents who fear carbs, and over restrict them in their kids. This can fail too. Non-sugary, unprocessed carbs are a cornerstone to fuel the tutorials going on in a young child’s gut, between gut flora and the developing immune system. They also fuel growth and gain, and protect the lovely fats and proteins needed for other functions. The trick is finding which ones work best for your child’s circumstance. This is something I work with closely in my practice, for each individual child.
So even though GAPS aims to eradicate fungal load by restricting all carbs for a while and by adding extremely high potencies of probiotics with fermented foods, it can backfire. I often see disrupted stool cultures in kids coming off GAPS attempts, showing weak beneficial flora and ample dysbiotic bacteria, and even yeast in some cases.
When Leaky Gut Begets Leaky Gut – Some GAPS mainstay foods are renown suspects when it comes to intolerance or allergy. Eating broth with probiotic foods for three weeks is not long enough to clear pre-existing food antibodies, which circulate for months; in some kids, for years. If a child starts GAPS with hidden food allergy or sensitivity to egg or nuts, using these daily can exacerbate leaky gut, even when using that beautiful kraut or other probiotic food. I often find strong egg and nut reactions on IgE and/or IgG panels children who have used GAPS for several months. Even yolks can trigger immunoglobulin reactions that may not show on the “drop on wrist” test suggested in the GAPS protocol.
Better move: The “dot on wrist” test may not be enough. Do some food antibody testing before you start any special diet. Identify what foods are safest to work with before you begin. Check for both allergy (IgE) and sensitivity (IgG) to several foods, and work from there. If eggs and nuts light up your child’s panel, GAPS is not for you – or, it will be a bumpier road – consider easier paths than GAPS to gut healing in this case – there are many options.
In my practice, I find that ALCAT testing is less useful. It tends to show too many reactive foods, which makes menu planning really difficult. Even when IgG and IgE panels are alight with multiple foods, in young children, it is not practical or healthful to remove them all. I will remove the top four or five offenders, rotate others, and dial in gut restoration tools suited to that child. This can include anything from simple organic aloe to direct herbal antimicrobial measures to products like Apex RepairVite to arabinogalactan, butyrate, glutathione, or a low FODMAPS + SCD compliant meal plan for a few weeks to start.
FODMAPS Meltdown – Many kids have difficulty with foods that are high in FODMAPs. Another GAPS mainstay, avocado (which is indeed a great food) is a moderate FODMAPs food that is poorly tolerated by many in my practice, especially babies and toddlers with FPIES. I am encountering many FPIES families who turn to GAPS, with poor results (vomiting to shock, blood in stool, lagging growth). Learn why FPIES may be as much about carbohydrate fermentation in the gut than it is about food protein reactions here. Meanwhile, if your child has FPIES, I would hesitate to recommend GAPS, because FPIES reactions can be severe and dangerous. I am seeing success with FPIES in my practice with other strategies, so if you need help, contact me for an appointment.
Dairy Dilemma – Dairy yogurts are another wonderful food that are simply wrong for some of us. If these have worked for your family, that is good. In my house, I can eat dairy while my husband and son cannot. I love raw goat milk. I have occasional organic yogurt binges. I eat ice cream, goat cheddar, sheeps yogurt, and whatever I want. My family can’t. I have countless children in my practice who show clean lab findings for any sort of dairy reaction from opiate formation to IgG, IgE, and ALCAT – but who still disintegrate terribly on dairy. Usually this is a “behavioral” reaction – anxiety, impulsivity, rage reactions, stilted social processing, or poor sleep. For those moms who took my advice and tried the three month, uber strict, zero tolerance dairy free diet, and your kids got inexplicably way better, got off psych meds, and started to eat better, don’t thank me – I thank you. It’s hard to go out on a limb and try something that seems to make no sense. But, sometimes, a meticulous elimination trial is the only way to know if your child really can manage a food.
Are dairy yogurts okay for your child? If you really want to know what is going on, consider doing a Cyrex Array 4 for cross reactivity testing. Your child may react to dairy foods when eaten with other foods, and this panel will find if this is true for you child. This test plus sensitivity and allergy tests (IgG and IgE) can guide you before you begin.
