You Get To Love Your Pediatrician

Jul 13, 2022 | Uncategorized

Do you love your pediatrician?

I did not love mine. In fact, my husband and I so did not love our pediatric group that we fired them when our baby was just six months old.

We pivoted.Our little guy never saw a pediatrician again. We wanted to love the pediatrician, not be furious with him.

We worked with our family practice doc, a naturopathic doc (ND), our MD GI specialist, and whomever else stood among the helpers/supporters. Unfortunately and unexpectedly, our pediatric group was not in that camp.

At six months, our little one had had way more office visits than expected. He’d been rushed to the ER, and he’d been hospitalized too. He rarely felt good or happy, rarely smiled, wasn’t interested in movement or much playfulness, and his gross motor skills were delayed such that he qualified for services. He was not sleeping, not feeding well, had constant rashes, kept getting sick, had seizures, and was slipping down the growth chart.

It was rough from the start. And throughout it all, every measure the pediatric group had given us had hurt, not helped, that baby boy. Every. Single. One. From telling us to “let him cry it out” (huge fail) to “more shots right now or we call child protective services” (I complied, and all that ensued were more seizures, more vomiting, more misery, less growth and gain, rashes, pain) to “this is fine, this is normal” (nope) … nothing offered by this pediatric office did any good.

We were done.

So, one day, during yet another phone call with the pediatrician, I hung up on him.

Years before this happened, I had completed my graduate and undergraduate degrees in nutrition and public health, as well as registration as a dietitian/nutritionist. Licensure followed once it became available for my profession too. My training in pediatric nutrition and maternal and child health had drilled me on the power and necessity of nutrition for a baby’s brain, not only in utero, but through the first three years at least. Nutrition, feeding, and a functional gut are crucial. The brain takes half the fuel the body draws out of food during that moment of explosive growth and development. Nutritional compromise, if severe enough, can injure a baby’s brain for life. At the tender age of a few weeks or months, it doesn’t take much to injure a growing brain – especially if it is not corrected.

Wait, did my pediatrician not receive that training? I later learned, they pretty much didn’t, and still don’t.

Frayed to the bone after just six months of being a new mom, there I was on the phone again with the doctor. At this point, we were failing on all formulas, and on breast milk. We’d cycled through different formula trials, each one with the expectation that I’d stop breastfeeding, pump and save the milk, then resume breastfeeding. Breastfeeding had already exhausted me. My son sipped slowly and took 10 hours out of every 24 just to eat even at six months of age. On top of that, he still hadn’t managed to sleep more than 20 or 40 minutes at a time. We’d all been awake 24/7 for six months, relying on mini cat naps. His stools were explosions of mucousy yellow that reached his neck and soaked his clothes up to 8 times a day – to which the pediatrician had mused, “I think it’s [the mucus] coming from the diaper”.

True story. My pediatrician actually said that.

I had to find a new way to feed this guy. He needed to grow, feel better, and sleep better.

I asked the doc, “what did you guys feed babies back in the day, before all these formulas, and when a mom couldn’t breastfeed?”

“Just keep using soy formula” he said, “Nothing else you can do.”

Ok – context: This was 1997. GMO soy formula was the popular go-to if a baby failed milk protein formula. There were no organic infant formulas, no goat milk formulas, no goat milk formula recipes, no internet to speak of, no European alternative formulas. There was milk protein formula (some with more whey than casein, which also failed), there was soy formula, and there was semi-elemental formula (like Alimentum or Nutramigen). That was it. Elemental formula like Neocate was new to the US at that time – but we had already tried that too.

My reaction was: Wait. What? Just keep doing what hurts this baby? Who hadn’t been able to pass stool for 12 days? Who prior to that, was passing black hard pebbles every few days, maybe, with struggle and duress? Whose appetite vanished because he couldn’t poop at all? Who can’t sleep because he’s hungry or is in pain? Just keep doing this? Because…. just because the doctor I’m speaking to is too poorly trained to help this infant thrive?

I slammed the phone down. Fun! Back when you could slam a receiver down on an actual phone. I hung up on my pediatrician. We never spoke to that group again. That was that.

Best decision I ever made. That’s when I really started to find my feet as a mom. That was my moment of empowerment. I took permission, which I realized was mine to begin with, to go with my instinct, and listen to my true nature as a woman and a mom, to take care of the baby I’d carried into this world.

That was also the moment I knew this would be work I’d do, not just for my child, but someday, when I could, I’d do it for other moms who forgot how to hear their intuition, their own power. Because I couldn’t possibly be the only one, and my baby couldn’t possibly the only one struggling with no effective help from the doctor.

Fast forward 25 years. I’ve been in private practice as a registered licensed dietitian/nutritionist for over two decades, helping babies and kids leverage nutrition and food so they can thrive. I’ve pulled them out of the wreckage that conventional pediatrics has made of them.

Ouch to the docs –  I get it. But – truly, what I have witnessed in these years in practice has been daunting. Discouraging. Shocking. Frustrating. How are you guys not seeing it? Once you do, you can’t un-see it: Pediatrics has gone off the rails.

