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Respiratory Illnesses in Children with Kate Holm

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Respiratory Illnesses in Children with Kate Holm

How do we prime an infant’s immune system to help guard against the development of respiratory illnesses?

Nutritionist and Naturopath Kate Holm returns to FX Medicine to discuss the strategies in treating common respiratory complaints in children, including otitis media and asthma, as well as how gut health, the immune system and food sensitivities play a role in the development of these illnesses. 

Covered in this episode

[00:58] Welcoming back Kate Holm
[01:35] Prevalence of asthma
[02:40] Regulating the immune system before birth
[05:43] Safety of paracetamol and ibuprofen in children
[11:24] Natural options for pain, fever relief and teething
[17:34] Are antibiotics effective for otitis media?
[21:53] The links between food sensitivities and otitis media
[24:14] Benefits of breastfeeding and colostrum
[33:35] Croup
[39:34] Key differences between croup and whooping cough
[44:14] Bronchiolitis and bronchiectasis
[45:20] Managing cystic fibrosis
[49:36] Food allergies and anaphalaxis 
[53:02] Nutrients for asthma 
[55:05] Dosing in children
[58:08] Freezing colostrum for use later
[59:46] Drop dosing and use of herbal remedies in children
[01:01:59] Herbs for upper respiratory tract infections
[01:05:04] Remedies for otitis media
[01:12:15] Additional resources
[01:15:06] Thanking Kate and final remarks

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

Kate has always had her professional devotion to children, and her interest in preconception and fertility care drives her passion so that couples may experience the joy of parenthood with the best possible health outcomes for their children. 

Welcome back to FX Medicine, Kate. How are you going?

Kate: I'm well. Thanks for having me again.

Andrew: Our pleasure. Now, today, it's part two of paediatric or common paediatric complaints. So, we're going to be talking about respiratory illnesses. So, I guess, to start, we must start with the big baddie that everybody knows about. Let's start with asthma.

Kate: So, asthma is hugely on the rise within our paediatric population, I guess, just within the population on the whole. In 1982, it was about 10% of children who were affected by asthma. And then in 2002, and believed to be roughly the same today, that's increased to about 36%. So, despite all of our advances in medicine, in health, there are certain conditions that are definitely still on the rise. And following on from our previous podcast about skin complaints and big chat about eczema, we sort of see asthma as that next progression in that atopic march. So, really dysregulated immune system and, yeah, I guess a whole number of factors that can be underlying that.

Andrew: You just hit the nail on the head — dysregulated immune system. I mean there's the million-dollar question, isn't it?

Kate: Yeah.

Andrew: How can we bring back regulation and priming to our immune system? But it seems like once you've set a poor foundation, doesn't matter how you change the house on the top, you’re always going to have a wonky house. So, it goes right back to, how can we intercede with preconception and fertility management? That's really where the beauty lies.

Kate: Absolutely. And that's why I'm so passionate about getting couples before the baby has even been conceived. Because not only are you then changing habits within a household, whether that's dietary habits or use of chemicals or other things around the house, you're actually able to affect the DNA of that child that's conceived. And then all of the development in utero, which we know has a huge impact on the gut microbiome, on the regulation and appropriate regulation of the immune system, and then hopefully the reduction in some of these conditions that we are seeing, really, really increase in that paediatric population. Yeah, it's a big one.

Andrew: Yeah. Talking about that immune priming, we cannot move forward without mentioning the use of probiotics here and the successful trial with Lactobacillus rhamnosus GG only was successful when you gave it in the last trimester of pregnancy. Once that baby is born, the immune system is primed.

Kate: Yeah, absolutely. And during pregnancy, even looking at the use of antibiotics and also the use of paracetamol and other medications as well, but that's being shown to increase the risk of asthma. So, it's not even just bub's exposure to, say, antibiotics in those early days and months, years of life, but also in utero, again, and how that's impacting that priming of the immune system. 

So, yes, definitely we want mum to have a huge focus on that gut microbiota, and gut health, and good diet, and all of those things that we should be aiming for through pregnancy anyway. And this is coming from a currently pregnant who has seriously struggled to maintain a good diet. So, I really empathise, and I'm just keeping my fingers and toes crossed to this day. Yeah so, if I birthed a corn chip, I wouldn't be surprised.
But there is so much that we can do, and we know that that's evidence-based and is going to help to at least reduce the risk. I think there's never any guarantees, but when we have this window of opportunity, we really should do whatever we can to mitigate something that can then have these ongoing effects through childhood, but then also through adulthood as well.

Andrew: I want to get on to antibiotics a little bit later. But can we talk about paracetamol safety a little bit, please?

Kate: Yeah. So, I think it’s... I mean it's been deemed to be safe in pregnancy. And so, a lot of women do use it fairly routinely, I guess.

Andrew: It was the archetypical “safe drug" during pregnancy.

Kate: Yeah.

Andrew: Throughout my nursing career. In any exam, if you didn't know the answer, paracetamol.

Kate: And even through childhood, we think of infancy and children who are teething, children who have fevers, children who are just a bit fussy, you're not really sure why. Children's Panadol just flies off the shelf, and it's very, very commonly given to children. But we do know that it's perhaps not as safe as we once thought. And this is largely to do with how the body has to metabolise it and how it's depleting glutathione as a result. 

So, glutathione, obviously, being very, very important internal antioxidant, supporting all of those detox pathways. And with that, one dose of paracetamol, yes, it's going to have an impact. Whether that impact is prolonged and something that we need to get too upset about, couldn't say for sure. But definitely that repeated use of paracetamol is going to deplete that glutathione and then basically muck up those detox pathways.

So, when you've got a child, for example, who's fevering or trying to get on top of some kind of infection, then not being able to effectively detoxify or have that internal antioxidant status is obviously going to be problematic on many levels, really.

Andrew: Now, there's something I haven't looked at, and that is, what is... We know that paracetamol is more toxic than what we originally thought. And when you think about toxicity, you have to also include or contemplate the risk of overdose. And kids... Forgive me, let me word this properly. Paracetamol overdose is the most common admission to emergency units in Australia for childhood drug overdose. Given that, I don't know if normal dosing, or how much normal dosing shows an adverse outcome. I haven't looked on the DAEN, the Database of Adverse Event Notification. I haven't looked and tried to tease out children's paracetamol specifically.

But you know something that really interested me was an old paper now by Catherine Lozupone. And she spoke of the p-cresole sulfate which is a metabolite from — and I get this is a broad term — dysbiosis. So, here's my question. Could the previous or overuse of antibiotics even in the mother predispose the infant to a poor microbiota diversity and therefore be setting them up for a higher risk of paracetamol toxicity? 
And for our overseas listeners and viewers, forgive me. Paracetamol is equivalent to what you would say acetaminophen. Same diff. Same drug. Sorry. Over to you, Kate.

