Have you done food allergy tests or food antibody tests for your kids, but aren’t sure what it all meant? Tried elimination diets to remove the reactive foods, but didn’t see results?
Scratch tests, IgE blood draw, IgG food sensitivity, skin prick testing, Mediator Release Testing (MRT), and more – there are many ways to assess food reactions, food allergies, and food sensitivities.
It gets confusing. There are different types of reactions to foods, different ways to assess these, and possibly, different inter-actions between food and gut microbes that aren’t well studied. For example: In some cases, it’s unclear if the food is the issue, or if symptoms are due to an imbalanced gut microbe that eats the food – causing production of toxins from disruptive microbes that lead to symptoms. In many cases, I’ve found that just balancing gut microbiome allows a child to eat a food that was suspect for reaction.
In general, mainstream medicine – that is, your MD allergist – only recognizes one type of food reaction (hives, anaphylaxis), and typically only recognizes drug treatments with avoidance of the extreme triggers. That’s all well and good …if that is what your child needs. But what about all the other symptoms and reactions that don’t need the Epi Pen, Zyrtec, steroids, or other drugs? Symptoms that leave your kids feeling lousy with painful gas, bloating, mixed irritable stools that swing between mucousy loose stuff or hard pebbles, chronic stomach aches, migraines, headaches, joint pain, frequent colds or rhinitis, acne, eczema, asthma, hives or rashes that come and go, trouble with focus and attention… All of these can come from reactions to foods your child eats on the regular. How do you sort it out?
Because an MD allergist will only screen for food allergy (with skin prick testing or blood draw for IgE reactions), many kids go without correct diagnosis and continue to feel lousy, for no reason. Food allergy is only one type of reaction to a food. At the very least, there are three types of food reactions:
1) Food intolerances:
may or may not involve the immune system.
- They occur without immune response when we lack enzymes needed to break down certain foods. An example would be lactose intolerance, where the body can’t break down the milk sugar lactose. The result is gas, bloating, and diarrhea. Rashes are usually absent (except perhaps diaper rash, from the skin-irritating loose stools). Kids who are lactose intolerance can often manage yogurt (because the lactose has been fermented into smaller sugars), Lactaid products (because the lactose has been enzymatically treated in manufacturing), or harder cheeses (which don’t contain as much lactose as softer cheeses) – but not regular ice cream, fluid milk, frozen custard, or other products with a lot of milk or softer cheese (because these still contain lactose).
- Another example of food intolerance due to poor enzymatic action on a food component is when opiate like peptides are absorbed from food proteins. If you’ve got a super picky eater, this may be your problem. Learn more here.
- Food intolerances can also happen with immune involvement when too much histamine is made. In this scenario, IgE or hives to a food can be negative, but tingling, stomach pain, or reflux may ensue. This can be part of mast cell activation syndrome (MCAS). Mast cells are white blood cells that help regulate the immune system and are responsible for histamine release. A human stomach has mast cells scattered throughout its lining, where they play a role in regulating stomach acid secretion (we need strong acid to break down food and prepare it for the small intestine). In fact, mast cells can be found along all of the GI tract. A variety of conditions – including chronic exposure to a triggering food – can disrupt mast cell function so that too much histamine is released.
2) Food allergies: Food allergies do involve the immune system. They occur when the body creates IgE antibodies to a food, which then trigger the release of histamine and other pro-inflammatory mediators from mast cells next time you eat that food. These reactions are typically rapid, occurring within minutes or hours. An example would be a peanut allergy that causes swelling, hives, and difficulty breathing.
3) Food sensitivities: Food sensitivities ALSO involve the immune system, but not IgE antibodies.
- Food sensitivities may involve IgG antibodies instead, in which an IgG antibody is made to a food. This can create a delayed reaction that might play out several hours or even a day or two after eating the food. The reaction can be dull pain, loosened stool, explosive stool, mild rash, migraine, behavior changes, bloating, gradual build up of eczema, or mild congestion.
- Food sensitivities can also occur when white blood cells might react to a food protein, additive, or chemical, and release pro-inflammatory chemicals known as “mediators” into the bloodstream, which cause symptoms throughout the body. These reactions are often delayed and dose-dependent.
- An example of either would be a gluten sensitivity that causes stomach aches, diarrhea, or brain fog the day after eating a moderate amount of wheat; a strong behavioral reaction to food colors or artificial ingredients; or eczema that comes and goes, but improves dramatically once a trigger food is removed.
Any one of, or all of these, can happen at the same time!
How To Tackle It All – Where to start? Here are five steps to get rolling.
- Get IgE and skin prick testing done with your MD allergist. Rule out the big offenders this way. If there are multiple positives, start only by removing the most serious offenders that are actually life threatening to eat, or that cause significant discomfort (vomiting, hives, diarrhea, stomach pain). If some of the positives are tolerable to eat, keep them in rotation.
- If working with your allergist MD doesn’t give resolution or if symptoms persist and food allergy screening was negative, move on to IgG food antibody testing. As above, work with only the top two or three high offenders on your findings. This testing is my preference – tho white blood cell media release tests (MRT) are also popular among some practitioners, I have found in my practice with children – especially young children – that MRT is an over-sensitive test that doesn’t yield the actionable information I need to organize and build a supportive, growth-worthy food intake for a child.
- Remove an offending food completely only if:
- eating it is life threatening (ER visit, Epi Pen, hives)
- your child eats it every single day (give the body a break from it for two months to start)
- your child has significant and noticeable impact from that food. This can mean impact on mood, volatility, and attention and focus as much as stomach pain or stool changes that are untenable.
