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Paediatric Skin Health with Kate Holm

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Paediatric Skin Health with Kate Holm

Skin conditions such as eczema, rashes, cradle cap, and urticarias are quite common in children and infants, sometimes causing major distress in not only the kids but their parents and carers as well. 

In this episode, Naturopath and Nutritionist Kate Holm returns to FX Medicine to discuss the most common skin conditions she sees children present with in her clinic, what might be causing them, and how to treat them. She also talks about food and environmental allergens and children with atopic dispositions, how to assess kids for nutritional deficiencies, and how skin conditions can affect other systems in the body, including a child’s emotions and temperament. 

Covered in this episode

[00:51] Welcoming back Kate Holm
[01:33] Most common skin issues in children
[02:57] Cradle cap
[06:02] Eczema
[07:21] Increasing rates of atopy and allergies
[13:40] Urticarias
[18:06] Mottling
[21:04] Infectious rashes and sores
[22:28] Assessing virtual patients
[23:56] Herpes simplex 1
[27:51] Molluscum contagiosum
[28:57] Keratosis pilaris and Vitamin A deficiency
[32:04] Managing treatment of children
[38:22] Assessing nutritional deficiencies
[43:46] Avoiding environmental allergens
[49:57] Mineral deficiencies
[52:43] Topical allergens and chemical load
[54:42] Treating acute symptoms versus underlying causes
[58:31] Treating the mother to treat the infant
[01:02:38] Kate’s preferred topical treatments
[01:06:28] Children’s emotions and temperament
[01:08:45] Working with other medical professionals
[01:12:00] Thanking Kate and closing remarks

Andrew: This is FX Medicine. I'm Andrew Whitfield-Cook. Joining us on the line today is Kate Holm, who's a naturopath, nutritionist, speaker, and previous lecturer, who recently took on her most important and exciting role: being a mum. 

Kate has always had a professional devotion to children. And her interest in preconception and fertility care drives her passion so that couples can experience the joy of parenthood with the best possible health outcomes for their children. And today, we'll be discussing skin complaints in children. 

So, welcome, Kate, to FX Medicine. How are you?

Kate: I'm well, thanks. Thanks for having me.

Andrew: It's my pleasure. It's our pleasure. So, let's first go through some of, and this is a textbook here, some of the most common presenting skin complaints, at least the ones that you see.

Kate: I guess the most common that I would see in clinic is eczema, for sure. And I guess, partly, that's just because of the chronic nature of the condition and where naturopathy and alternative medicine can fit into the care and the management of eczema. But there's so many skin conditions that children can have throughout their childhood, and I guess we can have them in adulthood as well. So, whether that's just post-viral rash, that kind of miscellaneous rash that can happen after they've been unwell. 

Even things like hives or urticaria, which can also happen post-virally, things like your chickenpox or hand foot and mouth disease, all of the fun ones that they can pick up from other kids, like molluscum or impetigo, those ones you might actually catch in clinic as well, they can come on acutely, but they will tend to linger for a little bit longer. 

You can have your heat rash. You can have your just general mottled skin, which can sometimes indicate things are not going quite right. You can have cradle cap. I could probably go on, as you said, it's a textbook of possible complaints that kids can have.

Andrew: Well, yeah. So, let's talk a little bit about cradle cap, because that's one of the earliest presenting symptoms that naturopaths will see and parents look for help. So, how simple can the treatment be there, with regards to emollients? And indeed, have you seen any frustrating cases that you've had to delve in deeper?

Kate: Yeah, definitely, when we're looking at cradle cap, you can go from having just small amounts of scaly bits on the head, all the way to big crusty sores that can actually become quite infected. And I think when we're looking at it from a more holistic point of view, we need to take into consideration so many things. So, starting with the birth of the child. How was that birth? Were they delivered naturally? Were they delivered via C-section? As that can definitely influence that skin microbiome. 

I think largely with cradle cap, bub's skin is so fresh and new and adjusting to the outside world, and sometimes parents can go a little bit too gung ho with all the creams and lotions and bath oils and things that they want to use for their children, shampoos, which babies absolutely do not need on their head. So, sometimes we're seeing cradle cap is actually just a response to these new things in the environment that are either being applied or are just generally in the environment.

Sometimes it is more related to, I guess, other immune dysfunction or even just issues with the skin barrier, in general, in which case, it might not respond to, as you said, some of those emollient therapies. I find that actually the best thing is just either olive oil or your herbal oil with a really gentle brush. Sometimes you actually don't need to do anything and it will just pass in time. But other times it can be sort of a little glimpse into the future of maybe there's some issues with that skin barrier function.

Andrew: What about our Western preponderance for wanting things nice and shiny and clean? Like a baby, they've just come out of the birthing canal. And the vernix. We have this want to clean away all of the blood and the gunk, and to have this lovely, shiny, polished porcelain thing, which isn't nature. So, what about leaving the vernix alone for a while?

Kate: Yeah, absolutely. And this is why I find it so important. And if I could have my way with everyone, I'd love to work with couples right from preconception all the way through the pregnancy so that you can actually have those conversations and encourage families not to bathe their children immediately, even leave them for the first week or so. 

Obviously, you can wipe off anything that's maybe really excessive. But their skin and that vernix, it's so symbiotic, and the vernix is really protective and it will be absorbed into the skin. So, removing that too soon will definitely disrupt some of that barrier function. And we don't need babies to be shiny and perfectly clean, they are perfect just as they are.

Andrew: Absolutely. So, things like, you say that eczema is a very common presentation. I'm going to take a stab that the reason that parents are seeking your help is because they're not satisfied with or they haven't reached adequate control with orthodox treatment.

Kate: Yeah, sometimes. I'm finding... There are definitely a lot of cases when it's very chronic in nature and families have found that they haven't had great success, maybe they've had some change in the symptom, but it tends to rebound, or in some cases actually gets worse when that treatment is removed. Other families I do find are wanting to explore natural alternatives at the outset, which I think is really fantastic, particularly because I'm seeing a lot of eczema actually pop up in very young children. 

So, even today, I had a four-month-old boy who's had eczema since about six weeks of life or maybe a touch before. And actually, this was mum's first step, which was really fantastic because there are just so many things that we can do that not only set up the skin to heal and for that condition to resolve, but then to support the immune system and to support that child holistically moving forward.

Andrew: And obviously, we're talking about atopy here. So, this is a whole constellation within itself. So, yeah. How much do you delve into or lean on the family history when we're looking at gleaning...? Do you need both parents, for instance, to have atopy for a child to present with eczema or can it just be one distant relative or...?

Kate: Yeah. And to be honest, absolutely having that immediate family history is going to predispose you and make it much more likely, but so many kids don't have any family history that's known of that sort of atopic presentation and they can still be developing it. 