Kate: Yeah. I mean I don't know the answer to that question. I don't know if that was just a thought or a question.

Andrew: It’s just, I wonder.

Kate: I would say, potentially, but I don't have an answer. But I mean, for sure, what we know about the gut microbes and their effect on detoxification, and then even thinking about the reduction of glutathione and then prolonged dosage with paracetamol, how appropriate is that same dose level over a long period of time when the body now has reduced detoxification capacity? 

So, I think there's a lot of questions. And I think if we can educate parents and families on alternatives and things that they can do rather than just jumping straight to that, totally understand that that's challenging when you've got a really unsettled or fevering infant and you don't have the knowledge that we have as health care practitioners. But that's where we want to catch them early, so we can educate them and give them other tools in their toolkit so that we're not jumping to these things which we know do have side effects down the track.

Andrew: Well, here's the other "safe" medication. I'm using air quotation marks when I say the word "safe." Touted as being safe. And that is ibuprofen.

Kate: Yeah.

Andrew: Now, I'm waiting for an avalanche of early age oesophageal or stomach ulceration in kids. I'm just waiting for it.

Kate: And even if we just look at, I guess, the number of infants that are diagnosed with having some sort of reflux or colic or just that really unsoothable and constantly unsettled infant, you've got to wonder what's going on within their stomach. And it's obviously a population that we're going to avoid doing a scope if we possibly can. So, we don't know for sure, but, yeah. 

Again, hard to say, is that actually what's having an effect? I'd say it's something that's worth definitely keeping in mind. And again, if we can jump to alternatives and just take that potential risk factor out, then that's going to be better. And we know that ibuprofen also increases the risk of development of asthma. So, taken in those early years as well.

Andrew: Yeah. Okay. So, now that we've breached that issue of medications for pain relief and we've gotten off respiratory, I think we need to offer our viewers, our listeners some sort of options, natural options perhaps. So, for instance, with teething, let's say.

Kate: Yeah. Okay. We're doing a totally different podcast today.

Andrew: Yeah, I know. I know. We'll come back. We'll get back on to it.

Kate: No, it's fine. I mean I don't want to name products, necessarily. But there's a really fantastic homeopathic product that you can buy as a practitioner which is really good for pain of any sort in children, whether it's teething, pain, unsettled tummy that you're not really sure, they're disgruntled. 

Chamomile is sort of the herb of choice for infants and definitely with teething. I feel that, often, people are a little bit scared to use herbs in young children. But we can use them very, very gently. And even chamomile tea, my son has always loved to have a bottle of chamomile tea. So, just leave that to brew really, really strong, and you'll actually get some of those active constituents which are very, very calming, great for that pain relief.

If we're talking fevering, then again, this...your good old YEP tea. So, the yarrow, elder, and peppermint. Fantastic for helping to break that fever, and tastes really good. So, herbal tea is fantastic for administering to children. You, obviously…in a child who hasn't started solids yet, you wouldn't be giving them a huge bottle of tea. But you can give them a strongly brewed tea, just a few spoonfuls here and there. And they're so sensitive that, often, they don't need much more than that. And that's where homeopathics work really, really beautifully as well.

I think, also, educating parents around the purpose of a fever and, yes, in children we don't want that to be getting ridiculously high to the point of febrile convulsions, and also it's about maintaining comfort for the baby or child. But that the fever is actually serving a purpose. So, if we can support the child and support the body through that fever, then for whatever reason it's in there in the first place, that will actually help to reduce that, so if there’s virus or bacteria or whatever it is. Yeah. I'm trying to think what else for fever.

Andrew: Well, a warm bath.

Kate: Yeah. Warm bath. Teething, doing...

Andrew: Yeah.

Kate: Topically, lavender essential oil can be quite nice. Even you can make up a little very diluted blend of essential oils with a bit of clove bud in there as well, which is really, really analgesic and quite numbing. And if you dilute that heavily in a bit of olive oil, you can rub that on the gums, or coconut oil or whatever oil of choice. So, there's lots of things that we have in our toolkit.

Actually, chewing on — again, if they've started solids — frozen capsicum sticks can be great, watching that they don't bite it off because we don't want them to choke on the big chunks of capsicum. But their capsaicin is, again, quite analgesic. And when it's frozen, it's really nice and sort of numb the gums. So, there's plenty that we can do. There's heaps. And then lots of cuddles, lots of breastfeeds, all of those nice things.

Andrew: I’ve never thought of cayenne there. I so wished I'd known that when my kids were younger. Capsicum.

Kate: Yeah. It's never nice seeing your child going through something that's causing them discomfort. But I also feel that our role as parents and our role as clinicians is not to completely remove all of the discomfort. It's virtually impossible. So, giving those painkillers, it's going to shut off that pain pathway. They're not going to feel it. Great. Everybody gets sleep, everybody's happy. 

However, it's a process, and I don't want to say it's just part of life, but it kind of is just part of life. And if you can support them through it and be there...it might mean that everybody is up for a few nights, and that's pretty exhausting, and it's really hard to navigate when you're working full-time and doing all the things of the world out there. But it's what they need. They need cuddles, they need your love. And usually, that's quite a good pain relief in itself. And, yes, breastfeeding.

Andrew: That's exactly right. We very often, too often, underestimate the power of a hug for reducing stress which amplifies pain, the sensation of pain. 

Teething rings. I remember going through this. We all had frozen teething rings when we were kids. Then they were evil. They were totally evil. They were known to 100% cause ripping off of the gum line because of that humidity, frozen issue, which has happened. "Dumb and Dumber," anyone? You know, tongue stuck to the pole. So, it can happen, but it's rare. But what about just making it cool?

Kate: Yeah, absolutely. I mean if you had something in the freezer and then it was out at room temperature and in your hands for a little while, it's not going to be so frozen anymore. But even just a teething ring normal at room temperature, just something that they're rubbing on the gums can be really helpful as well. And each child will cope with it differently. Some children, their teeth will just pop through and you're like, "Oh, hello there." And then there's definitely other teeth in the mouth which are a bit bigger and a bit more painful. So, I think just navigating it as best you can.

It's not necessarily an easy time. It's so relentless. I feel like it just goes and goes and goes and goes and goes. And with Jude at the moment, I'm just waiting for those two-year-old molars to come through, and then I think we're done. But, yeah, you've just got to work with them again. And like everything that we do, it's supporting the body to do what it's naturally trying to do, and trusting that we do have the ability to move through it especially with a little bit of extra help.

Andrew: Now, we've gone from teething which is part of the respiratory oropharyngeal area. But it does impact, particularly when they've got the accessory or sometimes comorbid condition that is the otitis media. So, let's chat about that because that's fraught with conundrums, even medically.

Kate: Yeah, for sure. This is another condition that's absolutely on the rise. And where they used to see this sort of peak onset of otitis media around four to six years of age, it's now happening much, much earlier. So, even before six months of age, but that sort of peak around 6 to 12 months. 