- always replace a withdrawn food with another one of equal or better nutritional value. For example if replacing cows milk with almond milk, you must add protein and a fat source because there is little protein or fat in almond milk. Use a clean collagen boost and some coconut milk or MCT oil and blend as a shake, or give extra servings of chicken, eggs, avocado, ghee, grass fed beef, or nut/seed butters if safe. You can also ask your provider about elemental formulas if your child has multiple food allergies.
- Work with high potency probiotics, especially histamine degrading strains: Lactobacillus reteuri, Lactobacillus salivarius, Lactobacillus rhamnosus to name a few, plus Bifido strains. Start low, with a 10 billion CFU dose daily and if possible work up to 50 or 100 billion CFU daily. Use probiotics year round.
- Keep good anti-inflammatory supplements in rotation. These can be used even if your child uses medications like antihistamines or steroids, always let your doctor know:
- DHA fish oils to 800-2000 mg/day (many liquids available)
- curcumin and turmeric 400-1200 mg/day
- D-Hist Junior chewables, 2-6/day (quercetin, N-Acetyl cysteine, nettles, vitamin C)
If you’re using one, give an elimination trial a go for a solid six months. Food proteins like gluten and casein (milk protein) are especially good at triggering all kinds of reactions at the same time, so elimination trials will only work with those proteins if you do it for 4-6 month duration; have zero known cheats including trace amounts in processed foods; also avoid pea protein concentrates at the same time (think Ripple Milk, Daiya cheese, or most “vegan” protein bars, powders and drinks), which look a lot like gluten and casein to the gut; and eat strong replacements for these foods (plain almond milk and French fries won’t cut it!).
If you’ve achieved that, and it’s smooth sailing, go for the re-introduction trial. See how it goes! If you’ve got leaky gut resolved – this is what got the food reactions going to begin with – you won’t see the reactions return. If you’re part of the way there, you’ll see a slow build up of those old symptoms after your child resumes eating the old offenders. In that case, you can judge if you want to continue elimination diet, rotation diet, and/or how much support with anti-inflammatory tools like probiotics you can use ongoing. Good luck and share your experiences below!
Fever is a mainstay line of defense for the immune system. But you could say we’ve become afraid of fever, as we are told to make it go away when our kids have one – as though the fever itself is a bad thing.
The truth is, fever is one of the body’s many brilliant means to disable a pathogen. It’s not something to be afraid of. And mounting a vigorous fever is a beneficial component for a child’s adaptive immunity to develop. For example, a 104 F degree fever (~40 degree C) will cause a 200-fold reduction in replication rate of some viruses. Powerful stuff!
So why are we told to use drugs like acetaminophen (Tylenol aka paracemetol) to make it go away, especially in kids? I’m surprised to hear parents in my pediatric nutrition practice report that this is still encouraged, especially with vaccination – where evidence has emerged across many investigations that acetominophen reduces immune response to vaccines – making vaccination among the worst times to use it.
Let’s go there for a moment. There has been quite a fiasco over the use of Tylenol in children, and not without reason. For starters, giving acetominophen with fever is problematic. While the body is endeavoring to raise its temperature as a means of attack against a pathogen, Tylenol will un-do the process by lowering temperature and can thus prolong infection and inflammation.
Second, Tylenol quickly depletes glutathione, a natural peptide made by the body as key detoxifier and free radical scavenger. This means it lowers glutathione right when we may need it most, potentially enhancing the toxicity of whatever the body is grappling with.
Tylenol use – especially in toddlerhood when multiple vaccine visits are compulsory, or during pregnancy – has shown an association with the development of autism later on.
Giving Tylenol, plus eating RoundUp (aka glyphosate – the abundant and ubiquitous agricultural herbicide in our food supply, including infant formulas), plus using antibiotics, can create a perfect storm with the power to alter gene expression such that the end result is predictive for autism. No single “gene for autism” has ever been identified, despite years of hopeful searching and untold sums of money spent in the hunt. We know that autism isn’t solely genetic in origin. Rather, there are groups of genes that will be expressed differently, if environmentally challenged with toxins, antigens, or infections at vulnerable moments (like in utero or infancy or toddlerhood). If the gene expression is altered under the “right” conditions (that is, frequent toxic and immune challenges), autism or other neurodevelopmental can result.
Back to fever. What can you do about it, and when to step in?
- Stay in touch with your doctor for close monitoring when your child has a fever.
- A normal fever is between 100-104 degrees. If it climbs higher, be in closer touch with your doctor on next steps.
- Newborns should never have fevers – if your baby is less than 3 or 4 months old and has a fever over 100 degrees, let your doctor know right away.
- Some natural tools to manage fever and discomfort are…
- Curcumin, available in liquids and chewable gummies, can reduce inflammation and soften pain. Nordic Naturals Curcumin Gummies or Apex Turmero Liquid are easy for toddlers and school aged children to use.
- Magnesium is another useful pain reliever especially for muscle aches and pains. It’s available in topical lotions like Cooks Organics Creme, as Epsom Salts in a tepid bath soak, or can be used orally in liquid suspensions like Blue Bonnet Liquid Cal-Mag.
- Calcium lactate is a fast absorbed form calcium that can actually reduce fever in a beneficial way. During fever, as muscle tissue warms, calcium is leached from bones in a free unbound form called ionized calcium. This activates white blood cells which in turn mount their attack on invading bacteria or viruses. By giving calcium lactate, you make a quick support for white blood cells at the ready rather than having to leach it out of bone through fever. I have many anecdotes from clients for the success of this practice, which may also reduce the likelihood of febrile seizures. 100-200 mg calcium lactate every hour or two til fever drops is usually effective. Standard Process sells this form of calcium as a powder or in small tablets. (Milk and dairy products do not supply calcium in the right form for this task, and other forms of calcium will not work as well if at all.)