Did GAPS Work For Your Kids? Great! Share your success stories here, I’d love to hear them. If it failed, don’t despair. Get individualized expertise for your child’s gut healing (and thus total body healing) journey. Your child deserves to visibly trend toward thriving. If you’re still struggling, get help, give me a call, set up an appointment. There are many ways to replenish, restore, and heal the gut; it’s okay if every kid is different. Honor your instincts as mom, because they are good as gold.
When I hear a parent tell me that their kids get ear infections, upper respiratory infections, stomach bugs, and need antibiotics more than once a year, I wonder why. Are your kids passing colds back and forth all winter long? Sniffles and fevers every month, for someone in the house? It can be better.
It didn’t used to be this way. Are kids less healthy?
The answer is yes. More kids than ever before have chronic illness, obesity, and/or disability in the US – in fact, over half of them do. And more US children are in poverty now than in the last fifty years – which means many, many kids are eating poorly and falling into mild to moderate malnutrition.
Kids spend more time indoors and in front of screens, less time moving and playing outside in fresh air, and are swimming in electromagnetic forces (EMFs) from wireless devices, 24/7. They can barely escape the flow of media targeted at them.
Their stress is unprecedented too, as schools dial up testing, homework, and extracurricular activities.
Add to this unprecedented use of prescription drugs for kids – from reflux medicines to more vaccine doses to Tylenol, anti-inflammatories, steroids, psychiatric medicines, and antibiotics – and you’ve got even more toxicity for the body to clear. Flu shots in particular may add to this problem – are they spreading more infection than they prevent? Viruses from vaccines can shed and spread; this is called “secondary transmission“, and flu shots are among the most common culprits for this effect. The data are not very supportive of annual flu shots – read more here.
Lousy food. More stress. Less sleep. More toxicity. It’s a perfect recipe for dropping an immune system!
Luckily, what kids eat makes a huge difference, possibly the most important difference, and you can work with that. There are “extensive, synergistic, antagonistic, and cyclical interactions” between nutrition and infection (source here). Infants and children in strong nutrition status get sick less often and recover faster than kids who are underweight, overweight, or who are marginal for key nutrients. Marginal or low status for even one vitamin, mineral, or macronutrient can lower the immune system’s power! Give your kids the building blocks they need to fight infections.
Think of it this way: When the rains come, you want your roof to be strong and water tight. You don’t start repairing the leaks after it starts raining. Food and nutrition is like that roof. If it’s leaky to begin with, your child will stay sick longer, get sick more often, and may have complications. Sure, you can give your child supplements to support clearing of infection and fighting fever when they are sick. But you can also prevent leaks to assure that the roof weathers the storms.
Get these in, day in and day out, year round:
Enough Food – Simple, right? But if your child is picky with a narrow, weak appetite, this is a problem to fix. Kids who are too thin for their height (weight for length, weight for stature, or body mass index below 10th percentile) will get sick more often and stay sick longer. Appetite can be suppressed by reflux, mineral deficiencies, antibody reactions to foods, or latent gut overgrowth of Candida, yeast, parasites, or unfriendly bacteria like Klebsiella oxytoca and others. Contact me for an appointment if you would like to troubleshoot this and turn your child’s appetite around, so they can eat enough to thrive.
Varied Food – Kids need carbs, protein, fats, oils, plus minerals and vitamins – the works – most every day. Many parents I meet in my practice have become afraid of certain foods. Some over-restrict carbs, others over-restrict fats and oils, while still others give only one or two protein sources (usually, dairy). Using a Flintstone’s chewable won’t go far to overcome a poor diet. Most over the counter kids multivitamins are just that – a few low potency vitamins. No minerals, and if any, they’re at irrelevant dosages. If your child is picky and eats mostly dairy for protein, s/he is probably missing a number of key nutrients that the immune system needs to build its defense mechanisms. Plus, whole fresh foods offer antioxidants and phytochemicals that aren’t classified as “essential” nutrients but are notable for their beneficial immune modulating effects. Variety is so essential to fueling a strong growth pattern and strong foundation for your child’s immune system to run its many moving parts. Even if growth status is good and your child eats enough quantity, if the quality is sub-par, s/he will be more vulnerable to infection.