So, I think that speaks to what's going on in our environment, what's going on in our diet, what's going on throughout a pregnancy or in preconception, that what we once believed as something to be inherited is perhaps manifesting without that genetic line in there as well. So, yes, definitely, if Bub got unlucky and mum and dad both had that atopic presentation, then it's much more likely that they're in that at-risk category for developing something themselves, but it's not always the case these days.

Andrew: With atopy and allergy, we have a societal increase in this. All Western societies have this. I mean, in my day of school there was the kid with asthma, then, of course, it was me, but there was always the kid with asthma, who was usually commonly ill. And now, what is it? Two in 5 children, 1 in 10 adults, allergens are being seen exponential. Nuts, wheat, peanuts particularly, what was the other one? Bee allergens, milk allergens, huge, milk sensitivities, I should say. But it's a massive increase. So, what's being done to or what do you find are the real culprits in our Western lifestyle?

Kate: Yeah, I'm going to write another portfolio.

Andrew: Is it just Western lifestyle?

Kate: Yeah, look, definitely the food that we're eating is a huge one. And I guess we can come at that from a few different angles. So, your typical Western diet is not only going to be quite high in refined grains, refined oils, processed sugar, or just sugar in general, and they can be inflammatory in themselves. And then in those same foods, you're going to be incredibly void of those nutrients that are going to be protective not only of our mucous membranes, not only of our skin, but also of our immune system, our ability to detoxify those things in our environment. 

So, I guess just diet alone is setting up this perfect storm. And that's not even taking into consideration the potential chemicals that we're getting from our food, whether that's food additives, and preservatives, and colours, and pesticide residue, and all that other stuff. So you've just got this cocktail that is, I guess, putting us at the back foot when we possibly also have had maybe some issues through pregnancy, whether that's interventions at birth, or whether that's antibiotics through the pregnancy. And these children are coming into the world already at a bit of a deficit. And then if the family is eating in that certain way, then they're definitely, yeah, it's the perfect storm to just dysregulate everything.

Andrew: I can't stop myself here from mentioning one of my favourite things, and that's these segmented filamentous bacteria, the SFBs, which it's one of my little pet things. But they prime the infant immune system. And as long as you've got copious and healthy amounts of commensal bacteria, that they will put the brake on the priming of the immune system by the SFBs. But if you haven't got these good bacteria there, inadequate amounts, then you may get a runaway effect, particularly if you've got a genetic predisposition, as we've mentioned, atopy or autoimmune disease. Now, it gets back to Western society, our overuse of antibiotics, not just as medicines, but in the food chain. And then you get this whole sequelae of things that happen. 

A question here with regards to this priming for atopy or immune dysregulation is, firstly, do you find with eczema that there's other symptoms that go along with it, like wheeze, for instance?

Kate: Sometimes, but not always. I know that's really a vague answer.

Andrew: No.

Kate: So, I guess, with the population that I'm seeing, so, I do see a lot of infants. So, as I said, like today was a four-month-old patient and he's not the only one of that age group who's already presenting with eczema, all the way up to your sort of older primary aged kids. And I think as they age, then, absolutely, you get what they refer to as the atopic march. So, you start to have the eczema, asthma, like it's just that generalised presentation of atopy and that immune dysregulation. 

So, in older kids, I'd say yes, the wheeze and the asthma and that side of it is a lot more prevalent. And would love to go into more detail about that with you in, I know we're going to do another little chat about that.
Andrew: Well, maybe we can get you back for another podcast, yeah.

Kate: But in these younger children, sometimes the eczema is that's the only presentation at this point in time. So, in a way, I guess catching them then, hopefully, we can then prevent that progression of the disease or of that, I guess, immune dysregulation. But yeah, it just sort of depends at what point you're able to jump in and also what the triggers are and why they're in that situation in the first place.

Andrew: And what about other urticarias? How do they present? How do you differentially diagnose them?

Kate: I guess with other urticarias, you're going to see that flare-up and then it will subside as well. So, with the eczema, you tend to see redness is common between the two. But with eczema, it tends to be maybe a bit more dry, or scaly, you might get weeping. Whereas with the urticaria, it will tend to be more blotchy, you might get raised, but it's that kind of distinctive welt. 

In terms of the size and the shape and the way it patterns across the body can be different as well. So, with the eczema, you have your more common areas. So, it can be on the cheeks, it can be in the creases of the arms behind the knees. It can be head to toe, to be honest. Sorry, with eczema, it will tend to always stay in those patches and maybe progress and retract.

With urticaria, it can really just move around the body. So, depending on whether it's something environmental that they're responding to, whether it's something food that they're responding to, you're not always going to necessarily, I mean, never say never is kind of my motto, everything is related, but you're not necessarily going to always see it in that same exact presentation. 

So, I do think there's that, it's a fairly noticeable difference. Although it can be the same trigger. So you could have someone be, you know, allergic to a food and for them, that breaks out as eczema, and for someone else, they could be allergic to the same food and have that breakout as urticaria. So, yeah, triggers can be the same but presentation will look quite different.

Andrew: It's interesting to me that the classical, and I get the variation, but the classical presentation of eczema, atopic dermatitis, is very commonly on the face and the cheeks, but also in the cubits and behind the knees. It doesn't gel, it confuses me. I've never understood why there and there.

Kate: Yeah. I actually can't give you any insight with that one, Andrew.

Andrew: It's weird. Anyway. If somebody out there has this answer, please put it up on FX Medicine, up on our website or our social media. We'd love to hear from you about this one. 

So, you know, the general urticarias which are, I guess, immune derived versus things like heat rash. I mean, that's a confounding one.

Kate: Yeah, I mean, heat rash is usually fairly benign. So, children can get heat rash as a result of a fever. If they have fever, then that temperature has become quite high. But children can get heat rash just from having one too many layers on, or from running around in the garden for too long. 

So, with heat rash, I mean, unless if they've really been outside for too long and they've really overheated, then, yes, absolutely, they can be prone to dehydration and heatstroke. But I'd say nine and a half times out of 10, heat rash is purely going to be just temperature related. Sometimes even just getting in and out of a hot bath or a hot shower can do it to them as well.

Andrew: All right. Oh, I've never seen that. But it was really interesting how... Yeah, with my sons, particularly one son, how just sometimes, as you say, stripping off an extra jumper and putting them in a cooler bath, not cold, but just this tepid sort of bath was just this “ah”.

Kate: Yeah. And I think, as a parent, and especially if a parent doesn't have knowledge in the health space, any kind of rash is going to feel concerning. And especially because rashes sometimes can be quite concerning, and they can be indicative of a bigger problem. But with something like a heat rash, and I always, if I get panicked phone calls or emails from patients, just getting them to go through, “Okay, do they have a fever? Do they have any change in their appetite? Do they have any change in any other area of their behaviour or their health? Are they complaining of aches and pains? Are they looking like they're quite sallow in the face or are they really lethargic?” All those other things to kind of check through. And if the answer to everything is no, it's just this rash, then I'd say, likely, it's either a post-viral rash and it's actually showing that whatever it was is on the way out, or it's a heat rash.