Andrew: Right.

Kate: And they say that by two years of age, around 90% of children have had an ear infection. And often, especially if it's occurred earlier, that will be more likely to recur and be more severe as it goes on. So, yes, definitely one that pops up a lot. And interestingly... 

So, I personally, as a child, had heaps of ear infections. I've been meaning to… this just reminded me again that I want to check with mum when it first occurred for me. But it was recurrent through my childhood. And I had many, many courses of antibiotics as a result. I can still vividly remember the hideous tasting banana antibiotic syrup, whatever that was.

And so, when I got to college and we were doing some of our assignments, I can't remember which subject it was for. But we had to research the use of antibiotics, and find research papers that supported antibiotic usage for a particular condition. So, I was like, "Oh, great. I'll do ear infections because obviously that's going to be something where antibiotics are really useful. It's how I've always had them." So, I just assumed that that was an area where they were really effective.

And much to my surprise at the time — I feel less surprised now — but there's very, very little evidence to support the use of antibiotics with ear infection. It didn't show any reduction or any significant reduction in pain. It didn't show any reduction in the duration of the infection. It somewhat helped with reducing the risk of becoming bilateral, but it didn't change anything to do with the recurrence of the infection either. I remember reading that and thinking, "But what else would you do for an ear infection?" Because personally that was all that I'd known. That's the only experience that I'd had. And the other interesting thing when they've looked at the data is that the antibiotic usage comes with other risk factors. So, either diarrhoea or vomiting or rashes, that sort of thing, which then...it kind of negates that very small benefit that you may receive from taking them in the first place. So, I found that really interesting, and that's always stuck with me. But it is actually... Sorry?

Andrew: No, you go.

Kate: I was just going to say, it's...the prescribing of antibiotics for acute otitis media is actually the most common, or one of the most common prescriptions in the Western world. So, yeah, I find that really interesting.

Andrew: And yet it's got a bomb emoji. What do you call it? Icon in the...what do you call it? The Oxford Handbook of Clinical Medicine.

Kate: Right. Yeah.

Andrew: It's a bomb. It's controversial. My knowledge was that it had no effect on the longevity or severity of otitis media, but it might impact on pain.

Kate: I think there was...

Andrew: That's really interesting.

Kate: ...little to no...

Andrew: Right.

Kate: ...improvement in pain. And it was in different time frames as well. So, I think if it was taken within the first...I actually don't have the exact number of days written down. But it was different if it was less than seven days or greater than seven days or something along those lines.

Andrew: But I think it's really interesting also that, again, they've looked at probiotics for otitis media. Because, let's face it, it comes from the throat. It goes up the Eustachian tube. That's how you...and it closes off because kids have got really small Eustachian tubes. That's it. 

So, we've always got to think about, “Well why are those Eustachian tubes closing off?" Granted that they're smaller, is there something inflaming them? And then you get right back on to food sensitivities. We're going to discuss it, so we may as well discuss it now.

Kate: Yeah. I feel like a broken record because every challenge you have, honestly, it's going to come back to some of the same basics which, I think, again, as clinicians, is actually quite empowering because we can see that there's so much that we can do for our patients. And it's not just going to affect one aspect of their health. We can have this really far reaching effect over not just their health today even, but future presentations as well. 

So, definitely one of the big ones that pops up with regard to actually all of your respiratory condition, but definitely with that otitis media is cow's milk. So, whether that's a true cow's milk allergy or whether that's more of a food intolerance, both of them can have an impact. But also, that's going to affect if there's asthma, if there's allergic rhinitis, if there's recurrent tonsillitis or enlarge adenoids, anything that we can think of within that entire respiratory tract. So, I guess tracking back as well, as to maybe why we're seeing this increased occurrence in a younger population is the reduction in breastfeeding or the sort of early cessation of breastfeeding, and then moving on to a cow's milk formula. So, babies are now potentially being introduced to that cow's milk protein earlier than they were before.

So, I do think that we really need to be protective of women's breastfeeding journeys, and try to encourage that as much as possible because we know that there are protective effects, not only for otitis media and reducing the risk there, but all of these kind of atopic presentations. So, the asthma, the eczema, and really anything with the immune system.

Andrew: But then you get back into that priming, don't you? I mean if the mothers had a history of... You mentioned it yourself. When they were younger, the multiple episodes of otitis media, multiple causes of antibiotics. So, their gut bacteria is messed up. Again, I'll refer back to this Catherine Lozupone paper which the discussion was actually about that, how multiple causes of antibiotics can muck up the garden and now...forgive me, and set it to a poor garden, was her point. 

So, when you talk about what her point was being made, when you talk about missing microbes by these eminent professors in microbiology, when you talk about how we know that we're causing antibiotic resistance by the overuse and overprescribing of antibiotics, the inappropriate, sometimes, use of antibiotics, then how much do we have to work on the mother to be able to get good, nutritious, full of enzymes, less reactive antigens, milk into the baby?

Kate: Yeah. I think it's definitely important to work on mum. And when we're thinking about supporting that first inoculation...well, it's actually not even the first inoculation. You're getting some exposure to those microbes in utero. But then, obviously, if there's a vaginal birth, they get that big influx of microbes. So, we really want mum to have good microbiota of her own to pass on to bub in that instance.

But in terms of breastfeeding, and I should probably look into this a little bit more deeply, but I feel like breastmilk is such a dynamic food. And it's always changing to adjust to bub's needs. So, if you can capture mum in that preconception window and, yes, do some gut work, but make sure that she's really well-nourished and that she's nutritionally replete in other regards, and then continuing to eat well through breastfeeding. 

I really believe that food is just so powerful and so dynamic that the effect of her perhaps less good gut in earlier life shouldn't be too much of an impact on bub, especially when we're getting all of that great colostrum in those early days and then even the lactoferrin and how breastmilk itself has antimicrobial properties so that we're supporting or encouraging the development of those beneficial microbes in bub's gut even if perhaps they weren't always there in mum. 

But I'm not saying that from...I haven't done a clinical trial myself, but that's my understanding of the power of breastmilk, really.

Andrew: You know, this... I'm winding back... Forgive me for doing this, but I'm winding back to that paracetamol issue with the glutathionylation. And I remember reading some research. The actual research was on a multi-level marketing product. But all of this raw material, as long as it's well produced, it would be applicable to, and that is whey.

Now, I get that it's from cows, but it's not milk. It's whey. You do get some similar proteins, but a vastly different molecular makeup, particularly the immune fractions. Do you find that it's sometimes beneficial to give, say, the mother the whey? 

And we should stress, it's got to be properly made. It's got to be...I shouldn't say unheated, but it's flash-heated. But it's undenatured so, you get the intact immune complexes, the immunoglobulins, the lactoferrin, lactoperoxidase. Do you ever find giving that to the mum might be beneficial to help her nutritional status?