- Homeopathic remedies can be effective for fever also. Belladonna in 30c pellets is a classic solution for a hot, rapid onset fever with bright red dry hot cheeks and flushing. These pellets are available over the counter, but it’s ideal to work with a knowledgable homeopathic practitioner when using these powerful tools. For more detail on using these in your home, see Everybody’s Guide To Homeopathic Medicine This book was a mainstay in our home when my son was little and saved us many trips to the doctor.
What about before fever? The most important thing you can do for your child is maintain a healthy, solid growth pattern.
If you’re not sure whether your child’s growth pattern is where it should be, check this blog on underweight in children. Even small shifts away from your child’s expected progress for growth are costly when it comes to infection and illness. Growth is the single most powerful predictor of how often a child gets sick and how sick they may get – that is, severity and frequency of illness both go up when children are lapsing off their patterns for growth.
Kids don’t feel hungry during fever, which is a good thing – the body needs resources for the task of infection fighting, and doesn’t want to steer blood flow and energy toward digesting a meal. But fevers are exceptionally costly in terms of the fuel they consume – literally, heating fuel! It can’t be replenished easily during illness, which is why it is so important to keep children well fed and growing strong between infections and illness. Once illness comes calling, the reserves need to be there already.
Top nutrients for the immune system to do its work during illness, that should be well replenished before illness, are vitamin D, vitamin A, zinc, iron, and total protein. Total protein doesn’t mean your kids need a hundred grams of protein a day in food (that’s too much). It means they have good tissue stores, healthy muscle tissue, and some body fat as reserves.
Iron doesn’t work well to supplement during infection, as it may increase inflammation or help microbes, which also love iron as much as we do. So make sure your child’s iron status is strong day to day (click here to learn more about when kids need iron).
Zinc however can be used during illness and doses of 30-100 mg are what I may suggest depending on a child’s weight. Vitamins A and D are stored in fatty tissue and certain types of lipid (fat) molecules in the blood. Make sure your child has ample sources of these vitamins in their day to day routines, before illness. Cod liver oil, wild caught (not farmed) salmon, organic calves liver are all good sources. Regular fish oil (minus the “liver” part) does not provide vitamins D or A, which are key for lung tissue and many facets of strong immune response to viral infections especially.
There are may herbal tools that your local naturopathic doctor is trained to use to help manage infections and illnesses. Check here to explore finding a naturopathic doctor (ND) near you.
Long short, your kids can have fevers safely and effectively, and there are a several options to support them through it. Instead of reaching for NSAIDs like acetominophen or ibuprofen, you might like trying natural and nutrition tools that work with the body to fight infection and recover handily.
|Kids can need detox help too! Like the rest of us, they encounter toxins from ordinary routines, activities, water, food, poor air quality, and more.
The body has many mechanisms to manage day to day toxic exposures. But unlike adults, kids – and especially babies – are more vulnerable due to their smaller size. Toxins and their effects can build up and make it harder for a child to stay well. Behavior changes or agitation, sensory processing glitches, gut symptoms, rashes, or more serious concerns like cough, unexplained fever, or even seizures can result from slowly built up toxic burdens or from an abrupt large exposure. Some circumstances that burden their bodies and make it harder to detoxify are…
- Wildfire – including proximity to leftover dust and burnt debris – has especially toxic and lingering effects. Watch this video to learn more.
- Poor air quality from car exhaust, industrial pollutants, fracking, ozone
- Regularly eating processed foods with additives, colorings, artificial ingredients, glyphosate and other pesticides (organic foods help minimize this)
- Well check visits where multiple vaccines are administered at once (check here for more detail on detoxifying vaccines)
- Shampoos, fabrics, bedding, soaps, toiletries and anything used topically can contain parabens, fragrances, formaldehyde, aluminum, titanium, bisphenol-A (BPA), talc, flame retardants – these and many more toxins are in products our children put on their skin every day.
- Excessive heavy metals from air, water, medications, food, or even toothpaste – which can give your child too much fluoride if they swallow some every day (avoid that with a fluoride free toothpaste).
And a new twist on toxins for children concerns covid vaccines. Learn more about these concerns here. At Flatiron Functional Medicine, where my office and practice are embedded, Jill Carnahan MD has suggested supportive supplements to help mitigate possible negative effects of a covid vaccine dose. We recommend doing this for 4-6 weeks following a vaccine dose.
These are items I have safely and effectively used over the years in my pediatric nutrition practice. Children can use these items. Check with your doctor if your child uses medications for other conditions or if you’re not sure whether these options are right for your child. Any of these products can be found in my FullScript platform. Set up your own account from here to view any of these products and choose the format (chewable, liquid, powder, capsule) that best suits your child.
Browse any of these below by setting up your own access to my secure FullScript platform.
Click here to set up your own access to these items below.
Circulation Support – Myocarditis and cardiovascular events including stroke have emerged as a potential negative effect of covid vaccines, especially in teens and children. These functional foods and compounds can reduce inflammation and help prevent clots:
- High potency DHA and EPA omega 3 fatty acids – at least 500 mg DHA and 500 mg EPA. Use a pure and clean brand that allows independent product testing for heavy metals and toxins. My favorites for kids:
- Nordic Naturals Pro Omega 2000 Junior 2 softgels daily (chew or swallow)
- Pharmax Finest Pure Fish Oil 1 teaspoon daily (good option for high potency with low volume of liquid)
- Barlean’s High Potency Omega 3 Key Lime (pudding like texture)
If your child can swallow capsules:
- Pycnogenol Douglas Labs 25 mg capsule daily. Pycnogenol has been shown to lower inflammation in children with asthma, to reduce asthma medication needed, and to have beneficial effects on cardiovascular health. If your child uses a medication for behavior or seizures, check with your doctor before using pycnogenol. Pycnogenol may lower blood pressure.
