Over the past years I have met many different children and their families who have found eating to be an adversarial part of their lives. As someone who truly loves food (maybe even too much) I feel for these children and their families. Eating is an valued act in many cultures. Unfortunately eating issues are complex. Often many factors have led to a child not enjoying eating. Chronic allergies causing food to lose flavor, anaphylaxis leading to the fear/awareness that food can kill, gut dysmotility, gut inflammation, sensory integration issues, trauma from a choking event and these are just a few on a mountainous list of reasons why a child may not enjoy eating. Children often out of fear will become extremely restrictive in their eating. As a parent with nutrition knowledge it is terrifying to watch your kid eating the same three foods day after day. Meals become stressful for everyone involved. Food delight is eventually lost for all involved.
I have recently been coaching on this concept of food delight as a likely healing pathway. I would argue that food delight has been lost for many Americans as a whole. The concept of savoring each bite of our supper seems absurd in our busy lives. I was reading Thich Nhat Hanh’s Savor: Mindful Eating, Mindful Life and came across what he calls The Apple Meditation (chapter 2). Even with my own mindfulness practice I can tell you I cannot remember the last time I actually savored an apple. When he suggests to smile at the apple prior to biting in I actually laughed out loud. But why do I find this hilarious? Is this revered teacher being ridiculous? Or is it that my own American lifestyle has me too busy to slow down and find the pleasure that is available to me in the beauty of the apple itself and in each bite I take? What is my relationship with pleasure in general? Eek. Cricket. Cricket.
Pleasure and enjoyment are absolutely contagious. This way of creating desire is what the entire American advertising industry is based upon. The folks in the commercials aren’t just bored with their new phone or car. They are loving every second of it. So that we might as well…
My simple theory is we can all benefit from more food pleasure. More mindfulness can provide actual enjoyment if we stop ourselves long enough to create space for the experience of eating. Food pleasure is contagious even to the most picky of eaters. Make food that is beautiful and delicious to you and your family. Show pleasure when you eat and describe what you are experiencing to your child. They may not jump right onto that broccoli but I bet you will at least have their attention when you begin describing the pleasure you get from its funny shape and brilliant green and the crunchiness. Man…now I want some broccoli. I’m telling you. Ham it up. It’s ok to be over the top with this. It’s ok to feel totally silly. But if your picky eater starts adding foods to their favorite three by you having fun and enjoying yourself wouldn’t it be worth it?
The apple in your hand has the body of the Cosmos.
-Thich Nhat Hanh
ebook available for download at the San Antonio Public Library
In Traditional Chinese medicine (TCM) there exists a concept called mother-child. This is the idea that a mother and a child cannot be dealt with separately with regards to their health. Beyond pregnancy, beyond the original physical bond between mother and child there is the continued existence of mixed qi (chi or vital energy) for many years. This mixing of energy is true for anyone who comes in contact with a young child but as mothers we have a particularly powerful influence over the health of our children. When I first read about this concept it hit me hard how we have entirely missed this simple common sense principle with Western pediatrics. Likely because it is difficult to test and there is no money to be made with the results. But if you are willing to make this jump, that a mother’s energy can affect a child’s health on an intuitive basis, a world of healing can open to both physician and mothers alike. I’m up writing this tonight because I believe this principle blended with other holistic concepts helped us stave off an illness.
In TCM Children are susceptible to external pathogens much like they are in Western medicine. I will use this recent pathogen as an example. Julien (my 4 year old) woke 2 days ago with sore throat and fussiness. Our nanny has had something similar prior to him and so have loads of kids I’ve seen at work. Clearly there is a physical virus at play. My first impulse was to soothe his pain with ibuprofen but as I have learned from my study of TCM this is one more thing an already deficient body must clear and so I made him warm tea with honey and boosted him with Gaia Kids Immune Support. With TCM the most common reason a pathogen takes hold rather than being expelled is that the child is somehow qi deficient. We had just taken an exciting camping trip and came home wore out. So I gave him a warm breakfast and kept him more bundled than usual to prevent further invasion from the cold weather that had come in. With the concept of mother-child I have learned that I have the ability to donate qi (healing energy) to my suffering child. I can do this by snuggling, reading, singing and simply being present and nurturing. Of course I had to go to work but I encouraged the nanny to do the same. Cue the crushing feeling of leaving my sick child to go to work.