Andrew: Yeah. Now, you were mentioning mottling before. And obviously, there's a very dangerous presentation that we've got to cover. So, when do you worry about mottling? What do you do about it? What pearls of wisdom can you impart on us so that we can be safe?

Kate: Oh, probably not that many pearls, because thankfully, it's not something I've ever had to see in clinical practice. But what we know of skin rashes, so, what you want is to have... I mean, you don't want to have any rash, ideally. But should you present with a rash, you want that to be what they call a blanching rash. So, essentially, when you press on that rash, it's going to disappear. So, you put a bit of pressure on whatever, it'll turn just back to skin colour and then the rash will reappear. 

If we find that there's what's called a non-blanching rash, so you apply that pressure and the rash stays the same, then it may be not a medical emergency, but always treat it as though it is a medical emergency. So, that person, do not get them to book an appointment with you. I do not want to see you anywhere near my practice. I want you to go straight to the emergency room so they can rule out meningococcal. That, obviously, is quite dangerous. And yeah, that non-blanching rash is a pretty... That would be one of the cardinal signs of meningococcal disease.

Andrew: Yeah. And unfortunately, that condition gallops along, and that's even one of the later presentations. But I remember the glass test. So you can get... Sometimes with a blanch, as soon as you take your finger away, there's the redness again. A glass was really useful because you can use that pressure and see the blanching through the glass. 

But I'll always remember, a higher-pitched cry, headaches and the lethargy, that listlessness, particularly in smaller infants. But also, the other one was if you got them to touch their toes and stretch the meninges, and if they had problems doing that, that was one of the cardinal signs, "Get thee to hospital." And order them to treat blindly. Don't take no for an answer.

Kate: Yeah. And I think just with paediatrics in general, I mean, it's not somewhere to mess around. And I mean, as the child gets older and can communicate symptoms and how they're feeling a little bit better, then maybe you've got more time up your sleeve. But with young children when they can't actually express their symptoms. If we're talking babies and toddlers, or even children who just don't have a very good grasp on language or descriptive words, you just always treat it with caution because it's better to be safe than sorry. And if you present to an emergency department, they're never going to turn you away if you're a concerned parent, and better to have that reassurance and I as a naturopath do not want to be the one over email at 10:00 at night giving you that reassurance, they need to be addressed visually.

Andrew: No, that's right. What about infectious rashes? And also, I guess we have to cover what other sort of, it's not a comorbidity, but it's a herald sign, like Koplik's spots, for instance. So, how expert do we really have to be? How on point do we have to be with figuring out which rash it is?

Kate: I mean, we, again, as allied health practitioners don't need to be really the expert. And if there's anything that seems infectious and it's coming alongside other symptoms…So, as I mentioned, fever definitely would be sort of the main one that I'd be looking out for. You want that diagnosis to come from a medical practitioner. So, send them to their GP or send them to a hospital if you're really concerned.

I think more likely you'll get parents maybe contacting you once they've had that diagnosis and they're looking for additional support to overcome whether it's measles, chickenpox, impetigo, whatever it might be. And that's where actually we can come in and do some really beautiful support. But we should have an awareness. And if someone happens to present in your clinic and you see a rash that you're a little bit unsure about, then you want to have some kind of awareness of what maybe it is. But definitely, I'd always say refer on to get that proper diagnosis.

Andrew: Do you find that in this age of COVID-19 and the change in how we do practice via Skype interviews, via telehealth, and that sort of thing, do you find that this might actually be an advantage because you're not bringing that patient into your practice with an infectious child? 

Kate: Yeah, for sure. And I think for my practice anyway, I've always done a lot of online appointments, just because I originally was based in Sydney and moved to Newcastle. So, I still had a lot of patients in Sydney and that was just always a part of how I practiced. But I think a lot of parents are quite savvy, hopefully. They don't want to bring their potentially infectious child around you. So, yeah, online is fantastic in terms of accessibility. 

And while you can't assess then the child or whichever patient right in front of you, I just always get people to send me some photos of the areas of skin that are causing problems. You can kind of get a look on the camera, it's not usually that clear. But photos are great and they can do that pretty instantly. So, you can still get a really good visual of what's going on.

Andrew: I think it's a great advantage nowadays. You can actually take a short movie, because I used to love getting photos and you go, "What is that of?"

Kate: What am I looking at?

Andrew: Taking a photo really close of a cubit. So, movies are great. But I guess light is always an issue and the quality of the movie. 

What about when we're talking about, let's say differential diagnosis of sores and other lesions? Let's say herpes simplex 1, cold sores, and impetigo. So, how careful have you got to be there? I mean, they're extremely infectious.

Kate: Yeah, yeah. I mean, both are extremely infectious. So, in terms of precaution around...if that person was presenting in your clinic, you as the clinician don't want to touch it or you really don't want them touching too many things either. In terms of the actual diagnosis, again, I'd really be wanting that to come from medical professional. And with impetigo and herpes simplex, they can actually look fairly similar depending which stage you're catching them. Both can get quite blistered and look quite infected and angry. So, sometimes they'll even swab them to be certain.

I guess with the herpes simplex, you absolutely want to be incredibly cautious, particularly with young infants because that can actually be life-threatening or lead to severe neurological issues. I actually do have one little patient who, she contracted it, she would have been probably around five or six weeks old. And unfortunately, her dad actually gets cold sores and was really diligent, or so he thought, washing his hands and not kissing her and all that sort of stuff. 

But he must have touched his face and then given her a bath, so she ended up with quite a big outbreak on her torso. But thankfully, they were able to catch it and it didn't go into the cerebrospinal fluid. So, she now would be about nine months old and has no issues with her development, no neurological implications, is on lifelong antivirals, or at least until they're confident that it's managed and she's a bit older. That one's absolutely one to watch for. 

And I think a lot of people don't actually realise how dangerous cold sores can be for young infants. So, making sure all of your friends, your family, grandparents, aunts and uncles just do not come anywhere near your baby if they are even questioning whether they have a cold sore. It's just not worth the risk.

Andrew: It's really amazing how complacent significant others are, isn't it? And you really have to be, as a parent, you've got to be really firm with your advice off the bat, before it happens, like or else there…

Kate: Yeah, absolutely. It is not worth it. And I think even if someone thinks, "Oh, no, I've had it for a while. It's on its way out, it's probably not contagious now." It's just not worth the risk.

Andrew: Probably it doesn't help.

Kate: You don't want... Yeah, exactly. It could still be infectious. And when we're thinking newborn babies or even if it's a toddler or a young child, they might not be fatal for them but you still don't want them to have cold sores for the rest of their life if you can avoid it. 