Kate: Yeah. I actually couldn't answer that question. I have to confess I'm pretty anti-dairy as a food for humans. So, I tend to steer away from any sort of milk proteins like whey protein. I do like colostrum, though. And I know that some of the colostrum powders, they do have a whey component. So, in that instance, I think that's amazing, but I've never used it specifically to support breastfeeding. So, I actually couldn't answer that question.

Andrew: Well, what about the mother's innate colostrum? I mean this is something that I feel is sorely missing. I understand the issues of breastfeeding. I get it. I'm not being Draconian about it. I just wish that more women would be aware of the importance of...even if they didn't want to breastfeed for whatever purpose, I get it. I understand. I'm not judging you. But if they were just aware of how beneficial those first few days, weeks of colostrum is. Oh, man. Talking about changing an immune priming in the gut of that infant.

Kate: But even the continued breastfeeding, I mean the World Health Organization still recommends that you're exclusively breastfeeding your infants to six months. Absolutely, some women have medical reasons why they can't breastfeed. I do think that those women who are making a choice for other reasons not to breastfeed, perhaps again, if we could catch them earlier and do a lot more education. 

Look, it’s not going to be right for everyone, and again, it's not to pass judgment, but I think when we're statistically seeing so many changes to the health of our paediatric population, and we know that there's so much that we can do to support that through this immune priming and through priming the gut microbes, that we just really need to... 

I think the judgment goes both ways. People who are pro-breastfeeding, it's not to… I think that shouldn't be judged either. It's not trying to force a different ideology on someone, but rather it is evidence-based. And we know that there's no food on the planet like it. And if we can just get through it and give whatever support that mum needs to make that happen, then, yeah, I really think we should aim for that.

Andrew: You make a brilliant point, an absolute brilliant point. Sometimes, we get so beaten down in being politically correct that we forget to give the actual evidence.

Kate: Yeah.

Andrew: And we're too scared of standing up for the actual truth. So, I wholeheartedly adhere to what you say. That's brilliantly said. I think we all should…

Kate: It's just passing on information. Ultimately, each mum and each mother/baby unit has the final decision. But, yeah, I do think that we should maybe take a bit more responsibility with what we do know and gently, of course, and with as much support as that person needs, just be encouraging. And I think that the way that formula is available and is promoted has a lot to answer for as well because it's quite in-your-face.

So, I think women, it's an...

Andrew: And it's very caring, isn't it?

Kate: Yeah. But it makes it an easy option where, I think, there can be so many steps in between to perhaps just savour that relationship for a little bit longer, if possible. And if not possible, then we employ the other strategies that we have to go in and mop up anything that we think might be missing or any sort of side effects that we think that baby might have. 

So, there's always something we can do on either side of the equation. But, yeah, it's definitely something that I'm passionate about, being protective of it.

Andrew: I think, also, when we're talking about the era of convenience and also pressure on women to work as well as look after a very young infant, I think the manufacturers of breast pumps have a lot to answer for, too. Please, can we get more designed by mums? I mean some of them, they were suitable for cars. They were horrible.

Kate: Yeah. There are some interesting contraptions out there. I'm just thankful that when I went back to work, the main population that I work with is mums and babies. So, if ever I needed to excuse myself or if I ever started — sorry if it's too much information — but leaking through my top, then they're all like, "Oh, it's fine. I understand."

Andrew: Yeah. I remember one of the big things from my sisters when they had their children was the homemade double-sided flannels sewn together to put in their bras. It was a must.

Kate: There's much nicer, bamboo and reusable breast pads these days, thankfully.

Andrew: I'm old. I'm old. So, we've mentioned it before with otitis media, and we've gone there a little bit, but infections, we have to go here. So, how long is a piece of string for this one? How many house have you got? But let's start with croup.

Kate: Yeah. So, croup is actually a symptom, not an infection in itself. So, some children, as a result of a virus or bacterial infection, will then go on to develop croup. So, that's that typical seal barking cough. And some children could have the same virus and not have symptoms of croup at all. I'm not actually sure why some children are more inclined to develop that particular type of cough. But it can be quite distressing, not generally leading to... Although, I mean with any kind of respiratory infection, it can lead to difficulty breathing. But generally, croup is just very noisy and can be quite disruptive of sleep and keep children up at night.
So, in that instance, it's more about keeping the child comfortable and, I guess, employing the herbs and the things that we have to just soothe that cough so that they can actually get some sleep. And, obviously, supporting the immune system with all our great antivirals and everything else that we can do there to target whatever that initial infection was. But, yeah, definitely, that's a noisy one. It's going to keep the whole house awake at night and can be quite concerning for families if they've never heard a cough like that before as well.

Andrew: That's right. And we'll talk about different differential diagnosis with a much more serious disease a little bit later. But what about remedial things, like the hot, steamy bathroom, things like that?

Kate: Yeah, absolutely. Really can help. So, again, lots of cuddles no matter how old your child is, and go and sit in the bathroom with them. Turn on the shower, close the doors, close the windows, keep the fan off, and just allow that room to steam up. Also doing...again, depending on the age, but doing an inhalation of steam can be really useful just to kind of relax the airways and loosen anything that might be sitting there. 
The croup kind of cough generally is a dryer cough. It's not overly productive. So, they can also end up with quite a sore little throat or even a sore chest. So, doing some nice teas or Manuka honey can be really soothing just to give them that relief, I guess, from that discomfort that they're feeling.

Andrew: There's some beautifully crafted — I'll say that word — herbal remedies as well. We are non-branded at FX Medicine, but let's just say from New Zealand. Beautifully crafted childhood remedies, particularly for soothing the respiratory tract as well in a...

Kate: Yeah.

Andrew: ...lovely tasting base.

Kate: Yeah, definitely. And I think, also, if we are doing herbs and supplements with our children, some parents are all for it, and they're happy to just go with your recommendation. Others really like to see on the label that it's made for kids, and then you'll have that child appropriate dosage. So, for peace of mind of parents, sometimes going for an actually pre-formulated product can be a good thing. And the brand that we won't mention, I believe you can buy over the counter. So, that's also quite useful.

Andrew: I believe parents can get it very easily.

Kate: Yeah.

Andrew: It's beautifully crafted and very sensibly crafted because there is a caveat that we have to say with regards to honey in under 12 months old.

Kate: Well, the current recommendation is to avoid honey in children under 12 months for the risk of botulism. So, having that organism potentially present and then...yeah, obviously, you don't want them to contract that. That said...

Andrew: However...

Kate: Yeah. I mean I think back through generations, and I would absolutely not be advising this, but our parents' and grandparents' generation used to dip dummies into honey so that the child would take the dummy. Anyway, not to say that I'm encouraging that, but yeah, I guess…

Andrew: It’s one of those things that we have to say, but let's think about, let's say, the Hadza tribe who intake 30-odd-percent of their calories during summer from honey. 