- Allergy Research Group Nattokinase 36 mg capsule – Nattokinase is an enzyme with capability to reduce arterial plaques and lower blood lipids.
Anti-oxidant and Anti-Inflammatory Support –
- DaVinci Labs CoEnzyme Q10 ChewMelt – 1/2 chewable daily
- ReadiSorb Glutathione 1/2 to 1 teaspoon daily
- Empirical Labs Liposomal Curcumin / Reseveratrol 1/2 – 1 teaspoon daily
- D-Hist Junior chewables – 2 (smaller children) or up to 6 chewables (kids over 50 lbs) daily
- Seeking Health Optimal Vitamin D drops 2000 IU per drop – get a baseline vitamin D level at your pediatrician to discern if more than 4 drops weekly are needed.
Gut and Overall Immune Support –
- SBI Protect 1 scoop daily in soft food or liquid
- Probiotics – Allergy Research Group Lactobacillus or ProFlora 4R Spore Probiotic
- Animal sources of vitamin A: Cod liver oil 1/2 teaspoon daily for children <50 lbs and 1-2 teaspoons daily for larger children. This gives the form of vitamin A (14 hydroxy retro-retinol) that turns on T cells. Synthetic vitamin A supplements (retinyl palmitate) don’t do this and neither do plant carotenoids (at least not without some metabolic transitions first). You can also use vitamin A rich foods like grass fed organic full fat dairy foods including butter, pastured egg yolks, and liver.
- Cats claw – capsules or drops available:
- QuickSilver Scientific Cats Claw Elite – 1 pump daily
- Pure Encapsulations Cats Claw capsule 1 daily (children over 70 lbs)
|To set up your own account for access to these and other products I recommend and use in practice, contact me here.
Did you know that reflux medicines (aka Proton Pump Inhibitors or PPIs) are among the most overused drugs in the world?
Reflux medicines make the list of top ten most prescribed drugs in the world. If your baby or child is on one, your gastroenterologist (GI doctor) probably prescribed it to lower stomach acid for presumed gastroesophageal reflux disease (GERD).
In your doctor’s eyes, these drugs are considered generally well tolerated and are not considered harmful to adults or even children. The problem is that (some of ) these drugs are only approved for short term use in children – but, it’s common to leave babies, toddlers or older children on them for months or even years at a time. I see this in my pediatric nutrition practice all too often! When these drugs are taken for months at a time, there is potential for serious side effects that can cause lasting digestive and immune system issues.
Another dilemma with getting a PPI for GERD is that the diagnosis is typically based on a brief conversation with mom about spit up, colic, or vomiting. Rarely seen is an actual diagnostic test for whether someone needs this drug – in adults or kids. Measuring stomach acid is the confirming diagnostic for “excess stomach acid”. This requires an invasive endoscopy procedure which must be performed under sedation or anesthesia. Even with endoscopy, if inflammation is seen in the esophagus’ tissue during that procedure, it is assumed that excess stomach acid is the cause. The only way to assure if this is actually true is to add a pH probe to the endoscopy procedure. This probe measures the pH (acid level) in the stomach.
Another way to confirm is to observe stomach acid actually entering the esophagus (that is, stomach contents are going up instead of down) with a barium swallow and observing results, live in real time, on X ray.
If a pH probe shows that the stomach is indeed too acidic, a PPI may indeed help. If the problem is normal acid levels that gurgle backwards up in to esophagus, a PPI may help, or may not help at all – it may make the problem worse over time. And here’s the other twist: Even weak stomach acid (at a pH of 3 or 4) is still too acid for delicate esophagus tissue. But it’s too weak to do a good job of moving food out of the stomach and into the small intestine. So, this leaves food sitting in the stomach, and gurgling back up in to the esophagus. A PPI may temper that burning sensation a bit, but it will not solve the problem of getting food moving along in the other direction – in fact, it will make food sit longer in the stomach, giving more opportunity for the food to gurgle backwards into esophagus. This is exactly how many of my young patients end up needing more, more, and more reflux medicine… until it stops working even at the highest dose.
Here’s When To Intervene
Babies normally have some spit up or vomiting. If your baby is clearly in pain, crying hard, unable to eat, and not growing or gaining, then a PPI can offer some temporary relief. Likewise, if your doctor saw highly irritated esophageal tissue on an endoscopy, then a short term use of PPIs may soothe the situation. Babies should not be left to cope with pain when a medication can immediately help.
Create a strategy up front with your doctor to use those tools temporarily. A switch in feeding can often make a big difference. Changing a breastfeeding mom’s diet can help, by removing foods like dairy, eggs, or high FODMAPs foods like onions, garlic, apples, prunes, or broccoli.
Formula fed babies can improve with a switch to something more digestible: Consider hydrolyzed formulas like Alimentum Ready To Feed, or formulas with a different protein profile like Gerber Soothe (more whey, less casein), or a goat milk formula option. All of these are worthy measures before placing your baby on a reflux medicine.
There are also gentle herbal glycerite tinctures for children that soothe the stomach and gently encourage normal digestive function. One of my favorites is Gaia Herbs Tummy Tonic, which I’ve used with success for many years in my pediatric nutrition practice. This herbal tincture is one of may herbal blends known as digestive bitters. They gently stimulate the stomach to produce its own normal array of acids so digestion can begin.