Andrew: Right. No.

Kate: So, I think, yeah, it's important to be really cautious around that. And same with kids where things like your impetigo or molluscum, they're not going to be lifelong issues. They're not particularly dangerous, but they are highly infectious and highly annoying. So, if you've got a toddler or your friend has a toddler who does have some kind of skin infection, keeping them away from your children and babies as well.

Andrew: One point five meters.

Kate: Yeah, definitely.

Andrew: My wife is a teacher aid. She is shocked at just how many kids come to school with active impetigo. And the teachers and principal have to get involved and go, "No, you are going home now." Really amazing. And maybe that's a societal thing about the stress also on the parents to go to work and two parents working, that sort of thing. But there's a time and a place where you just have to cut it. 

You mentioned molluscum contagiosum earlier. Now, tell us more about this, about, is it only restricted to those whose immune system is compromised or do you see it in otherwise healthy children?

Kate: You could definitely see it in otherwise healthy children. I guess it would more be the duration of the condition. So, in relatively healthy children, and again, like never say never, my motto, there's exception to every rule. But if a child's relatively healthy, so, it's a viral infection, it will usually clear within a few weeks. 

In a child who's maybe got some struggles with their immune system, it can actually last for I'd say even 12 months or potentially longer. And it may go up and down during that time. But they can still have those sores for quite a significant length of time. Hopefully we've seen them at some point there and we can work with their immune system and do our beautiful antiviral support and clean up their diet and all of those things, and definitely some topical treatments can help as well. But yeah, I would say in children who are struggling, it's going to be hard for them to really get on top of that.

Andrew: Okay. A rare one, and I have no experience in this, and this is keratosis pilaris. Tell us a little bit about this. I've never seen it.

Kate: I actually would say I see that very, very commonly. And keratosis pilaris, I guess we think of it as being a manifestation of vitamin A deficiency.

Andrew: Oh, this interesting.

Kate: Yeah. Yeah, I'm always asking the question, why is there a vitamin A deficiency? So, yes, definitely diet can be very deficient in vitamin A. But it usually comes back to the gut. And the way I like to explain it to patients is, your body is always going to prioritise its most vital functions. So, for us looking at the skin, that's pretty important. It's on the outside. It's what's being presented to the world. Keratosis pilaris generally doesn't itch or cause any problems. It more is just that aesthetic issue and I guess that indication that there's something else going on internally. And I have to say that oftentimes, it's because the gut is requiring that vitamin A to heal the mucous membrane there. 

And usually, I'd say it's connected with a gluten issue. Not always. But I have found often that if you pull gluten out of the diet or at least wheat, or excessive amounts of either wheat or gluten, that you can get some change there. Essential fatty acids, definitely another one. And in a lot of children, they're not going to be necessarily the biggest fans of sardines or lots of oily fish in their diet. So, that can sometimes be a player in all of these skin manifestations actually.

Andrew: Got you. And you found decent resolution of that?

Kate: Fairly decent resolution. I think the challenge often with children is when we're talking about dietary interventions, you have to have the family's full commitment. And then it's not just the family's commitment. You've got to have people outside of the family. So, whether that child's in daycare, oftentimes daycare will be very, very vigilant if it's a food allergy. But if we're talking about a food intolerance and it's something as benign as keratosis pilaris, they're perhaps not quite so diligent. We're talking grandparents and how they might play a role. We're talking friends when they go to their house. So, you can't necessarily control every single thing that's coming in. And I think working with the family to slot in, based on the severity of whatever they're presenting with, so, where you can have that lenience, and if they're willing to accept that maybe you're not going to get a complete resolution, and they're okay with that, then so be it. 

Where you can have that strictness and maybe it is much more necessary. I’m thinking of a little boy who used to see me who had head-to-toe, terrible eczema, ended up in intensive care with wet bandages, like, horrible, horrible time. And for him, he has no choice but to be 100% strict in every single circumstance. So, yeah, I think that's often the challenge with children and with family dynamics of just meeting people where they're at and taking them just that one step further, but still within a realm that's going to be manageable for a family.

Andrew: Let's discuss that a little bit more. You've got something, as you mentioned, a child who's been in intensive care, hospitalised, and has the wet packs, wet bandages applied. Thinking about how a child grows and interacts, how a family takes the child to meet other children, they have playdates, but this child can't. So, as I said very early, there was always the sick kid. You know what I mean?

Kate: Yeah.

Andrew: And I never thought about this when I was a kid. But now, as an adult, my heart cries out for these children. They're the child that is crying out for interaction and love and acceptance by their peers. But there's also the family. There's pressures on the family to, as you say, conform to an eating pattern. So, how great are these issues that you have to surmount?

Kate: Yeah. They can be huge for some families. And I think it depends where that family has come from. I get a pretty wide spectrum of patients in the sense of some people are coming to me and already their diet is probably better than mine. They're doing everything from scratch. It's all whole foods, it's all organic. They really know what they're doing. And then we have families, and it's completely new information. So, it's so overwhelming to even think about removing one thing from the diet, let alone having to be 100% strict on possibly multiple things. 

So, I guess, yeah, it is a huge stress. And referring specifically to eczema, when they've done evaluations of the impact on families and on children, they've classified that eczema can be as significant an impact as type 1 diabetes in terms of emotional cost, financial cost, disrupted sleep, just changing family dynamic. So, it is actually really significant.

And we'll have the kids who have a little patch of eczema and that's not the patient that we're talking about, but in these children who have these really severe presentations, it's huge for them socially. I think a lot of it comes down to…it's hard because you've got to be as gentle as possible while still being firm enough to move them in the right direction. And so much of it, depending on the age of the child, is really working with mum and dad to ensure that they have the tools to provide alternatives. 

So, it's not that the child misses out on the birthday party, they just might have to have their own little special lunchbox that gets packed with the gluten-free, dairy-free, egg-free, nut-free alternative. Find the things that they really do love and ensuring that they get those. Having the language to, I guess, just reassure them that they're not weird, it's not bad, it's just something different and it's just something for this moment in time. And the more we can be diligent right now, the more we can potentially move back to something normal.

And I find kids, when supported, they're actually really resilient, and they have better understanding than we give them credit for. So, really involving them in the process, I'm sure there'll be tantrums and meltdowns and protests at different points in time, but getting them on board as much as they can, and as their body begins to heal. Often, as we said earlier, these things don't occur in isolation. So, you might find that a child has big eczema or asthma or some other health condition, and usually there's some behavioural or mood things going alongside that. So, as we're healing one, we're actually healing the others. So, maybe that, their mode of protest or that emotional side of it will actually dial down as everything else dials down in the body. 