Kate: Oh wow.

Andrew: Yeah. Massive amount from honey. They're not overweight and I don't know about the reporting or anything like that. But that tribe has survived.

Kate: Manuka honey in particular is so fantastic for anything respiratory and for kids because it tastes great. They're going to happily take it. It can be a really good way to get actually other herbs into them. You know, mix a few drops of your herbs with a teaspoon of honey and they'll down that no problem, generally speaking. But also it's really anti-inflammatory. It's antimicrobial. If it's anything throat or chest, you're going to get that lovely sort of local action. So, I think honey can actually be really, really therapeutic. And going back to our last chat, it's great topically as well. So, definitely, honey is something we should keep in our medicine kit.

Andrew: Oh, absolutely. And Manuka honey has the fame, and it has been shown to have antimicrobial action. They've patented the UMF, Unique Manuka Factor. But that's not to say that, say, jellybush, a related species in Australia, doesn't have any antimicrobial action. It does.

Kate: And even a good warm honey will generally have some antimicrobial and definitely that anti-inflammatory activity. Yeah. And I mean for kids, all that compliance as well.

Andrew: That's very true. 

Now, croup... We said before that we'll do this differential diagnosis. So, can you tell us a little bit about the differential cough, the bark, from the whooping cough?

Kate: Yeah. I mean I don't know if I can reenact either of them, but they will actually sound quite different. And so, generally, with the whooping cough from whooping cough, children will really struggle, or anyone who has it will struggle to take that inward breath. So, they're getting that more...the sound is more on the inhalation, and the croup cough is often on the exhalation.

With croup, you never say never because, absolutely, depending on the other symptoms of the virus and how well that child is, it can progress to that respiratory distress. But, generally, as I was saying, it's just a bit noisy and disruptive. Whereas whooping cough, you will actually find that often the child will cough to a point where maybe they change in colour. So, going blue or even going red in the face first. They can cough to a point where they're vomiting. They're often quite distressed because they're not really getting that much air in. And whooping cough, absolutely get them to a hospital.

Croup, on the other hand, possibly something you can manage at home just, again, depending on… like still keep your eyes out for all of those other changes as with any respiratory condition with your kids or with anyone, actually. So, whether it's bronchitis or bronchiolitis or just your common cold with a bit of a cough, as long as the person is able to breathe and their rate of breathing is not really rapid or really, really decreased, you don't want to see any...particularly in kids, you'll start to get what they call the tracheal tug where you're actually getting...you can see from the outside that the neck is kind of getting something in with the breath, and also around the ribs and the abdomen. So, they'll be showing those physical signs of, like, the breath is really laboured and they're starting to use some of those accessory muscles to try to actually intake that oxygen.

We don't want to see any change in colour. So, whether they're going really, really red or going really blue, particularly around the face, the lips, and the mouth. If the breathing is really noisy, so, not when they're coughing, but they're getting that kind of really rattling, or whistling, that's obviously not great. And, yeah, if the child is seeming distressed or otherwise really unwell, then definitely consider it to be a medical emergency because, in kids, things can progress really quickly and in both directions. They can get well in just as much time as they got unwell. But I think it's always better to be on the safe side with our little ones and particularly when it's coming to breathing.

Andrew: And can I just impress the importance of calling an ambulance to you rather than trying to make it to the hospital thinking that you're going to get there in time? Because if you have an emergent situation along the way and you have to stop, an ambulance can't find you at what street corner.

Kate: Yeah, absolutely.

Andrew: We are blessed in Australia to have such a fast response time with ambulances. Obviously, that differs in the country, which sadly has different outcomes. But in urban areas at least, we are very blessed. 
Now, there was something else I was going to mention there. 

Kate: Yeah. And I think we, as naturopaths, nutritionists, whoever else is listening, if we're not doctors, then if patients are contacting you, concerned about these presentations, we'd actually...it's good to know, it's good to have information. But we don't need to do the diagnosis. It's always, send them to their doctor, send them to the hospital particularly, as I said, when it's coming to respiratory issues and in children. So, go through with them those warning signs and things to look out for.

If it is croup, for example, and they're just like, "Oh, my child has got a really noisy cough," then it's not necessarily a medical emergency. You can actually do some support for them. Great that we can do things online, so you don't necessarily need to bring an infected child into your practice. But if they are showing any of that respiratory distress or any of the other signs that I mentioned, then just get them straight to the hospital because that's where they're going to be in the best hands, and be able to get that proper diagnosis.

Andrew: I think we need to move on also to — I said it before — the stricture of the bronchus. What about the bronchioles, the bronchiolitis, or indeed bronchiectasis?

Kate: Yeah. So, bronchiolitis is the most common lower respiratory infection that you'll see in infants. And fairly common...I mean I guess when babies are born, their lungs, they're developed, but they're still developing. Same with their immune systems. So, they are definitely more susceptible to getting those kinds of infections when they're unwell. And also because they don't have that same cough reflex. 

So, babies actually can’t, if they do have that mucus kind of pooling in the lungs, they can't actually cough effectively to get it out. So, again, that's going to be something that hopefully you're not seeing actually presenting in the clinic in front of you. But you may have a patient who's...the child has had it in the past. But that, again, is kind of heading towards a medical emergency. You definitely want that baby to have medical treatment.

Andrew: And what about cystic fibrosis? Have you had any experience treating kids with this?

Kate: We're not treating cystic fibrosis, actually. No. I know that anecdotally and from what I've read, N-acetylcysteine is really fantastic. I mean N-acetylcysteine is great for anything respiratory when we're talking about mucus production anyway as well as a million other things in the body. But I know it's particularly good with that cystic fibrosis. 

And I guess...and, yeah, sorry, this is coming only from theory, not from my actual experience. But all of the typical things that you would do anyway to support the respiratory system. So, in showing it's an anti-inflammatory diet, whatever that means for that person. So, removing any foods that they're intolerant to, looking at those mucus-forming foods.

So, again, coming back to the cow's milk protein and whether that's something that should possibly not be in their diet. I definitely acknowledge my bias there. I honestly almost put a clause on my website to say that I think everybody should have at least a month of gluten and dairy before booking an appointment with me because I feel like, in so many cases, symptoms would resolve.

Andrew: Wow.

Kate: But anyway, I haven't done that. And, of course, that's not the solution in absolutely every person. And there could be a bunch of people who would do that and show no improvement, but I just feel so strongly that those two things in combination, particularly when we're talking kids, are often, if not the driver, then at least an aggravating factor.

Andrew: Do you advocate both or and/or?

Kate: Depends on the situation. So, when we're talking respiratory, I would say it's much more likely to be the cow's milk protein. That's not a hard and fast rule. But if I had to pick one, I'd say, okay, let's go cow's milk protein. When we're talking skin, possibly more likely to be gluten, although definitely cow's milk protein. Again, talking like babies and being formula-fed, that can often be an issue. And then when we're moving on to behavioural and urological stuff, I would say it's both. Got to get both out. But that's a huge generalisation, and it's definitely not that simple.