Since reflux drugs lower stomach acid, they also lower the protection we get from having that natural acidic barrier between the big bad world and our bodies. This acid barrier is supposed to be very acidic. A gastric juice pH as low as 1.0 is normal. This can prevent harmful bacteria that may be in our mouths from entering the body. But if the stomach pH gets too high – that is, if it becomes less acidic – this matters for 3 key reasons:
- Potentially harmful oral bacteria can work its way into lower parts of the GI tract, a trip that would not be made possible when there is enough stomach acid. Once it makes its way into the GI tract, foreign bacteria can cause such infections as Clostridium difficile, Salmonella, Campylobacter as well as Escherichia coli.
- When harmful bacteria invade the GI tract, they can begin to overgrow and compete with the “good bacteria” that we rely on to help us with digestion and immune system support. Over time this impacts the diversity of our microbiome and can cause dysbiosis, a condition where the good bacteria is reduced and too much bad bacteria is allowed to grow – creating an environment that can also lead to yeast overgrowth, constipation, irritable loose stools, picky eating, food intolerances, food allergies, or pain.
- Too much of the wrong kind of bacteria and not enough of the good kind can lead to inflammation in the gut, which then cause the gut wall barrier to be more permissive – that is, the tightly compacted tissue structure inside the gut wall gets a little loose, with microscopic spaces that can allow larger molecules than normal to enter circulation in the body. These can be partly digested food proteins, toxins, or microbial organic acids. This is known as “leaky gut” and people may experience all sorts of discomfort or chronic systemic inflammation as a result.
My child was treated with a PPI. Now what?
Long term PPI use can disrupt healthy gut microbiomes, and favor yeast or fungal species. Over time, these drugs can make weak, picky appetites, weak protein digestion, weak absorption of minerals like iron and zinc, and poor B12 absorption. You can…
- Use my Sensory Nutrition Checklist to look for signs that certain nutrients are not being well absorbed. Supplements can help cover the deficits in the short term, as you repair your child’s appetite.
- Explore with a stool test that assesses helpful bacteria as well as pathogens, fungal species (yeasts), and disruptive commensal species.Stool study findings can be addressed with non prescription tools in many cases, such as rotations of certain probiotics or herbal compounds that discourage fungal or disruptive bacteria species. Most of these tests include measures for inflammation and digestive function too. This is an easy way to sort out what is going on. Be sure to work alongside an experienced integrative and functional practitioner when ordering your child’s stool test to understand and interpret the results and what the best protocol might be to improve your child’s microbiome health. They are likely to have knowledge and experience with therapeutic herbs and probiotics that can be used to help resolve your child’s GI issues in the most gentle way possible. Clearing gut dysbiosis directly in this way can accelerate restoration of normal digestion.
- Join my Nutrition Cafe secure on line group chat, where we tackle topics like this in detail on a regular basis in HIPAA secure live zoom chat with me.
- Change up your baby’s feeding routine per suggestions above. Find easy to digest foods; these are usually low FODMAPs fruits, vegetables, and grains, plus gentle protein sources like white fish, chicken, or turkey. Avoid fermented foods or bulky high fiber foods at first; these may become easier to handle later on.
- Avoid high potency multi strain probiotics at first. Start with a simple one like Klaire Factor 1 or Klaire ABx Support. More complex products like GutPro may be better tolerated later on.
- Gently restore stomach acid with a combination of a digestive bitters tincture like Tummy Tonic, with 1/4 teaspoon Braggs Apple Cider Vinegar, at meals or feedings. This can be mixed with pleasant tasting juice such as a small amount of elderberry juice or pineapple juice (which has some natural enzyme in it too). Other helpful soothers and gentle gastric stimulants are peppermint, ginger root, lemon rinds or lemon juice in water, or chamomile tea. Use these regularly and steadily for a gradual repair of gastric juice.
Give this project some time, especially for kids who have used a PPI for more than 3-4 months. Gradually a healthy appetite without bloating, hiccups, gas, constipation or pain can be restored.
Thanks to Rosanne Walsh, AADP board certified nutrition and health coach and RD intern for building this blog post with Judy!
Picky eating is for real. No, you didn’t cause it by feeding the wrong foods or being a bad parent. It may have snuck up on your child through background noise in the digestive tract that nobody noticed! Good news: Picky eaters can make full turn arounds, and it may be easier than you think.
Picky eaters can get entrenched enough to profoundly affect their health, development, and functioning. Reversing picky eater behavior focuses mostly on that – behavior. Therapists strategize on how to present food, how to desensitize toddlers and kids to new food textures, and of course, on ruling out any mechanical swallowing concerns (important to rule out with your pediatric OT or SPL). It’s a slow, arduous process. There are many dozens of specialist clinics for pediatric feeding disorders in the US (find one here if you like!) that will work with young children with this approach, to teach new habits and less defensiveness around food.
But what I always wondered is this: Why did picky eating even become a thing in the first place? It truly did not used to be. No, we are not all that much smarter at noticing this stuff than we were a generation ago. Kids mostly just… ate. Sure, some of us had our finicky stretches. But this was so not in the pediatric nutrition landscape that my training – graduate, undergraduate, and clinical rotations – made zero mention of the extreme picky eating now so common in kids: Picky eater behavior bad enough to cause growth failure, malnutrition, frequent infections, need for a feeding tube, or clinical intervention.
What happened? This was the question for me, as a dietitian nutritionist working with these kids. Why would a child “choose” to start aversive eating – in infancy? Or even as an older kid, when the diagnosis might become “avoidant restrictive eating disorder” (ARFID). I couldn’t get my head around that part. I figured there has to be a reason why this gets rolling in the first place.
ARFID diagnostic criteria include this statement: “The eating disturbance is not attributable to a concurrent medical condition”.