So today I was off work and J started to develop a low fever. Where normally we would lay in bed and watch shows snuggling we had very minimal television. TCM states that TV drains kids. Again these are things that we may all know instinctively but I have never seen them applied to a viral illness. So no TV, no ibuprofen, instead we just read books and did some light drawing and importantly we snuggled and took a nap! I had to bribe him as he is NOT a napper. Throughout all of this I stayed focused on the concept of giving to him with the purpose of healing/boosting him up. I laid with him and gently rubbed his back and interestingly he told me that it was helping him feel better. He sweated intensely during his nap and woke up fever free. Then his dad surprised us and came home early from work and poured more love into him. Julien had been missing him intensely since the short vacation ended. My husband is a resident. Kids of residents can always use extra qi/loving.
According to TCM as parents we can actually donate energy (qi) to our children when they are deficient to help them heal…if we have extra. There are times in our lives where we are so depleted that we can barely function ourselves let alone have extra for others. I’ve been there as well. There is no perfection in mothering. There is simply this moment wherever we are. It isn’t as though prior to studying TCM I would have simply ignored my sick child. Awareness is powerful though as well as intention. My clear intention was to pour qi into Julien for healing purposes and to boost his own. In the end there is no doubt that he has immunity to this strain of virus. However thanks to TCM I now have a better framework of what immunity is and how I can play a conscious part in it for my child’s health.
Cough and colds plague this time of year. At our practice bronchiolitis has been the main diagnosis the past two months. This is an illness that comes every year. Despite causing more deaths annually in young children and the elderly it gets less attention in the media than influenza because there isn’t a safe or cost-effective vaccine available for the general population (currently a subgroup of high risk premature infants are vaccinated for RSV only). Terrifying right? Yet a second grader with this illness may look like they have allergies with no fever and play normally! If your school-age child has a runny nose this time of year please be cautious with contact with young infants. I often hear Moms declare their child has allergies as the kid coughs their brains out spraying virus everywhere. Just because a child doesn’t have a fever doesn’t mean they are not contagious. To Moms of young infants keep your guard up. Wear your babies. Don’t let school-aged kids kiss them or touch their faces or hands. You’re not being a jerk. You’re acting as a part of their immune system. To breastfeeding moms don’t wean in the winter if you can help it. Just wait until spring when this bad boy has passed us by. If planning a pregnancy make a summer baby! It’s a safer time of year to be tiny.
Often what we see this time of year is a mixed picture of some typical respiratory viruses. Let’s focus on the illness called bronchiolitis. Ie the cough that won’t quit. It is the manifestation of one of typically three respiratory viruses (parainfluenza, respiratory syncytial virus and human metapneumovirus). They make their way into our respiratory tracts this time of year causing few symptoms in those who have been previously inoculated (young school children, older pediatricians, teachers, Moms) and causing moderate to severe symptoms in those who have never danced or forgotten how to dance with these guys (young infants, teenagers, elderly). Your typical second grader is a pro with this illness. They likely will have no fever and appear to have some mild allergies. That same viral syndrome in a young infant can result in a stay in the hospital for respiratory distress or 103+ fevers in a 3 year old. Those prone to inflammation such as children with histories of wheezing and/or eczema are also vulnerable to more severe expression. At baseline these children have a tendency towards the inflammatory pathways and this type of illness causes marked inflammation to the smaller airways (bronchiol-itis) which is where the name comes from. These kids get an amplified inflammatory response which results in worse than average bronchospasm. Also these kids have slightly thicker phlegm at baseline which can result in respiratory plugging and also make them more prone to secondary bacterial infections such as ear infections and pneumonias. When we attempt to support a child with this illness it is all about the the phlegm.