But it's really tricky. Yeah, it can be hugely emotional and very, very taxing on families. So, I think that's where we just have to give as much support as we possibly can and be really understanding. And I might have in my mind ideally what I'd like them to do, but if it's really not achievable, I'm not the one living there day-to-day. I'm just there to provide the tools and give them guidance. So, yeah, I think we can sometimes sit in that counsellor chair a little bit as well.

Andrew: Yeah. So, a couple of things, I'm such a child myself, that I realised how frustrated I get when I've got an itchy mozzie bite, and how incessant it is, and how it can be frustrating. Imagine that in a significant portion of your body. How frustrating that must be, especially for a child who doesn't understand what's going on. 

The other thing I was wondering about was, maybe in this day and age of popularised gluten-free diet, ketogenic diet, these allergen-type avoidance diets, and inflammation avoidance diet, I actually wonder whether children these days might have a more accepted time of having to have that lunchbox.

Kate: Absolutely. I would say if there's any benefit. Who would have thought that we could find benefit in the rise in atopic presentations, but if there's one benefit, I would say that it is more common. So we're going to find that, statistically they say it's about 20 to 30% of children are going to suffer eczema at some point in their childhood. So, that's a lot. It's not going to just be you in the classroom. Hopefully there's others who are also may be exploring these avenues to help get some change to their condition. 

But I totally agree, there's so many more families and children who are eating in certain ways, whether just by choice or whether as a therapeutic kind of tool. So, I think it definitely is a lot more accepted. And there's so many more products available. That's the thing. You can actually walk into a supermarket now and if you can't prep something at home, you're likely going to find an alternative that will be suitable there. So, I think there's definitely that kind of benefit. I'd hate to be doing this back in the '70s and '80s if you had to go gluten-free.

Andrew: Oh, no, absolutely. The other thing I was thinking about was nutrient deficiencies. Do you find that it's restricted mainly to the people who have no knowledge of refined carbohydrates, poor dietary nutrient quality intake? Or do you find that maybe it's from a restrictive diet that they might have tried?

Kate: Can be both or it can be just seemingly random. I think with children, there's a few things to keep in mind. So, definitely, we know that Western diet's going to be void of most of those key nutrients. A very restrictive diet, if not done properly as well, can be void of a lot of those essential nutrients. If the family is fairly across having good variety of whole foods, they're prepping things from home, not just buying the packet gluten/dairy-free option, then hopefully they're covering off bases. But children have food preferences and they'll let you know about them. So, you can have some issues with fussy eating, which can cause nutrient deficiencies. 

Andrew: No!

Kate: Never. No children are fussy. I think as well looking at their appetite, sometimes they actually just don't need as much food as required to hit some of those higher levels of the nutrient values that they might need for therapeutic application. They go through phases of having a favourite food and maybe not wanting to eat other ones, the family might already have other children that they're catering for as well. So, there can be a whole host of reasons. 

I find once kids hit primary school age, no matter how good an eater they are at home, so many of them don't eat their lunch. They're just too busy. They want to go and play. So we've suddenly got these gaps in nutrition that even with the best intentions are maybe not getting filled. So, yeah, I think there's a variety of reasons. And if we have a child who has that atopic presentation or tendency, then their requirement for those nutrients are going to be slightly higher again. So, there's definitely some situations that you just can't eat your way out of in general. And I think for kids, that's certainly the case.

Andrew: Now, I think I have to cover, how do you assess nutrient deficiencies in kids? We look at white spots on the nails for zinc, or the cracks in the corner of the mouth for B vitamins and iron. How do you do that?

Kate: Yeah. So, as best I can, I would avoid doing any blood tests on young children. And definitely, again, it just depends on the severity of the presentation. Sometimes you really need to have that information in order to move forward effectively or to be really targeted. Otherwise, it's as you say, as much as possible from that just physical assessment, even getting the family or the child to take a diet diary for three to seven days, and getting just a good snapshot of what they usually eat. And then from there, you can ascertain what might be deficient. 

And I think as well, we can see it and we know about these conditions. There's certain nutrients that do come up over and over again. And you'll be able to still support them with supplements without quickly pushing them into a toxic level. So, I find that you have a bit of room to move without necessarily needing to go down the avenue of blood tests straight away, because we just want to avoid as much trauma as possible for our little people, and even for some of our big people. Yeah, I don't think it's always necessary.

Andrew: And what about combining the assessment, not just looking at fingernails and tongues, but what about your dark circles under the eyes, or the pale...? I've got palpebral fissure on my brain, conjunctiva, pale conjunctiva in iron deficiency, particularly when you might be suspicious of a wheat issue. Do you then refer them on for investigation into celiacs and things like that?

Kate: Yeah, that would be one thing. And thankfully, with anything genetic, I mean, I know that the celiac gene doesn't necessarily give you the whole picture. But if we can start there, at least you can do a cheek swab, and that's going to be completely non-invasive and then move forward with other tests if needed. I really, really, really do try to avoid blood. So, anything that's going to be invasive for my little people, because I think having them on board with what you're doing and them feeling comfortable with you actually is part of that therapeutic process. Because if they are terrified of you and what you're going to do next, then they're not necessarily going to be as compliant. 

So, all of those visual things that you mentioned give us a decent indication. And I think if we're seeing positive change in those things, as well as change in symptoms with some basic supplementation, and not going into mega doses at first, I always actually would dose fairly conservatively with children anyway to start with because they have such different rates of metabolism. Even within same age child, the build can be completely different. The way that they move their body is completely different. So, I think looking for that minimum dose to get some sort of effect is always going to be the best option. And then you can change your approach from there, whether that be change in dosage or decide that actually you do need to jump ahead and do some pathology testing.

Andrew: And we've spoken about avoidance of allergens in the way of foodstuffs. But what about if it's an inhaled allergen? What about animal dander? What about pollens? What about things that you just simply cannot avoid?

Kate: Yeah, it's really unfortunate. I find definitely with eczema, there can be a huge issue with dust mites. So, I do a lot of education with families around how to manage the dust mites. And I feel sometimes a bit bad because I think the mums are thinking, "Why is she giving me a lesson in cleaning my house?" But it's really I guess just more specific around having filters on your vacuum and doing the wet dusting and staying really on top of it, much more on top of it than you would with just normal house cleaning. 

With things like pollens, that's so unfortunate because, short of moving house, or moving states sometimes, you can't necessarily avoid what's around you. So I guess that's where we jump in and we can work with helping to modulate the immune system. So, we can't obviously change what's going on outside the body but we can change the way that the body reacts to that.

Animal dander, another tricky one. So, yes, the cleaning. But if it gets to a point where the family pet is really causing the problems, then you've just got to address that. Thankfully, I haven't actually had to have anyone rehome their pets, usually they can come up with a solution. Maybe the pet doesn't sleep on the child's bed or the pet has designated areas of the house and the child's very careful with hand washing and not touching their face after touching the pet. But yeah, those environmental ones are big. 