Andrew: I totally get it. There are so many pieces of string here. We're trying to oversimplify something that you've spent years perfecting.

Kate: I don't think perfecting is even the word.

Andrew: But there was one point which I forgot to make earlier. That's what I was trying to remember, and that was when we were speaking about cow's milk earlier with regards to asthma. And that is that, granted this will be relevant for a very small percentage of the population who are truly allergic to cow's milk, not sensitive to cow's milk. Most people are sensitive, a very small amount of people have IGE reactions.

However, I noted that in terbutaline, the trademark of which is Bricanyl, so we can say that. That's fine. They have the turbuhalers, the self-actuated...basically, it's controlled by how much you inhale. Right? There's two different ones on the market, the M2... Gee, I hope I've got this right. The M2 one has no lactose in it. The M3 one does have a small amount of lactose. And I remember MIMS stating that there is a warning there for people who are truly allergic to cow's milk, that they may indeed suffer a reaction. So, if you're concerned about true allergy, use the M2 if you're using Bricanyl. I guess that's up to the doctor, though.

Kate: Yeah.

Andrew: But I think it's interesting...

Kate: Good to know and good to flag if patients have started on these medications and they're perhaps not getting any improvement or maybe are getting exacerbation whether prolonged or just momentary after using it. I think that's really interesting to know.

Andrew: Now, what was the other one? I know that we're segueing here into food allergies, but it causes a respiratory...the anaphylaxis. And that is peanut allergies. I mean talking about something that's increased out of sight, I mean this is just amazing. What's happening here? What do you think is happening?

Kate: Oh, gosh. I think all of the factors that we just continue to speak about. So, change in microbial diversity, both internally but also in the environment, change in everything else that's in the environment. So, when we're talking about an immune system that's just overstimulated from day one, coming into a world that's very polluted or...well, actually, generally coming into a room that's very sterile, and then moving into an environment that's quite polluted and maybe, use of household chemicals. Definitely looking at family history, and again, perhaps what's going on with the DNA that's being passed on to bub, and mum's microbiome through pregnancy and all those things that we mentioned.

I guess, as well, we can't ignore the food processing that's occurring and perhaps the final food that's ending up in front of us is, for whatever reason, more highly allergenic. So, whether that's to do with what it's being sprayed with or how long it's been sitting on the shelf for or who knows what else. I think utilisation of those medications that we spoke about, so, both the paracetamol and the antibiotics and how that's changing gut integrity, just that mucosal integrity and that barrier that we've got there.

I know that it's really tricky with the research because they're saying that introduction of those allergenic foods earlier, so, definitely pre-12 months. But they're saying even from four months of age seemed to show some reduction in the development of allergy. But I just feel like there's a bit of trouble with that thinking as well when we've got a lot of babies who are already at risk before they've even had the introduction of solids. So, I'm just always really mindful to navigate that with the families based on their individual experience and, obviously, family history.

There's huge increase in allergy. And I think while not necessarily as severe and definitely not life-threatening, a huge increase in food intolerances and food sensitivities as well. So, yeah, just this immune system going haywire in all regards.

Andrew: I yearn for the day where perhaps from the work of Dan Littman, Ivaylo Ivanov, people like that at the Columbia State Uni, in New York State Uni, on these...I'm going to bang on about it again, segmented filamentous bacteria, the priming or one of at least the priming bacteria of our immune system, infantile immune system. And I wonder if one day — I hope, one day — there is this way in which we can say, "This child is of increased risk. We need to X therapy," so that you don't prime for further atopy or even worse, the anaphylaxis and things like that. I wonder. I hope.

I guess now is the time, though, Kate, that we have to think about therapy. So, we need to wind back a bit. We've discussed those beautiful herbs, those beautiful nutrients where you mentioned NAC, which even has been used in a medical facility. Cystic fibrosis patients used to have inhaled NAC. 

So, let's go through some of the nutrients first. I know we should have gone and done this along the way, some of at least the key ones which we can use, and then the herbs as well.

Kate: Yeah. For sure, and...

Andrew: So, let's talk about asthma.

Kate: Okay. Well, nutrient-wise with asthma, the biggest one that I think of is actually magnesium. And that's more around actually relaxing the airways and also relaxing all of those intercostal muscles. That can really help with not only...I mean if someone's having a full-blown asthma attack, you're probably not going to have an opportunity to give them magnesium. But as a bit of a preventative or if you know that there's a particular...let's say it's exercise-induced or maybe it's seasonal or something like that where you can just give a little bit of a buffer and a bit of relief, I find magnesium to be fantastic.

Vitamin C also is great. It's a really good natural antihistamine. And there's actually research that has shown that having a high dose of vitamin C before undertaking exercise, if you've got that exercise-induced asthma, can reduce the risk of actually having an asthma attack. 

Everything for mucus membranes. So, looking at your omega-3s and cod liver oil is just my favourite for children because you then got that naturally occurring vitamin A and vitamin D which also is so supportive of those mucus membranes. 

Zinc, we can't look past zinc for anything related to the immune system. And again, looking at that mucosal health is just so important. What else? Kind of everything...

Andrew: Can I just ask you? Talking about high-dose vitamin C. Now, obviously, this is going to be far greatly reduced in an infant, in a child. So, what dose do you go down to? Do you have any caveats on age that you might institute a therapy?

Kate: I guess with any of the oral supplementation, I'm always mindful in infants who haven't started solids. I guess that's kind of my line in the sand because you don't really want to be putting too much other than whatever milk they're having through the digestive system until it's a little bit more mature so they can actually break things down and absorb it. And all of our supplements, while there's definitely brands out there that are amazing and very clean, there tends to be excipients with flavours and things like that that you don't necessarily want to be giving to a really young baby. 

So, I'd say, from six months onwards, but still I'd probably be a little bit more cautious in those younger 6 to 12 months around dosage. And again, they're fast responders. So, you don't tend to need that much. So, you know...gosh, I'd say, if we're talking 1,000 milligrams is a normal dose for an adult, then 1,000 milligrams over a period of time would be a high dose, like very high dose for a baby. So, 250 milligrams might do the trick. 

But often, you can get these pre-formulated children's supplements that will have a combination of a bit of vitamin A, a bit of zinc, a bit of vitamin C. But with something like vitamin C, for example, really, the worst that's going to happen is a bit of a loose stool. And, generally, they've got pretty loose stools anyway. So, it's something that if you were to play around with that dosage range, you're not going to do a whole lot of harm.