Such a gross word right? Phlegm. Make it your friend. When your child is sick with bronchiolitis/cold symptoms this is who you are working with to heal your child from the inside out. Down in our respiratory tracts there are these fingers that are working to slowly lift gunk up and out of our lungs (cilia) via the phlegm. Now if your secretions are like glue it makes their job a lot harder. If the snot is thin and fluid their work is much easier. The body will heal the cold. My goal with my own child is to avoid antibiotics unless absolutely necessary. Secondary bacterial pneumonia and ear infections which could require their use are more likely to form in thicker phlegm because the immune system has a harder time getting to where the bad guys are at. Think of the native immune system rushing in with their Hummers but they get stuck in deep gooey mud. This is how most cold medicines/antihistamines make things worse. In an attempt to dry up the secretions they end up making it thicker and screw over our native immune response. The body is trying to flush itself of the bad guys. That’s what the copious snot is for! It is also your friend. Now if you are an adult and you HAVE to go to work feel free to keep your nose from dripping on others. For kids, leave it alone. In fact augment the runny mess with warm teas (no honey for friends <1 yr old). As you sip them down your esophagus they warm and thin the phlegm in the adjacent trachea. We use something my son calls “stink tea.” In the winter this is actually something he drinks daily. It is a mixture of steeped cinnamon sticks, raw honey and Gaia Kids Defense tincture. Diffusing essential oils such as Breathe (Respiratory Blend) by DoTerra will help to loosen the secretions and even has some antimicrobial benefits as well. My patients all use and swear by Vicks. I don’t fight it but suggest to use it only on the soles of the feet with socks over top. Even with expensive EOs it is better to avoid sensitive skin areas on children. The soles of the feet are a great place to start. Humidifiers, nasal saline/Nose Frida suction, warm baths/showers, less dairy/gluten, chicken noodle soup, avoid sweets…do you see the common denominator to what your grandma was thinking? That’s right it’s phlegm maintenance. There are many natural anti virals as well but they deserve their own blog! More coming I promise.
For most kids this phlegm based approach will get them through. Fever will break usually in <72hrs however the cough with this illness can be severe and last over 2 weeks! No they will not sleep well. Occasionally they will cough until they vomit. Don’t panic it will go away eventually. Also remember to remind your sleep-deprived self next year will be better with this new hard-earned immunity! Remember though there are the subgroups that do poorly no matter what a parent does. If your child is having difficulty breathing, fever >72hrs, issues with feeding seek immediate care. If your child has a history of asthma hope for the best but prepare for the worst. Have your emergency medicines filled and ready. Good luck out there. Be well.
Fever (temp>100.4F) is an appropriate response to foreign invasion by the body. Some kids rage. Other kids simmer. I spend a lot of my time in clinic working to reassure not only patients but co-workers as well that fever is not in itself dangerous. It can be an important indicator of disruption and useful for both diagnosis and healing. I have intuitively had mixed feelings which resulted in reservations about using Tylenol (acetaminophen) since I started practicing medicine. This intuition was shaped by personal trauma in almost losing my little brother to the toxicity of this drug. Glutathione is an important intracellular antioxidant. Tylenol eats this stuff up. This is the last thing we need when we are ill. That being said small, well-timed doses are different than using max dose Tylenol around the clock throughout an entire illness. The body can regenerate glutathione if a kid had a healthy diet before they became ill. I have parents that start treating kid’s “fever” the second they hit 99F. Which results in more doses than any liver should have to accommodate.
Ibuprofen has its risks to immune function and the kidneys as well. But when a child’s fever is terribly uncomfortable or even more dangerous the child is not drinking fluids due to lethargy from super high temps, fever control can be an excellent adjuvant to their care. I like that ibuprofen is an anti inflammatory because much of the discomfort we feel when we are ill with fever is due to the inflammatory changes in the body. Yes, inflammation is another normal reaction of the body to invasion but too much is downright uncomfortable. Again it is about judicious dosing and careful use. If you are going to make the body clear a substance make it worth it.
Many parents ask me at what temperature is a fever dangerous? If you have a normal functioning brain your body will not go higher than ~107. Febrile seizures are not normal. They occur in persons who are susceptible and often have family histories. And even as scary as they are simple febrile seizures are not dangerous. Complex febrile seizures are a different animal often occurring in folks on the spectrum of epilepsy. And with epilepsy illness lowers seizure thresholds. People with epilepsy often know to adjust their seizure medicines when they are ill because of this phenomena. But again this doesn’t apply to a regular kid. So no. Your kid will not seize with a high fever unless they have a type of seizure disorder!
Fever duration is much more interesting than how high it gets. For some beautiful reason most viruses cause about 72hrs of fever. Almost like magic. There’s a few outliers but for the most part if your kid runs fever for <72hrs they are fighting a virus and will clear it. This applies to kids over 6mos. Lil babies are different and warrant a look over by a provider as their immune systems are still trying to figure themselves out and their blood brain barrier is more permeable than an older kid.