In my training years, the only mention of pediatric chronic conditions was in a single brief rotation at a Shriner’s hospital for kids with severe birth defects (rare) or severe spinal cord injuries. There was no autism, little to no pediatric Crohns disease (and definitely not in infants and toddlers), no diagnosis codes for pediatric OCD, ODD, or severe anxiety disorders – not to mention more recent diagnoses like FPIES or intestinal failure, for which cries for help hit my in box now on the regular.

In the late 1980s when I completed graduate school, 6% of US kids had a chronic condition, developmental disability, other disability, or obesity. Now, even conservative tallies place this at over half of US kids.

I’ve worked with children as young as 2 years old with confirmed Crohns per biopsy. Children with autism diagnoses have made up the bulk of my practice for many years. It’s as though they have nowhere to go, after being placed in ABA therapy and given drugs to control behavior or seizures. Having been in practice so long, I am now seeing a second generation of children – and they are sicker than the generation before. Despite inventing and prescribing many more drugs and biological products for children than ever, our children have only become more sick, less able.

It seems pediatricians no longer understand what health looks like. Or, they have a new super low bar for it, and think it’s “health” when kids need a lot of drugs and shots:

• If a child stops growing, they wait until the child drops to failure to thrive status, then refer to GI for a tube feeding – for a surgically inserted tube that will deliver a GMO formula with corn syrup and potentially inflammatory proteins.
• If a child doesn’t sleep, their behavior becomes untenable, or they have environmental allergies, the doc will prescribe drugs to suppress symptoms, which often escalate to more illness and worsening symptoms later on.
• If a child gets repeat colds and infections (>2 or 3 per year), they are given antibiotics – over and over, even as these fail – and more shots.

There is no investigation. No inquiry. Pediatricians have become rote drug dealers with little skill beyond their prescription pad, and I hear deep frustration about this from families nationwide every week.

Let’s just say it: American Academy of Pediatrics, you’re fired.

Your family deserves good health and a provider who knows how to help you create it

I encourage parents to find the providers who are helpers. Helpers encourage, problem solve, troubleshoot; they hold you up when you are unsure; they restore health by resolving root cause. Are your doctors doing this for your family?

I’ve noticed this in my private practice tenure: Parents who take charge and who cultivate partnerships with providers who are comfortable with fewer prescription drugs, and who respect parents as equals – these are the families whose children move away from debility and chronic illness, and toward higher well being and happiness. The endless upward cycle of more and more procedures, diagnostics, and drugs is worth questioning: Has it made your child healthier, happier, stronger? If so, keep up the good work. If not, there may be a better way, a hybrid of natural parenting with good medical care when warranted.

If your car broke down and stranded you every time your mechanic worked on it, would you keep this mechanic?

• Naturopathic Doctor – Naturopaths are licensed and/or require registration and monitoring in 25 states, with 3 more states pending this legislation in 2022.  In many states they can order labs, imaging, or blood draws, and can be recognized as Primary Care Physicians. Their focus is on natural non-drug solutions and root cause.
• Family Nurse Practitioner or Pediatric Nurse Practitioner  – either may be a helpful ally. FNPs are licensed, independent practitioners.
• Family Practice Physicians care for the whole family, all ages. Consider looking for one certified in functional medicine. See my caveat about functional medicine for children here.
• Classical homeopathy  was a profoundly effective tool for my child’s health from a young age, and my family still relies on it today. I was fortunate as a young mom to have this resource in my community, where one of my providers was a pediatric nurse practitioner who was a trained classical homeopath. If you don’t have a homeopath in your area, pick up a copy of Everybody’s Guide To Homeopathic Medicines. This is an invaluable help for resolving minor bumps, bangs, fevers and routine illnesses of childhood, from teething and broken bones to anxiety, sleeplessness, and digestive upsets. It saved me countless doctors visits.
• Weston Price Organization – If there was ever an organization fierce on whole family wellness, nourishing real food, nutrition, and natural health, it’s this one. You’ll find a great community (local chapters abound) as well as a deep well of information on all  family and child health topics.

Food Allergy and Food Antibody Testing For Kids – What Works?

Mar 24, 2022 | Uncategorized

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:

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.

1. 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.
2. 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.
3. 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.
4. 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.
5. 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!

Natural and Nutrition Supports During Fever

Mar 2, 2022 | Uncategorized

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.

My Baby Was Treated With Reflux Medicine. Now What?

May 18, 2021 | Uncategorized

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: 

1. 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. 
2. 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.
3. 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…

1. 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.
2. 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.
3. 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.
4. Avoid high potency multi strain probiotics at first. Start with a simple one like Klaire Factor 1 or Klaire ABx Support (use ABx Support no longer than 28 days). More complex products like Seeking Health HistaminX may be better tolerated later on.You can order these in my practice dispensary here. Set up your own account and then search by product name.
5. Gently restore stomach acid with a combination of a digestive bitters tincture like Wise Women Herbals Tummy Glycerite. This is also available in my dispensary, and I’ve used it often in infants and young children as a gastric stimulant and support. Start with a quarter or half dose to test tolerance. Then use it with feedings or meals at least twice daily, ongoing. Watch for a gentle shift away from reflux features.
6. You can also try 1/4 teaspoon Braggs Apple Cider Vinegar as a soft boost to stomach acid, at meals or feedings. Mixt it with a small amount of water, a tart sip like lemonade, 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.

Picky Eaters Are Made Not Born

Mar 9, 2021 | Uncategorized

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.