But, obviously, and I think this is with all patients, going to food where we can and really encouraging families, especially as they're starting that feeding journey, to look at those nutrients, so there's foods that have those nutrients that are going to be a bit more therapeutic. And coming back to respiratory things and immune system, something like bone broth, I find, is so fantastic and so easy to give to babies when they're starting to eat. And it's going to be great for not only the gut in helping to heal and seal that gut lining, but same effect within...that you've got...if it's chicken broth in particular, it's really rich in N-acetylcysteine. So, you've got all of those properties of, helping to break down the mucus. You can add things to it like your garlic, and your onion, and ginger, and those culinary herbs that we've got to further support the immune system and break down mucus.

So, yeah, there's so much that we can do. And because they're such little people, where we might have to drink litres of broth to have a really therapeutic effect, a little baby only needs to have a small amount mixed in with whatever they're having or they can sip on it in a bottle. And generally, it's going to have a more therapeutic effect for them.

Andrew: You mentioned colostrum earlier on.

Kate: Yes.

Andrew: This is one of my most favourite things to use in any gut infection. I think I might have spoken to you earlier about its use in nappy rash. I've had severe excoriation with a poor child with nappy rash, I mean to the point where there was blood on the child's nappy. It was horrible. And within three days, this mother thought I was better than sliced bread. But I said, "It's not me. It's colostrum. This is how this stuff works." And that was only topically. Actually, no. Topically and internally. But it's so, so beautifully soothing. It's just…

Kate: Yeah, absolutely. If mums can somehow get their hands on a deep freezer before baby is born and express colostrum and have a stash, that would be amazing. And when you're freezing it that way, depending on the type of freezer and how often you open it, but sometimes it'll last for 12 months, which is so great to get them through that first year of life with your colostrum. It really is liquid gold.

I'm kicking myself because when Jude was born, I actually had expressed and frozen quite a fair amount of colostrum and stupidly took it all out of the freezer to take to the hospital in case we needed it, which we didn't need any. And I was like, "Oh, no. I'm just going to throw out this..." Yeah, so valuable. So, anyway, we've got a chest freezer now. So, second time around, think things differently.

Andrew: A chest freezer full of colostrum. It is a great...

Kate: Not yet. But that's the goal.

Andrew: Herbs. Now, I mean I can still remember my firstborn. His fifth word was “etnacea,” a three-syllable word.

Kate: Oh, I love it.

Andrew: And he loved it, whereas my other son hated it. But admittedly, we had this beautiful honey-flavoured glycetract Echinacea, but it had the tingle. It was really good quality. And he loved it, along with colostrum and that sort of thing. 

So, tell us about your experience. How early do you use these herbs?

Kate: Yeah. I mean, I'm kind of guided by the parents and how onboard or not they are. Some parents are pretty cautious around herbs, and understandably. They are often in an alcohol extract. When I'm dosing for infants, I'm doing drop dosing. So, the amount of alcohol that they're getting is so, so minimal that I personally feel totally comfortable with it. 

My son, unfortunately, got a little cold when he was only four weeks old. So, we went off to my herbalist and I had him on herbs at that age. So, that for me personally felt really comfortable to give them directly to him. The alternative, if bub's really young and mum and dad aren't comfortable, then you can also dose through mum. And we do know that some of those herbs will make it through the breast milk. It's not quite measurable, but there will be some influence.

But otherwise, I feel pretty confident to do that drop dosing in really young children. And I know a lot of the very old-school, traditional herbalists, they would also do drop dosing of herbs. I guess you've just got to lean into what you, as a practitioner, are comfortable with. And, obviously, communicating with the families as well. And they'll let you know if they don't feel okay with it. It's not a topic to be trying to convince people to get on to the herbs if they don't feel comfortable. But some people, they've grown up taking herbs themselves. So, they're just like, "Yeah, great. Let's do it." So, yeah. Did that answer the question?

Andrew: Yeah. That's good. 

Are there any herbs that you're cautious of, particularly with, say, upper respiratory tract infections? The thing that will keep parents up at night is that horrible dry cough.

Kate: Yes.

Andrew: Can we talk about herbs like licorice, marshmallow, versus wild cherry?

Kate: Yup. So, I would very confidently actually use all three of those herbs. I mean the wild cherry is fantastic as a cough suppressant, and you want to use it appropriately. So, at night time when you've got a child whose sleep is disrupted, that's a good time to use a herb like wild cherry because you do want to have that suppressing action. 

But if during the day you actually want them to be able to get the cough out and break up mucus and get that out of the body, then it's not going to be appropriate to use that kind of herb. That said, you don't want to be using a lot of really stimulating expectorants in very young children because, as I mentioned before, they don't actually have that same cough reflex. So, things, again, like licorice and marshmallow, really soothing, licorice, very, very gentle expectorant. That would be perfectly fine to use.

And I actually recall my one experience with natural therapies as a child was my sister had this horrible continuous cough all day, all night, that went on for months, that no one could really figure out what was going on. And I remember mum must have been at her wit's end. Mum's actually a nurse. So, this was far out of her usual toolkit, but took her to see a naturopath who, I remember vividly, gave her a tincture of licorice and marshmallow. And at the time, I felt really hard done by. I was like, "Why does she get to have licorice and marshmallow? I want to have licorice and marshmallows." Yeah, now I know better. But they're really beautiful herbs for that sort of paediatric dispensary. 

I mean Echinacea, like you mentioned, the tingling can sometimes be a bit off-putting for kids. Some don't care at all. And again, if we're talking really small dose, then it's not going to be the same as if you down 5 mls of Echinacea yourself.

Andrew: That's the trick is to use small doses. Everybody gets used to it. There's a very... It's the people who are truly allergic to the Asteraceae family, the daisy family, you don't give Echinacea to them at all for that risk. Just because its risk.

Kate: Yeah. I think also warning patients that they might have that sensation so they don't think they're having an allergic reaction, is important as well.

Andrew: That's right. I mean I can still remember the first time I...typical stupidity. Just overdid the Echinacea on my first ever dose. I thought I was going to choke. But now, I don't dilute it now. I just drink it.

Kate: Oh, wow.

Andrew: Yeah.

Kate: No, I still have to dilute it.

Andrew: Might have something to do with the alcohol. We'll talk about that at the AA meeting. 

What about things like...we were mentioning otitis media earlier on. Historically, I've heard of the use of garlic oil drops. I've been reticent. I've never used garlic oil. I have however used colostrum in a non-perforated eardrum. I won't use anything externally in a perforated ear drum, obviously. But the other one...and I never actually got these because there was only one supply that I could find, and it was mullein drops. Have you ever used these?

Kate: Yeah. And fantastic. And often a combination of the garlic and mullein together, really, really nice. So, again, quite soothing. You don't want to put them in the ear if there's any perforation. But assuming that there's not...not assuming. You want to know for sure that there's not a perforated eardrum. Yeah, beautiful. Helps to definitely clear that infection, give a bit of pain relief. Even actually just doing a warm olive oil, and you can infuse it with a bit of garlic at home, can be really nice and soothing.