Is that true? Or maybe the problem is … we need to do a better job of ruling that out.
When things are out of balance in the stomach and digestive tract, or when certain nutrients are depleted, kids become picky. Very picky, and their desire or even tolerance for food can drop out (same with elders, whose stomach acid diminishes in later years, and who are often given medications that stop appetite). Identify and fix these out-of-balance issues, and appetite can be restored. I have supported kids in this very way, many times in my clinical pediatric nutrition practice. And they make brilliant turn arounds. They eat, they poop, they stop throwing up or gagging, and they grow. But best of all, they go out and play again and they stop worrying about food.
In the kids who have come into my practice with ARFID, picky eating, and growth failure from these circumstances, I usually find that there has been no nutrition screening done for them – not even basic lab studies to screen for the most ordinary, but highly impactful, nutrition deficits that can mess with appetite. I’m often the first to look! I will scrutinize causes for things that can cause pain, or make a child feel full all the time, or trigger gagging and texture aversions. And, I find them.
What this means is that picky eater “behavior” is often not so much a behavior as a response to the body trying to cope with something out of balance. Eventually kids will develop behavioral responses that seem counterproductive and exasperating to us adults – as they experience stress from being forced to try to eat things that they can’t digest, or to eat foods that may cause pain they can’t verbalize.
Here are some nutrition and gut features that will trigger or worsen picky eating:
- Reflux medicines, current or past – these diminish stomach acid over time, which eventually leave the stomach sensing that it’s “full”. End of appetite. These also encourage fungal microbes to grow in digestive tract, which can cause gas, more reflux, and picky cravings for starchy food. Finally, they prevent absorption of minerals and B vitamins, which can also affect what you feel like eating.
- Antibiotic use – whether these were given to a child, a child was exposed in utero, during delivery, or through mom’s breast milk, these can alter gut microbe balance enough to disrupt appetite and eliminations – especially when exposures occur in the first weeks or months of life.
- Poor iron status – Anemia and pre-anemia (weak iron status or ferritin with normal hemoglobin level) will cause peculiar cravings (a condition called pica), and at the same time, make appetite overall weaker and more picky.
- Poor zinc status – this tends to worsen oral texture aversions, gagging, and refusal of anything but that one favored texture (usually, crunchy starchy snack food). Mixed foods will cause gagging. These are kids who love biting stuff like erasers, pencils, rubber chew toys, or… other kids!
- Overgrowth of opportunistic bacteria or yeasts in the gut – microbes move in thanks to the ever worsening picky eater diet and/or reflux medicines and/or antibiotics. Helpful microbes are not be able to stick around. The vicious cycle begins. More overgrowth of the wrong microbes –> more reflux –> less digestion –> more pain, nausea, constipation, diarrhea. Appetite drops. These junky microbes are not necessarily pathogens (like Salmonella or Giardia) but I have been the first to find those too on occasion, using more sensitive stool studies than your insurer paid your GI doctor to use.
- Leaky gut has allowed poorly digested proteins from milk and wheat to enter the body in a form that mimics opiates. These are called casomorphin (morphine like molecule from casein, which is cow’s milk protein) and gliadorphin (morphine like molecule from gliadin, which is part of wheat protein). Guess what? These opiate like protein fragments are super addicting. This child will not want any food that is not made of casein or gluten – picky eating, full on. See my Milk Addicted Kids e book for more on this one.
- An existing, unresolved FPIES diagnosis that continues to make eating traumatic.
- Exogenous opiat- like peptides from certain food proteins that are addicting and cause refusal of foods other than dairy, wheat, soy, or pea protein concentrates (Ripple milk, Kate Farms, Orgain Vegan, or most any vegan protein powder, drink, or bar). For more on how that works, check this blog on fierce picky eating.
Endoscopies, celiac blood tests, and basic lab screenings like CBC and chemistry panels will often look normal – but all these other issues can be in play, wrecking your kid’s appetite. These should be ruled out too, before solely relying on cognitive therapy for ARFID or feeding therapy with an OT. Without clearing underlying physiological impediments to a good appetite, behavior based therapies will creep along at a painfully slow pace or fail entirely – which I have seen countless times!
Back to my original question. Why did picky eater behavior ever even become such a thing, to the degree that we have clinics in every city to help change this behavior?
Here’s my 2p: Barring mechanical or structural impediments to normal feeding, picky eating has been caused by overmedication of kids in the last generation or so. Before oral antibiotics were so widely used, before so many early doses of vaccinations were given in the first two years, before reflux medications became so popular for infants and kids, our gut biomes evolved naturally. This allowed normal appetite and digestive skill to progress uninterrupted. But since the late 1980s, we “interrupt” this process with many pharmaceutical interventions, from birth on – even for “healthy” kids.
When digestion is in tact, appetite evolves naturally, and vice versa. Many kids I’ve worked with have spontaneously changed eating habits once they have comfort and ease with digesting food. Screening for nutrition problems that disrupt this process can go far in helping your child enjoy food more readily, and to become a relaxed eater for greater variety.
This does get harder for older kids who have experienced more pain, trauma and frustration with feeding clinics that failed for them. Many of them also go on to fail with psychiatric medications, as they are diagnosed with having a “behavior” problem rather than a physical one. Eating disorders with a psychological component need help on both levels – with counseling and support, and good nutrition screening and strategizing.
Early on, protect your baby’s gut by letting it develop its innate skill for digesting and enjoying food. Use antibiotics only when truly necessary with your doctor’s guidance. Use restorative probiotics and pre-biotic foods. Consider spreading out, delaying, or deferring vaccinations until your baby is older, especially if you are breastfeeding – which gives the protective immunoglobulins and immune defenses that your baby needs. You might be amazed to see the progression of a healthy appetite in action!