Another one that I'm finding is quite a big trigger is mould. So, that chronic mould exposure and often people don't really realise that there's an issue with mould. It's not always visible. And it's not always as simple as just wiping it away and that's that. So, that can be quite a problem. And usually, we'll discover that that's a problem when it's school holidays, for example, and families go elsewhere and symptoms resolve without any other change. So, yeah, that can be really tricky. And I have actually had some clients who have needed to move homes in order to avoid the problem.

Andrew: Yeah. It's not just the massive mould outgrowth. It can be really insidious. We've even had in...I live in a nice house. And there was problems in the eaves, indeed, they collapsed during a storm. And we only then found out how pervasive the rot from the moisture was in the eaves, thankfully it was restricted to that.

Kate: And we know that mould is generally going to be an issue. It's going to be more of an issue for a certain subset of the population. But it's not an issue for you until it becomes an issue. So, you could have lived in that same place for a long time. But again, it's setting up that perfect storm where maybe it's just one more trigger and now you can't tolerate the mould at all. So, sometimes that's the thing with children as well. The good thing, I guess, with kids, they have a fairly short timeline. So when you're tracking back at how symptoms have progressed, it can be pretty easy to see where it started and work out what changed around that period of time.

But I'm stealing this analogy from Mark Donohoe, and I think it's fantastic. It's the boat with five anchors. So, you can remove those four anchors, and still the boat is not moving forward. And sometimes it is then that mould or something environmental, that it wasn't causing the problem before, but with these other things, suddenly causing an issue, it now has become the problem and will continue to be a problem. So, yeah, it's a really interesting one. And I feel like there's so many damp mouldy places around. I don't know about up in Queensland, it may be slightly better or no, you got that humidity.

Andrew: It still rains.

Kate: Yeah.

Andrew: Yeah, indeed. Yeah, actually, that's a good point. I took two suits in yesterday because in this brand new cupboard, as in six months, eight months old, mildew.

Kate: Really?

Andrew: Yes. Yes.

Kate: So we all need to move to the desert. We'll go and live in...

Andrew: I love what you said about dust mites. I remember from years ago, what was her name? Professor Ann Woolcock used to just advise her patients “Rip up the carpet.” And this is in Sydney, where it can get quite cold. So, all carpet, just get rid of them. Soft, plush toys were a real problem. And I think every town or city used to claim that they had the highest dust mite concentration. But I think I remember reading research that Grafton was one of the worst places. Yeah.

Kate: I'll keep that in mind. I don't know if that's something they want to claim...

Andrew: Because I might have only looked at six places.

Kate: …as a city, it's not really like a tourist slogan. I don't know why.

Andrew: No. This was from the pharmacists.

Kate: Yeah, right. Okay. It's free.

Andrew: What about encasings though? And I remember certain treatments that were around that used to denature the dust mite allergens. I don't know what treatments are on the market now. Do they work? Are they effective?

Kate: You mean in terms of like furnishings and that sort of thing?

Andrew: It used to be a spray, they used to denature the dust mite faeces, which was the most allergen. I don't know.

Kate: I'm not familiar with that. Sorry. I'm not too sure.

Andrew: Yeah. But I mean, the old thing was tea. The old wives thing was tea used to denature the protein. But in modern-day, we've got cheap, thankfully, encasings that we can encase bedding with.

Kate: And even good air filters. There's fairly affordable air filters that can be really useful and special allergy filters on vacuums and more high tech vacuums that you can get. So, yeah, there's a lot that people can do around their homes. I'm unaware of the spray though. That would be interesting to look into.

Andrew: Now, I did want to just ask a point, obviously we're going to favour foods, and we were talking about mineral deficiencies. So, let's take zinc for instance. Would you favour things like pepitas or would you look at... I mean, obviously, oysters would be out for kids, but...

Kate: I don't know. Yeah. I feel like some children actually, we have a lot of those mental preferences for foods, but children if they're introduced to them at definitely a younger age, they don't always have the same taste preferences. So, I feel like you can sneak things by them until they cotton on that maybe it's a little bit gross or weird. So, maybe oysters.

Other foods that I look at, I mean, definitely your nuts and seeds are going to be good. However, we're up against the issue of our soil being so depleted. So, where do we actually source nuts and seeds that are going to be really, really good in zinc? Some is going to be better than none. And obviously, they're quite usable, providing there's no nut allergy. You know, grind them into flours, use them in bliss balls, make granola, sprinkle them on salads, put them in smoothies. So many uses.

Another one, I mean, definitely red meat for zinc is a good one if children are happy eating it, which often they are. And that can come in any form, whether you're giving them a piece of steak or a spaghetti bolognese, it's still going to have zinc in there. And using organ meats as well. So, liver is really fantastic and such a nutrient-dense food. And I find that, again, young children don't tend to have the same taste preference or psychological preference towards liver. I personally find it really hard to eat despite knowing all of the therapeutic value. But I can grate it onto my son's food, and he has absolutely no idea. So, that's quite a good way. 

Andrew: Wow.

Kate: Yeah, if you've just freeze, always try to get organic livers and pop them in the freezer and then grate it really fine onto hot food and it basically just dissolves in there...

Andrew: Grate it while frozen?

Kate: Yeah. 

Andrew: Right.

Kate: It makes it... Because it'll be hard, so it's easy to grate that texture. And then you just get these really, really fine fragments that just mix right into whatever you're eating. Or even mincing it in with the bolognese or some kids probably would just eat it as it is. I know, personally, I used to love pate as a child. So, trying pate and little crackers or veggie sticks. But that's a really, really nutrient-dense food that you can give them.
Andrew: That's a really interesting point, because you put lamb’s fry in front of me, and I'm off. But pate, oh, well, that's different, isn't it?

Kate: Yeah, funny. It's presented as a bit of a delicacy, but I think when we think about those organ meats, fried up on a plate, it doesn't feel quite so gourmet.

Andrew: No. No. Now we've mentioned inhaled allergens. What about topical allergens? What about things like washing powders, even clothing?

Kate: Absolutely. I mean, so many of the chemicals that we have in our environment now, they're not good for anyone. But I think they're even worse for children who do have that sensitivity. So, that can be anything from washing powders, to soaps or moisturisers, as you said, clothing. So, certain fibres, particularly synthetic fibres, but sometimes natural fibres can be quite irritating as well. 

Yeah, there's so many things in the environment that come into contact with our body. And again, if we've got that epithelial layer, it doesn't have the same integrity to, I guess, the immune system that we have there. If it's hyper-reactive or maybe there already is some kind of eczema or other skin presentation, then those things are just going to aggravate further.

