Has anyone on your child’s care team done lab tests, only to tell you they’re all “normal” and there is nothing more to do? Or worse, you’re sent to a specialist for more tests and invasive procedures, when you still don’t understand what is going on?

This is such a common story in my pediatric nutrition practice that I had to address it. The truth is that any lab test result has two interpretations: Lab range, and functional range. Anyone, including babies and kids, can have test results that fall within the lab reference range (considered “normal”), when they are in fact teetering on health disasters. Functional range means your lab test results fall into a more narrow range, and this is where you actually feel good. You’re not just not sick, you’re well!

If your pediatrician is using only lab range to interpret your child’s results, then a lot of opportunity for well-being is missed. And, you may end up doing more invasive and useless diagnostics, when improving these initial findings is all that your child might need.

Establishing what is considered “normal” ranges for lab test results is difficult to do. Groups of individuals who have no known health problems are tested, and a range is created from their findings, for each lab test that exists. These ranges can be wide. But functional lab test results fall smack in the middle of the lab reference range. The lab range is wider than this, and may include findings for people who are not so healthy. This is why it’s good to look closely at your child’s findings and ask questions.

Here’s what to do:

1. Always get a copy of your child’s labs, after any visit where your doctor presents them, including emergency room visits. Keep these in an organized file.
2. Use your doctor’s secure on line portal (if they have one) to view your child’s labs. Download these and save them as pdfs if you like, so you can carry these into other provider visits with you, and get second opinions.
3. Scrutinize your child’s lab test results yourself. If you notice results that are close to being out of range, ask your doctor about this.
4. Don’t assume your primary care doctor or pediatrician always or immediately sees lab test findings done in an emergency room visit, or at a specialist visit. Always maintain your own files of these and share other providers’ test results with your pediatrician or primary care provider.

Some typical examples of  “lab range” problems from my practice…

• Gluten sensitivity may bet the most frequently missed diagnosis I see. Many doctors run celiac panels, which can be normal, even when a child has a gluten reaction. The problem here is that many celiac panels do not check for gluten reactions – they only check for celiac serology. It’s possible to have debilitating reactions to gluten, without having celiac disease. This is called non-celiac gluten sensitivity and it can really wreck your kid! Definitely get a second opinion if your child continues to grow poorly, have stomachaches or headaches, or experiences ongoing gut or even psychiatric symptoms.
• Iron and Anemia Screening: You may have seen a normal hemoglobin and hematocrit at your child’s annual physical, but this can miss other problems concerning iron. The hemoglobin and hematocrit test is done with a finger prick drop of blood. This will only fall out of lab range if your child has entrenched anemia. Read this blog on iron screening to learn what to do next – prevent complications from marginal iron status that don’t show up with the fingerstick test.
• Ferritin (the storage protein for iron) has a very wide lab range, and labs vary on how they report it. Some labs report a ferritin level as low as 10 as normal; others say it’s okay for it to be as high as 400. Either way, ferritin is so important for your child’s immune function, learning, behavior, sleep and more that more investigating is worthwhile if this lab finding is not somewhere between 40-85.
• White blood cells (WBC) fight infection, and the lab range may sound small: Anywhere from 4.0 to 14.0 for kids is considered “normal”. But if your child’s WBC count jumps from its usual level of 5 or 6, to say 11 or 12, then it’s possible your child is fighting a new infection – even though it’s still “in range”. Or if it always hovers at the low end, say 3.8 to 4.0, then your child may have an undetected chronic infection that keeps him tired, cranky, or inattentive. Is your child having any fevers, intermittent malaise, frequent colds and bugs, tired all the time, unable to shake off a cold or virus? Go back to your doc and ask about it. By scrutinizing the blood count further, your doctor can discern if your child is fighting a bacterial infection, a virus, or struggling with a moldy environment, and may be able to help you more.
• Vitamin B12 can be a red herring if it your child’s serum level is reported above range. This may mean B12 is hanging out in serum instead of getting into red blood cells, where it is needed, so those cells can function normally with normal size and shape. Further scrutiny of a complete blood count will show if B12 is needed, as will a test called methylmalonic acid. Serum B12 level alone can’t give the whole picture. Simple changes in nutrition protocols can fix this.
• Lyme disease antibody may report as a false negative if your child got exposed to this infection long ago and you didn’t know. If Lyme disease is at all suspected, ask your doctor to be as thorough as possible. Do both the Lyme antibody test, as well as all the “reflex bands” and a co-infection panel. Undiagnosed, old Lyme infections can impair immune response to other infections, so the co-infection screening is important.
• Blood tests for heavy metals are not terribly useful. Blood tests can “see” recent or active exposures to heavy metals, but won’t show you about past or old exposures. If your child’s mercury or arsenic screening came back ok, this doesn’t show whether or not those metals are hiding out in places they really like – like kidney, brain, or nerve tissue. Mercury, lead, arsenic and other heavy metals like to avoid watery spaces (like blood) and migrate to fatty tissues, where they tend to stay put. If you really want to know about heavy metals in your child, some other tools are necessary.

These are just a few examples of how your doctor might miss opportunities to really help your kids feel good. If you have questions, always ask. I maintain continuing education credits in functional blood chemistry, and enjoy helping families with using nutrition supports to help kids feel really well. Make an appointment with me today if you need extra help!

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