For toddlers and older kids who are picky, stay tuned for resources on busting this pattern by following me on facebook here. Repairing gut dysbiosis, replenishing imbalanced minerals, and addressing other underlying problems can turn this around.
I’m a pediatric nutritionist with long experience, and I wish you’d stop talking so much about food and nutrition with your kids.
That sounds crazy, I know. Food and nutrition are absolutely pivotal for your kids’ brains, behavior, growth, mood, learning… everything. No wonder then that food, recipes, and nutrition talk are all over the internet and mom blogger universe. From how to make killer bento lunches to keto for kids (mistake, BTW, unless under certain circumstances), everyone has something to say.
The good thing about this is that we are all woke now on the importance of what we eat, where food comes from, and how we grow it, whether it’s chickens, chocolate, or chard. We really are what we eat. We eat, and we turn the food into us – hair, bones, teeth, mood, and all. Period. That’s pretty much it (though a lot can go wrong along that path.. fixing that for kids is pretty much what I do).
But… there is a HUGE downside, and it’s bad for kids. It creates undue anxiety, stress, and overwhelm for kids, young ones and teens alike. It really stresses moms out too. I run into this often in my clinical practice, and I can tell you that it has gotten worse as our (justified!) enthusiasm for whole, healthy foods has exploded in the last 10-15 years. You’ll want to avoid these pitfalls with your kids. Here’s my list of Fail vs Fabulous, when encouraging healthy nutrition and food habits in your family.
It’s so easy to label a food “good” or “bad”. There’s plenty of junk out there, including organic junk. Obviously, it isn’t what kids should live on. But don’t drill these labels into your kids’ minds. What they need to learn is discernment – and they will. Eventually, ideally, when they’re out and about on their own without you, those “bad” foods should be neutral to them.
What do I mean by “neutral”? I mean that the idea of eating that food doesn’t provoke anxiety. It isn’t even compelling, because it was never forbidden in the first place. It doesn’t elicit judgment or shaming for themselves, or toward friends and peers who eat those foods.
As long as there is no safety or egregious comfort issue – as in, needing an Epi Pen, or a vomit-to-shock (FPIES) reaction, hives, migraine, nausea, bloating, burning diarrhea, disabling gas pain – then let kids have forays into junk. Not daily staples or regular snacks, mind you, but occasional dabbling.
Instead: Provide treats for special occasions (or every so often for no reason other than it’s fun) with no discussion about whether it’s “good” or “bad”. Again, safety issues and food allergens or triggers aside, simply make or buy some fun food, and let your child enjoy, care-free.
My one exception: Spoiled food. This IS bad and dangerous and kids need to learn that too. So, tell them.
2 – Don’t Expect A Young Child to Have Discernment (or even care)
Speaking of discernment, forget needing your four year old to have it. That’s your job. Children do not need to know what organic is, or glyphosate, or MSG, colors, additives, gluten or what have you. They shouldn’t care either. They’re little and they have much more important stuff going on in their little worlds. Please stop walking them through the supermarket and asking them to pay attention to labels or what you’re buying. Believe me, they are observing. They don’t need the specifics, and this will only be information overload that can lead to anxiety or meal time control battles. They need you to be chill, in charge, and happy that you’re with them (most the time). That’s about it.
Instead: Lead by example. Say less, do more. If your child accompanies you shopping, let them day dream and leave them alone; if they love chatter, join them in the randomness of it. Your child doesn’t need every moment to be teachable!
If they see something truly junky or sugary or processed that they pitch a fit for (and they will, because supermarkets place colorful cartoony packaging at your child’s eye level on purpose), that’s your call. Sometimes we can get away with floating to the next aisle with a soothing “Hmm no I don’t want to do that today” (and refrain from giving a reason why). Other days, you know the both of you don’t have it in you to make it home without giving in. Up to you, but avoid each supermarket trip rewarded with a junk treat.
If you’re in servitude to your stove or kitchen and miserable making all this scratch beautiful food, guess what – your kids know. Even your baby can tell. The most important thing here is that you get to be happy and enjoy food. Even if there are stressors, including big ones, about what can be safely eaten in your household, endeavor to find the joy in some of it. Joy is, above all else, why we’re here.
3 – Stop Explaining Everything and Stop Feeling Sorry For Your Kids with Diet Restrictions
You’re in charge. You’re the adult. If you know your child does poorly with a particular food, and they are fiendish about getting it and asking for it constantly anyway, oh well! You know best and have decided that they’re not going to have that food, period. Remember: This goes for foods that are a known danger or debilitating to your child – not for foods that are imperfect, but harmless.
Explaining and justifying your parenting choices to a young child (or even a teen) is, um, a bad idea. Doing so engenders entitlement in your child, which can make their opposition and protests even bigger. In little ones, expect tantrums, anxiety, and meltdowns when you try the “here’s why” route. In teens, expect impressive arguments, brooding, and door slamming. Most of all, don’t expect or need your kids to agree with you.
Instead: If a child asks for a reason why, offer it in the most developmentally concrete way for that child’s age. Refrain from volunteering comments like “it’s bad for you” or “will make you sick” or “your body can’t have that.” Don’t label the food or your child’s body as defective or bad.
Younger kids can be redirected with “there isn’t any more of that at the store so I found this one instead” or “I think this will feel really good in your tummy. Let’s try it and you let me know.”
Teens are reaching a point of practicing discernment on their own. Experimentation and screw ups are par for the course at this age. Let them experience the discomfort of eating the wrong food. You will decide when you have had enough as a parent: “I realize this isn’t what you want, but I am the one taking care of/rescuing you each time you feel sick from eating xyz. So, that food is no longer going to be in the house, and I won’t buy it anymore. If you eat it on purpose outside of here, I won’t be able to help you.” And then there’s always “..because I am the one buying the food, and I said so.”