Protein – Our immune systems are extraordinary intelligence if nothing else. They are comprised of countless molecules that we manufacture and “remember”, moment to moment, in response to our environments. These molecules are almost entirely proteins. They need a lot of building material! So do bones, skin, and every other tissue, as well as hormones and neurotransmitters that help your kid sleep, pay attention at school, or calm down in the evening. Protein demands are high in kids, who are growing, playing, and learning. Being sick increases protein demands. Not only do kids need enough protein, they need enough fats and carbs around that protein in their diets, to protect the protein so that it isn’t just burned up as fuel. Sure signs that too little protein is on board include slowed growth for height, brittle hair, peeling soft nails… and getting sick often. Protein needs to be good quantity and good quality: Use varied sources that don’t trigger inflammatory reactions. If your kids have eczema, stuffy noses, seasonal allergies, or picky bloated bellies, rule out food allergy (IgE reactions) and food sensitivity (IgG reactions). Making antibodies to food is one thing that will drag your kids’ infection fight down for sure. If they’re eating triggering foods all year, expect more colds and flu in the winter season.
Iron – …It’s complicated. We need it. But, iron is toxic if we have too much; in fact, it’s potentially lethal, so don’t give your kids iron supplements without professional guidance. Guess what else needs iron? Bacteria. Viruses may also target iron toting cells in the body for their own needs as well. This is why you don’t supplement iron when a child is sick. It’s like fertilizing the weeds, and your child may get sicker as they bloom in his body! Because of this, humans evolved with a number of tricks to sequester iron away from harmful infectious agents – like hoarding iron away from serum and into storage proteins like ferritin. Clever… but this can create a sort of anemia, or other problems. I help parents get blood work done to identify iron status for kids, and your pediatrician can do this too. If your child is teetering on the edge of anemia, has pre-anemia, or weak iron stores, then the next bug that comes along may have a better shot at your kid. Every time a child gets sick, iron stores are drawn upon to help fight infection. Read my blog on iron and anemia here – and get on iron rich foods like pumpkin seeds, hemp hearts, sesame tahini or seeds, lentils, dark meats, red meats, eggs, and dark greens. Kids with chronic inflammatory conditions or chronic infection especially need attention on this problem, as these circumstances change iron kinetics in the body.
Vitamin A – Before vaccines were available, a lot of effort was made to identify why some kids breezed through infections like measles while others had stark complications, died, or suffered vision loss from it. One of the first things researchers noted, as far back as the 1920s, was that animals with weak vitamin A intakes got sick and died a lot more often. Vitamin A has been studied extensively since. It has multiple immune modulating effects and exerts a protective effect against viral infections. It is specifically protective against measles and has been used as a treatment for measles in high doses by the World Health Organization. It maintains the integrity of tissues lining the gut and throat, so they can keep pathogens out. Kids low in vitamin A have more respiratory and ear infections. Give your kids vitamin A rich foods every day: Sweet potato, carrot, dark greens like chard, spinach, kale, or romaine lettuce; mango, apricot or dried apricot, peaches, cantaloupe, peas, grass fed butter or ghee, butternut squash; a half teaspoon cod liver oil daily is sufficient to keep vitamin A levels up for most kids. More is not better. Too much vitamin A can be hard on liver tissue, so don’t use more than two teaspoons cod liver oil daily for a child for more than one or two weeks. If your child is 0kay with dairy, use full fat organic grass fed milk or yogurt if you can, for best vitamin A value – it is a fat soluble vitamin and resides in the fatty part of the milk.
Sugar – Eating sugary food can suppress white blood cells, one of our most important defenses. Save it for special occasions, not for daily consumption. Lose the hidden sugars: Juice, processed punch drinks, processed snacks (crackers, chips, cereal, cereal bars, energy bars, power bars), fruits every day without vegetables, and a surplus of breads and pasta can translate into too much starchy, sugary food that drags immune defenses down. Any processed food is likely to have excess sugar or simple starches added to it, from ketchup to Pediasure. Use those foods infrequently and replace them with healthier alternatives. Explore healthy Pediasure alternatives here.
Pediatricians today mostly focus on drugs and vaccines, not food and nutrition, when it comes to managing infections and illnesses. But food and nutrients matter for immune defense – especially for kids. From zinc, to vitamins C, D, and E, to omega three fats and everything in between, there is research to back it up. Help your kids defend themselves with whole unprocessed foods, and potent supplements if needed. Want care advice for your child? I can’t give it here – but would be glad to help you in an appointment. I look forward to hearing from you!