Ideal body temp for our CD8+ T cell (our innate good guys) kill mode is about 101.5F. So rather than trying to get your child to normothermic this is a good number to aim for with your dosing. If your child is happy, warm and drinking fluids then just leave them alone. Let their body do the thing it is trying to do which is super efficiently killing bad guys! A cool cloth to the forehead feels good. A cold bath does not.
Fever >72hrs or fever associated with lethargy, inconsolability, urinary symptoms, or obvious skin lesions should always be checked out by a provider. Or if your intuition is telling you something more is going on here…always trust that. Sitting at home alone in fear sucks. Been there. Even if the trip results in reassurance listening to your own intuition is paramount. Intuition and fear get tangled up sometimes. More to come on that another day.
So I made it through four years of my child’s life and this is the first year that I have become aware of a growing concept in parenting psychology called “attunement parenting.” I thought we were progressive with our baby wearing, prolonged breastfeeding and co-sleeping. Turns out there is much more that is asked of us as parents. Something much more difficult than just being physically present to our children. Attunement means really dropping into the moment with your child and deeply participating with love. We can manifest this presence through listening, play or physical affection. Sounds awesome right? Except I have a ton of sh*t to do every single day. How does one do this yet manage to work, feed and clothe their family at the same time?
In comes the dance. The way we become more able to attune is actually to step away and then step back in. Yes attachment people I mean like actually leave them with someone you love.
Radical self care is how we make room to be present enough to attune. When we are surviving on psychic crumbs there is no way to hold this kind of space for our children. It really starts with our relationship with ourselves. This attunement lays in our ability to drop in and listen to our own hearts and desires. It is only then can we really hear the ones around us. Meditation, yoga, dance, writing, painting, fill in the blank. We need to be able to list 5 things that fill us up and be able to have access to some of them weekly. This ability to care for ourselves requires a partner that is also capable of self care or they could feel resentful when you try to step away. For me it took therapy, coaching, and dancing to really begin to understand what caring for myself looks like. My own mom was amazing at sacrifice but never showed me anything about loving on her Self. So despite all that seriously hard work she put in, I rarely felt heard.
I want something different for my own child. I want something different for the women I love that are mothering. If we can move this change forward the entire world could change with us. Mothers it is time for radical self care. And it is radical because in our culture self care is yet to be seen as a truly worthwhile endeavour. But I think it may be the doorway to something better for both our littles and ourselves.
Summertime brings so much fun and sweat. Unfortunately for our private parts this humidity can bring unwanted itchiness and discomfort. Many kids show up in clinic this time of year with urinary symptoms such as dysuria, itch and discomfort to their parts. Yet often the urine exams are normal for these kids. Once a urinary tract infection has been ruled out by U/A (quick dip) or urine culture (send off that take 2-3 days to result) the guilty party is most likely yeast combined with local irritation. This is what we call candidal balanitis for boys or vulvovaginitis for girls. This diagnosis is especially important for kids with bright red irritated private parts. This irritation is more common in our boys with foreskins and those of us with lady parts.
Candida albicans is the most common species of yeast that causes trouble for us humans both big and small. Yeast love dark moist environments and our private parts and creases are simply the dream home for these pesky guys. The way I approach this problem is 1st to rule out a UTI (urinary tract infection). If there is no evidence of bacteria I set my scope on yeast. The way to keep yeast in check is to take away what it loves. Yeast loves moisture so we keep our privates dry and aired out! This means as soon as we are done swimming we change out of at least our wet bottoms. If your child is going to be in and out of the water all day for example at a water park a good barrier cream such as A&D ointment can protect their privates from the prolonged moisture/irritation of a wet suit. Wear skirts! Sarongs! anything that lets the breeze blow. Dress your kids in cotton. Avoid synthetic underwear even those labeled as”moisture wicking.” Avoid skinny jeans, biker shorts and leggings as they make your rear sweat and they limit air flow. If your child is still in a diaper leave one off when you can. It’s good idea to let our kids go commando at home especially after bath time until they are completely dry! If nudity is weird to your family put a long T-shirt on them but leave their bottoms to air out. Very important though if your child is scratching at themselves terribly it is better to cover the area to avoid secondary infections. I often explain its ok to scratch through your undies but not under them as our nails can tear up the delicate skin and worsen the situation. Keep their nails clean and short though just in case. This is called the Summertime Itch for a reason!!!!