4 – Stop Feeding Your Kids Like They’re Gwyneth Paltrow (or expecting them to like it)
Oh dear. How many, many food diaries I have seen that look this beautiful: Green smoothies, pumpkin seeds, sprouted Einkorn homemade bread, kombucha, fermented kvass, homemade dosa, coconut flour pancakes, avocado toast, bone broth… Or, a list of light veggie snacks all day long: Carrots, celery, nori, cucumbers, and apple slices with a few cashews. Or, a food diary that shows me 120 grams of protein and less than 60 grams of carbs (a nearly ketogenic intake).
Those are beautiful foods. Some kids really love this stuff. But, usually, it turns out this is a little dysfunctional. There are too many food rules in the house, and it’s causing tension to comply so stringently with eating only organic, perfect whole foods.
I’ll also usually discover that in these households, kids are falling off their growth patterns, experiencing stunting, or underweight. What tends to happen here is kids end up low for total calories, low for carbohydrates, and high for fats and protein. This is a great eating style for adults (who are not growing), but it can cause stunting and underweight in children.
Here is a common anecdote from my practice: I began working with a mom whose child was eating an overly restricted diet. Mom removed all processed foods entirely, based on the belief that any of them, at any time, are bad. Her child also happened to be a picky eater and refused many textures, limiting her choices more. On top of this, based on a misinterpreted blood test for a food sensitivity panel that the mom had somehow done on her own prior to our meeting, the child was only allowed to eat 7 foods, and had been eating this very restricted diet for years. She was not growing, had miserable behavior and sleep problems, and was trending toward anemia.
It turned out, right off the bat, the child could eat many foods that mom had wrongly assumed were trouble. A shift in view point on the good vs bad food mythology helped a lot. The child’s behavior improved immediately and she gained some much needed weight. Finally, her brain and body were getting replenished.
But even after a few sessions, things didn’t sound quite right. So I asked for an updated food diary. Mom shared a usual day food intake of small quantities, throughout the day, of raisins, peanuts, maple syrup, rice, potato chips, and a brownie. That was it. That was a usual day of food. This explained the re-emerging problems: No protein, no good fats or oils, too little food over all, a grazing pattern, and few micronutrient rich foods (for vitamins and minerals).
Mom said this child would sometimes eat chicken. So I asked – what if you gave a chicken nugget, would she like that, or try it?
A big silence followed. Mom was stunned. She had never done that, and wouldn’t, “because, you know, they’re so junky.” We agreed to give it a try after a quick search gave us some brand options she could live with. There are ready to heat and eat versions of this stuff that aren’t so terrible, or are gluten free too.
Instead – This child was already eating a junky poor diet. It didn’t matter if the peanuts and maple syrup were organic. Those alone don’t make up a whole foods diet. So, toss in some fun. Find some ready to serve, heat-and-eat stuff so you don’t have to work so hard cooking it all from scratch. If you hit on something, then you can make your own scratch version even better if you like.
Let kids be kids. They need different diets than adults. They shouldn’t be eating they way you do, most likely. Peruse my blog for more ideas and tips on how kids eat, what they need, and some recipes to try.
• 5 – Baby Led Weaning Is Great… For Babies
No, babies and children don’t know what they need all the time, and don’t necessarily have a keen inner wisdom that they can tap at a moment’s notice. Some babies wean because they feel eager and ready to move on. Some can’t get there, and won’t, even when it is safer and healthier for them to do so. Don’t pressure your young child to know everything. I’ve met many toddlers way past the day they needed to wean, and mom is still waiting for permission to do so. Nope nope nope. You’re in charge, mom.
Likewise, toddlers and kids need direction too. Weaned or not, presenting food all day long in a parade of choices is often just plain overwhelming and frustrating for little kids. It’s too demanding to expect that they will know what to do. This strategy can create anxiety in young kids, while mom or dad get super frustrated by the poor growth and picky appetite that this can often trigger too.
- Don’t expect them to guide you in making their food choices. Sure they will have their preferences, but it is your job to feed them.
- Don’t expect that they will always know or verbalize when they’re full or when they’re hungry. Especially when kids have used reflux medicines, appetite and its cues will be weakened over time. If you need help with this, contact me or speak to your pediatrician.
- Don’t chatter about how important food is. Just make or buy something you love to share and enjoy with your family.
- Don’t allow non stop grazing. Toddlers and young kids grow, sleep, and behave better with distinct snack times and mealtimes.
- Don’t limit texture options to just pincer grasp foods and pouches. Kids can be rigid. The longer you wait for them to reach for a new food, the longer you may be waiting. I’ve met several four and five year olds who don’t know how to chew. It’s ok to rock their world a bit and expect them to progress much earlier on.
Instead – Make food a benign or pleasant background piece. At snack or meal times, it’s just there, beckoning. Allow a choice between 2, maybe 3 foods at most. Present mixed textures and novelty, including foods that might be messy or that require mastery of a utensil. Let your child feed himself or get messy. Good help can be had with a pediatric occupational therapist if need be – let your doctor know you’d like help, and get a referral, if feeding is so stalled that your child isn’t growing or gaining well.
I really meant it …
…when I said that the most important reason why we are all here is joy. Eating and food are great paths to create it, share it, grow it. More than anything you say or do around food in your household, making food a generally positive, inquisitive, and expansive experience is what will create good self care and eating habits in your growing family. For extreme picky eaters, you may have other problems afoot that need tackling. Check out my e book here for more details on how to redirect that too.