And interestingly, back to the usage of antibiotics with otitis media, we didn't see a reduction in pain relief there, but we do have these things in our toolkit that can help to reduce that pain. Even just doing a warm compress can be really nice. I think it's just about keeping the child comfortable.

I've had an ear infection in my adult life as well. It's very painful. I can totally understand why parents want to reach for something that's going to get their child out of pain quickly. But, yeah, now knowing what we know, or what I now know about antibiotics that I didn't know when I was a child, obviously, didn't have a say back then. But I think, yeah, if we can avoid those where possible, that would be really, really important. Yeah.

Andrew: And, obviously, any vomiting, any dizziness to the point of not being able to stand, that sort of thing. That's a condition where it might be a middle ear infection and you really need to...or an inner ear infection, you really need to get them.

Kate: Yeah. And I think, with everything paediatric, if you're worried if things have changed or if things have progressed rapidly, don't call your naturopath. You call your doctor or you go straight to the hospital. It's really better to just get it checked out and be told, "No, there's nothing to worry about," than wait and see when maybe there's this sort of sudden progression of symptoms. I think, always better safe than sorry.

Andrew: Yeah. There was a story. I've just written down a point here. I was recently reading a story about your asthma may be indeed severe reflux. Now, that was pertaining mainly to adults, but I wonder if these children with pyloric stenosis, an undiagnosed...pyloric stenosis is a bit severe. That's normally projectile vomiting and things like that. But let's say there's some issue with swallowing, and they might be having regurgitation for whatever reason. Maybe their midnight cough, their asthmatic type wheeze may be not asthma.

Kate: Absolutely. And same with ear infections, actually. Because, as you were saying earlier, the ear infection often is coming from the throat. So, if there is that reflux, then that can actually be something that's causing that inflammation and that recurrence of ear infection as well. So, yeah, I think definitely important to consider. 

On the flipside, though, with a lot of babies being diagnosed with reflux and being put on reflux medication, we know that that then has a huge flow-on effect to not only the stomach aid, but then the makeup of the microbiota, which is going to influence the immune system and their nutrient absorption and all of the things that go on from that.

So, yeah, again, it's so great when you can catch families before bubby has even arrived so you can educate them and let them know that there's these things in your toolkit and sort of be that point of contact when it's not a medical emergency so that perhaps you can maybe buffer some of these other things that can occur as a side effect of whatever intervention has been done. Yeah, it's a tricky one.

There's definitely a rise in… I don't know if it's a rise actually in reflux because I guess, to a degree, all babies get reflux because their diet is entirely liquid, and their sphincters aren't mature. But I think our… I don't know. Maybe it's self-tolerance or our knowledge around dealing with that. And there seems to be a lot more children who were put very quickly onto Losec and Nexium and those kinds of drugs which sometimes help the symptoms, sometimes not. But, yeah, at what cost? That’s the question.

Andrew: I was heartened by... I know we're getting on to gut symptoms here. But they have a reflex action, if you like, with the lungs. And that is... I was heartened by some research, smaller studies, but it was positive for coagulant. Bacillus coagulans.

Kate: Oh, okay. 

Andrew: But it was very positive, it was good. And then there was a negative trial, and then they redid the original trial, and it was positive again. So, you know, obviously, there might be something that we need to look at there, but I think there's a positivity. 

The other things, of course, are quite innocuous fibres like slippery elm.

Kate: Yeah, for sure. Depending on the age of the baby, I'm always a little bit reluctant to introduce fibre in a really young child whose digestive system is quite undeveloped. But I mean definitely use of probiotics, definitely cleaning up mum's diet, definitely I would use herbs quite comfortably in that situation. And I think, also, just a bit of education around what is normal for a baby. Because, absolutely, those babies who have reflux and it is absolutely reflux, it's not just colic, it's not just being fussy. But there are so many other reasons that babies can seem unsettled and can be inconsolable.

So, yeah, just eliminating those other potential factors, connecting mum with a lactation consultant so that it's not something positional or it's not to do with an under/over supply or perceived under/over supply. Again, education is key because then you can sort of intervene before maybe jumping to that extreme and know that the medication is there, should you need to fall back on it. But if there's things that we can do in the interim to then prevent the flow-on effect, I think that's really, really important and useful.

Andrew: Are there any resources that you'd recommend for other practitioners who wish to learn more about treating childhood diseases? I'm just looking about the books behind you there, Well Adjusted Children?

Kate: Yeah. Yes, Well Adjusted Babies, that's written by a chiropractor. She doesn't do...from memory, I don't know if there's a whole lot from a herbal medicine. Kerry Bone...

Andrew: Kerry Bone and Rob Santich a book, didn't they?

Kate: I’ve got that somewhere in here as well.

Andrew: Yeah.

Kate: I have so many books.

Andrew: Kerry Bone and Rob Santich. Right?

Kate: Yes.

Andrew: Yeah.

Kate: They've got a fantastic book about treating children and specifically from a herbal medicine point of view. The MINDD Foundation…

Andrew: Henry Osiecki wrote a book on asthma.

Kate: Yeah, okay.

Andrew: I think.

Kate: I don't have that one in my collection. Don't tell me too many other titles. I literally don't have room on my bookshelf or time to read them. But I can't help myself. But, yeah, Mindd Foundation. They have amazing resources on children's health. ACNEM also do a module on paediatric health which is great. Where else? Health Masters, they do... Am I allowed to name all of these places?

Andrew: Yes.

Kate: Yeah. They've got a few trainings on paediatrics as well. Where else?

Andrew: That's really good stuff. Can I make a call out to every practitioner, particularly in Australia, but also internationally? The Mindd Foundation is a charity which is set up to help kids specifically, or more for neurodevelopmental disorders. Leslie Embersits does an absolute incredible job running on the smell of an oily rag, and they need your help. If you're interested in treating and learning about treating children, and helping supporting the children and the parents with these neurodevelopmental disorders, then please support the Mindd Foundation. Really need your help.

Kate: Yeah. And they've got a huge focus, obviously, when treating those sort of neurological disorders. The gut, obviously, is a big part of that. And then when we're thinking of the immune system, the gut is a big part of that as well. So, there's definitely a lot of information there. And I think, while we can't treat children exactly as we treat adults, we can be smart about it, and we can see that there's a lot of similarities in a lot of the things that we employ with our adult patient that still will apply to a paediatric patient. I mean, I don't know everything at all, but if people have queries or they get stuck on particular cases, I'm more than happy where I can to field questions. So, please feel free to reach out to me as well.

Andrew: Great. I love that. That will be awesome. 

Kate, I would love to have you back on again at another stage because there's so much more to cover. And I thank you, Kate, for taking us through yet another phase of your expertise. I mean you are obviously so dedicated, and you are not just responsible, but wise, in your motherhood and your practitionerhood. So, thank you so much for sharing that expertise with us today..

Kate: Thank you for having me. It's lovely to be here.

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



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