Avoid soaping up privates. They are self-cleaning ovens. Simple warm water is the best bet for uncircumcised boys and all ladies. Soap disrupts the genitourinary flora giving yeast an advantage.
The next piece is harder. Yeast love sugar. Sugar is in everything. Read your labels and try to limit your child or yourself to less than 20g of sugar (preferably from starches). Limit completely empty/fast-acting sugars such as soda, juice, Gatorade, cookies, candies, ice cream, and popsicles. Drink water! Probiotics can help as well. The good bacteria help to crowd out the bad guys that make us itch. Be careful when buying yogurt as many have huge amounts of sugar per serving to make it less sour and more palatable to Americans. One easy way to avoid the issue is to buy plain yogurt/kefir and then sweeten it with a dab of honey. I dip a chopstick in honey. Swirl it over kefir (Trader Joe’s plain). Then I let the kiddo lick off what’s left. So with each drink he senses a ton of sweetness but compared to commericial yogurt it’s very low glycemic. Next time you are at the store check out the sugar content in the usual yogurts. It will blow your mind what is in this “health food.”
Finally antifungals such as clotrimazole used 2x/day topically on itchy parts can make a nice difference in just a few days. The only problem is that if we do not address our diets the yeast will come right back. Good luck out there! Cheers to happy, healthy parts.
July is here and summer is in full swing and swimming is a must! As summer begins we start to see a lot of kids with ear trouble. Swimmer’s ear is the common name for an infection/irritation of the external ear canal due to bacteria in the pool, river or lake we’ve been swimming in. Sometimes the irritation is simply due to the dryness that occurs to the sensitive skin of the ear canal. Ever notice how the skin on your legs can get dry after a dip in a chlorinated pool? The same thing can happen to the delicate skin of our inner ears. Swimmer’s ear can range from being a slightly uncomfortable itch to a downright painful problem for our kids and ourselves. Prevention really is worth a pound of cure on this ailment. A simple and effective way to prevent a severe external ear infection is cleanse/dry the ears with a 50/50 mix of rubbing alcohol and hydrogen peroxide. I tested this on Julien (4yro) thinking that he’d be the most sensitive in our household. Julien had water trapped in his ear canal from swimming and I knew this concoction can help dry ears as well. He was so happy and thankful that I tried it on myself and it burned me like crazy! Turns out I have the most sensitive ears in our family. I was running around the house holding my ears as he stared at me. Further proof that we are all unique. For me and the other ear sensitive folks out there I like to cleanse my ears with peroxide alone and have gotten good results. The only way you’ll know what works for you and yours is to experiment.
The way that you get the drops into the ear is to dip a clean Q-tip in your chosen cleansing drying agent and then apply each end to your respective ear canals once. As the bubbling or the burning in my case subsides I recommend that a small amount of virgin pressed coconut oil (antiviral/antibacterial) be applied the same way to another clean Q-tip and the canals be moisturized. Remember the dry legs after swimming? Your ear canals can be as well. Especially after applying a drying agent.
Ideally this regimen would be performed after each time you go swimming. Who has time for that right? For kids that have chronic issues with swimmer’s ear, it’s better in the long run to make time. Since we don’t have any chronic ear issues this season, we simply use this procedure for trapped water sensation. Works like a charm! For myself I’ve noticed there is a preliminary ear canal itch that is an early indicator that my ears are in danger. If I use the mix even once a day for 1-2 days as soon as I notice the itch I’ve been able to stave off bigger infections. And with the coconut oil added to the regimen I was actually able to treat a pretty nasty river external ear infection in myself. If none of this is helping go to the pediatrician or your doctor. Or if you know me personally come over and we can take a look together! Happy swimming and happy 4th of July.
***Update*** We recently had an impressive swimmer’s ear at our house and successfully treated it with apple cider vinegar mixed in a 1:1 ratio with warm water. I used a 5mL medicine syringe and then just applied 3-4 drops to ear ear with a 1 minute wait after drops were applied. Then using the blow dryer on the COOL setting dried ears completely. In 24hrs we had mild improvement. By 48hrs we had significant improvement in both pain and appearance of the ear canal! Just another DYI healing approach.