I guess the chemical load as well. So when we're thinking about taking a step back and looking at what's possibly dysregulating the immune system in the first place, if we've got this huge chemical exposure in every area of our home and our life and our environment, then that's going to put an increased load on the liver and all of our organs of elimination, and it's kind of just this, again, that perfect storm where your area of susceptibility is suddenly really going to be under pressure.

Andrew: Okay. Now, here's a 20 part question for you: treatment.

Kate: Yeah.

Andrew: How strongly do you favour addressing the symptomatic presentation of the condition, for instance, the wheel, or the rash, or the lesion, versus systemic treatment? And when do you and how do you use nutrients versus herbs?

Kate: Yeah. Okay. So, part one of the question with favouring the acute symptom versus systemically, you've really got to do both. I know that's vague but, essentially, we want to get that child out of discomfort as quickly as possible. And usually, that is going to involve doing something to address that acute symptom. So, whether it's a topical application, or something that you know is going to just give immediate, whether it's itch relief, or pain relief, or whatever it is that they're experiencing. At the same time, you've got to be addressing why you had that symptom in the first place. And this is, I guess, more when we're talking eczema or things of that chronic nature. You can't do one without the other. I guess you could if you had a really patient child and a really patient family address the more systemic things first. But really, if the child's under stress, they're sleep-deprived, they're scratching, they're actually ruining that epithelial layer from their own aggravation, then all the systemic treatment in the world's probably still not going to hold in the same way. So, yeah, you've really got to have both of those wheels turning at the same time.

I guess in terms of what that treatment actually entails is going to be really different from person to person. But the key things that I'd look at, and I guess this is where we want that timeline of when did it start and what was happening around the time that it started. So, in babies or in young infants who aren't eating solids yet themselves or maybe only just starting on solids, oftentimes you're getting either exposure to something through breast milk from mum, maybe it's the formula that they're having if they're not breastfed. And it can be those things, so, from a food perspective that are causing aggravation. Or it could be if they've had, either mum's had antibiotics throughout the pregnancy or immediately postpartum, or actually any time during breastfeeding. If bub's had any antibiotics in that first year of life, if bub's had paracetamol, that can actually increase it as well.

So, finding where it started, and then that allows you to, I guess, better navigate a treatment. Once solids are introduced and if that seemed to be the catalyst, then you'd be looking, okay, we need to look at which foods are possibly causing this and why the gut is maybe hyper permeable or not quite ready to deal with those food proteins. So then you're delving more into that area, whether it's actually doing food sensitivity testing, or looking at an elimination diet, definitely, again, supporting the gut mucosa. And those same nutrients are going to be great for the skin anyway. 

And then I guess, oh, gosh, it can be environmental things. It can be toxicity. It can be, maybe they've had a huge amount of other viral illnesses and their immune system is just all over the place. And you've got, I mean, children anyway are naturally a little bit more TH2 dominant, but you can have that real swing towards that antibody... I lost my word, totally lost the word, developmental antibodies. So, yeah, definitely supporting immune function.

It can even come down to, if you've got a child who, for some reason, has been through a lot of stress or a lot of trauma. And that even might be things that not necessarily perceived stress, but things like really, really poor sleep could even be an aggravating factor in just creating that inflammation in the body. So, it's multifaceted. And often you're having to do bits of all of those things. But I think establishing when the symptom first started and working out what was happening around that time will better guide your next steps. 

What was part two of the question?

Andrew: Well, I'll tell you what, do you ever treat the mother, particularly in infants, do you ever treat the mother's digestion with things like probiotics or say digestive enzymes? Have you ever found that they work, rather than doing a wholesale change in the mother's diet?

Kate: With digestive enzymes, definitely, I find that they can be effective in the person who's got the eczema. I wouldn't give those to a baby. But definitely, an older child, that might be appropriate. I actually haven't found that to be effective with giving it to the mother. I don't know if that's just me. But my understanding is that if bub is reacting to the food proteins from whatever mum's eaten, those food proteins are going to pass through the breast milk, no matter how digested. So, the issue...I mean, where digestive enzymes can be really useful is ensuring that things are appropriately digested before they get to where they're going next. But by the time they're making their way through the breast milk, it's sort of in the same form for bub regardless.

Definitely treating mum with probiotics can be really, really useful though. And we know that we do get some transmission via the breast milk. They don't know everything about all of the strains in terms of which ones move through and which ones don't, or to what degree, but we know there's some, so, that's absolutely an option. I find though that, usually, if we've got a breastfed infant, I tend to do both. So I treat mum and bub at the same time. And there's some really simple things that you can give to baby that are just good for the general well-being anyway. 

So, I'm a huge fan of cod liver oil. I think that's just so fantastic for babies and children for their brain development, for their mood, for their behaviour. It's anti-inflammatory. You've got that vitamin A and vitamin D naturally occurring. So, good for all mucous membranes, good for immune system modulation. So we're kind of like ticking off all of those different boxes that we mentioned that could be at play. And you can give that from birth. And again, we might turn our nose up at cod liver oil liquid, but babies don't really know any different and they usually will take it fairly happily.

Andrew: Yeah. I think we've been made paranoid about vitamin A. I get that there's issues with high dose. But that's high dose, it's a vitamin. You require some. And we are traditionally, not deficient, but we don't eat a heck of a lot of the organ meats and the high vitamin A-containing foods. Indeed, it’s what we were saying before, liver was a treatment, a medical treatment at the turn of the last century. So...

Kate: Yeah. And I mean, with the naturally occurring vitamin A in cod liver oil, and when we're looking at the dose that we're giving to infants, there is absolutely no way that you could get to a toxic level by giving them even slightly higher than the recommended dose on the label. So, for me, that's not really a concern. I guess the biggest concern with vitamin A is during pregnancy. But once bub is in the world, it's less of an issue. So, it's just so crucial for all of those mucous membranes, like the whole way through the gut and definitely the epithelial tissue as well. So, yeah, absolutely.

Andrew: Vitamin A poisoning is extremely rare. And look, it is usually from supplementation. But as I said, it's high dose. It's not what you would... It's high.

Kate: Yeah. And synthetic as well. So I guess when we're giving the body in that naturally occurring state, then your body has the ability to metabolise it as it sees fit. But when you're giving those synthetically derived vitamin A, the difference kind, yeah, then that's where it can definitely be more problematic. And I wouldn't be venturing there with little children. Cod liver oil really does seem to do the trick.

Andrew: Okay. So, treatment. Topical treatments. Is there any topical treatments that you favour, like Chickweed suckers, for instance?

Kate: Chickweed is beautiful. It's probably not the top of my list for eczema, to be honest. I really like it for like chickenpox, or yeah, any of those kind of itchy viral rashes. For eczema, I'm leaning more towards... I usually have a list that I give to families. And I find that, as with everything, there doesn't seem to be a one size fits all. So, kind of explore a few different options. 

Sunflower oil can actually be quite good and very affordable, easy to apply. I find with... I mean, babies aren't going to generally complain. Older children can get funny about textures of things. So, just being mindful of that. And if you want them to apply something a few times a day, then, yeah, just being mindful of what they will be happy to apply.

Topical vitamin B12 has actually been shown to be fairly effective for eczema as well, reduction of not only the itching but also of the actual eczema lesions. So, that can be really useful. Chamomile is beautiful as well. So, you can do that. If you make your own local creams, then that can be great. Even sometimes I basically get mums to brew like a big cup of tea in the bathtub. So, I use a combination of I get them to do the dried chamomile flowers and then also oats are fantastic, the old oat bath, really, really soothing. And if we can just take out that itch so that they're not continuing to scratch and aggravate the skin, then that's really helpful for healing. Manuka honey can be really useful.

What else would I use topically? Even Epsom salt baths can be nice and anti-inflammatory. So, that can be another one. Topical creams, I mean, there's lots on the market and I find, yeah, it just depends on the patient. Often they've tried a lot of them. So, maybe finding one that has different ingredients, whether that be a herbal formulation or even sometimes just a straight lanolin can be quite useful getting that really good barrier, especially if the skin is quite broken. 

Actually just on broken skin, there's some thinking that you want to avoid using creams that have a lot of nut oils in them. So, like a peanut oil, your almond oil, that kind of thing. Even though they can be really useful, if the skin is actually broken and you're getting essentially those... I mean, while it's an oil and it shouldn't technically have the food proteins. If there's traces of those food proteins and they're going straight into the bloodstream, then that can set up, I guess, that can dispose them to nut allergies. So, just being mindful there, especially if you've got a child who maybe already does have a nut allergy, I'd steer away from those if the skin is broken. If the skin's not broken, you may be okay with it. But often parents are a little bit nervous anyway. And when there's so many alternatives, I'd probably just pick a different avenue to go down.

Andrew: And what about rosehip and jojoba oils?

Kate: I love your jojoba oil. I would definitely recommend that a lot. You can even squirt a little bit in the bath. It's the same pH as our skin sebum. So, the body really readily absorbs it. It's really nice and anti-inflammatory. Yeah, I think it's fantastic. Again, never say never. I thought it was like the cure-all and every person would benefit from using jojoba oil. But I have actually had a handful of patients who have had an adverse reaction to it. So, I guess, yeah, anyone can react to anything in theory. And then maybe you go rosehip instead. But usually my go-to is the jojoba. I find that's fantastic.

Andrew: And what other factors impact on the severity of the illness? And I guess, you know, we mentioned earlier about how the child's illness affected things outside the child, like the family, and the interpersonal communication, and the socialisation, that sort of thing. What about how the outside influences affect the severity of the child's disease?

Kate: Yeah. I guess, aside from all of those, the nutritional and the environmental factors that are definitely playing a role, we know that... I mean, children don't necessarily experience and manifest stress and their emotions in the same way as we do. We know that stress is going to dysregulate the immune system. So, if you've got a child who maybe, I don't know, has a difficult sibling dynamic, or the family dynamic isn't great, or there's been a big move to a different school, or some of those sorts of things, that can really unsettle the child. And that could sometimes be enough to maybe not commence this disease progression, but definitely to cause flare-ups. And I think children do start to, I mean, as you said, they can be hugely frustrated by the condition. I would hate to have never-ending itchy skin. That would drive me mad. And I'm sure that I would be badly behaved if that were the case.

Andrew: Absolutely.

Kate: So, absolutely it can affect temperaments, can affect their confidence, and lead to things like anxiety and depression. And sometimes it's not necessarily the skin condition that's causing those behavioural and neurological issues, but rather the internal progression as well. 

So, we know that the gut plays such a huge role in whatever's going on the skin. But certainly, if we're talking eczema, there's going to be a huge link with the gut, that hyperpermeability, that dysbiosis. And we know that also is going to really affect the brain. So, sometimes you see these things going hand in hand where you've got a child who's predisposed to eczema and then they're also going to be predisposed to whether it's behavioural issues, mood issues, or even autism, there can be strong correlations there as well.

Andrew: You know, I'm reminded of Professor Theo Theoharides, what a name. But his explanation of mast cell activation syndrome and histamine activation inside the blood-brain barrier, causing behavioural issues is amazing. The diligent work that he did was just incredible. 

But along that line, I guess, maybe as a last question, what about how you interact with the medical profession? And I guess I have to ask, particularly when they have a very strong opinion of what works and what is acceptable, and that may well differ from what you wish to do. How do you improve dialogue there?

Kate: Yeah. I guess, look, it really comes down to sometimes a specialist and definitely the family. I find a lot of specialists, and maybe this is just my experience and who I've dealt with, so, not to generalise, I'm sure there's some incredible specialists out there who'd be very happy to have that open communication. But a lot are so busy, probably, that that's the main reason that they just actually can't, don't have the time and are also fairly firm in their belief and what they've seen work. So, I find that usually I'm not dealing directly with the specialist. It's more that you're dealing with the family and trying to navigate where they sit. So, as you said earlier, sometimes we're seeing families who are feeling pretty disheartened with the treatment that they've had from that medical paradigm and they're wanting to explore something different. And I would never ever sit there and say, "That's wrong. Don't do what they've told you." You've got to just sort of gently add in other things, and you can always come in alongside treatment.

So, even if, let's say, they've been recommended to use a steroid cream and you think that that's not necessarily the best step at this point in time, you can have someone doing a steroid cream and get them out of that discomfort immediately, while underneath you're maybe changing the diet, doing what you can to support the gut, support the immune system, change the environment. And then when we see symptoms improve, the family will want to wean down off that steroid. And hopefully, the specialist would also want to wean down off that steroid. 

So, I think there's room for both. It's really important in this sort of stressful situation. I mean, families with unwell children, no matter what it is, they're feeling pretty unhappy and stressed out. And you don't want to put them in the middle of a battle between allopathic medicine and alternative medicine.

So, ensuring that, again, they're supported in whatever decision they're making and know that there is room to do even subtle changes that are going to have some improvement. And I guess where we have a lot of strength is that process of education, and the more that you can educate families, the more they'll get on board with what you're explaining, and hopefully, eventually make the changes that are required in order to change the condition.

Andrew: Kate, I can obviously see that you take on your role of care for your patients with, not just a serious, but also a dedication. And I've got to thank you for taking us through what you've experienced and what you've helped your patients to ameliorate in their lives. 

So, thank you so much for taking us through some of the common skin conditions today. And I look forward to welcoming you back to FX Medicine to discuss at least respiratory issues. We have a lot more to delve into, Kate. Thanks for...

Kate: Thanks very much, Andrew.

Andrew: This is FX Medicine. I'm Andrew Whitfield-Cook.



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