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Working with the Paediatric Patient with Kate Holm

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Working with the Paediatric Patient with Kate Holm

What are some of the differences when it comes to treating children and adolescents versus adults?

Today Naturopath and Nutritionist Kate Holm discusses the differences around case tasking, dosing of supplements and herbal remedies, and pathology testing in children, as well as how to navigate the family dynamic and how to evaluate developmental milestones. 

Covered in this episode

[00:58] Welcoming Kate Holm
[01:46] Case taking for children
[04:47] Evaluating developmental milestones and temperament 
[09:08] Challenges working with families 
[15:58] Finding the root cause
[17:41] Dairy intolerance in children
[20:04] Treating behavioural issues
[24:35] Getting the rest of the family on board
[34:52] Using supplements in children from infancy to adolescents
[43:44] Pathology testing in children
[46:14] Thanking Kate and closing remarks

Andrew: This is FX Medicine. I'm Andrew Whitfield-Cook. Joining us on the line today is Kate Holm. Kate's a naturopath, nutritionist, speaker, and previous lecturer, who recently took her most important and exciting role as 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 may experience the joy of parenthood with the best possible health outcomes for their children. She believes that our little people are our world. And it's through educating and supporting families that are a ripple effect of positive health changes are made in both current and future generations. 

Welcome to FX Medicine, Kate, how are you?

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

Andrew: Thanks for joining us. And thanks for taking time out of your day. 

Today we'll be discussing working with the paediatric patient. So I guess we start with what are some of the differences, and even case taking, for a child versus an adult patient?

Kate: Yeah, I find that, I mean, depending on the age of the child, their history is not actually very long. If you're working with a baby, they may be days or months old. So the depth that you're getting in terms of past health history is not necessarily there for the child. But you may actually be finding that you're doing more questioning around, “How was the conception? How's the health of mum and dad? How is the pregnancy? How is the birth?” And really honing in on these areas that for an adult patient, you may find that you touch on but you skim over in not quite as much detail. It's also, I guess, because you have such a short history, every little milestone and every little blip on the radar with their health becomes a lot more significant.

So I do find that we spend a lot more time delving into each little area of health that may have had a problem arise. Or maybe they've been really well and you're actually just working with one significant event, which could make the consultation quite short.

Andrew: Yeah.

Kate: I find also that with the intake forms that you're using, you'd have quite different questioning there as well. So again, asking around conception, did that occur easily? Or was there maybe some IVF used to support that conception of the child? Are they generally of a good temperament? I mean, I know we chat to adults about their mood, but you may not necessarily on an intake form, ask them to describe their own temperament all the time? 

Do they have siblings? What's the dynamic there in the family? Are they in day care? Are they in school? And looking more at those social factors that can really significantly influence a child's health as well.

Andrew: Okay, so can I just ask with regards to the age of children that you care for, when we're talking about the paediatric patient, what age group are you discussing?

Kate: So anything really from the neonate, right up until the teenager.

Andrew: Right. Got you.

Kate: So there's a pretty wide range of changes that would happen across that...

Andrew: Huge.

Kate: ...those age groups as well. And so then the way that you work with those patients would change quite drastically, also. Obviously, the babies and toddlers aren't going to really have much to say in what goes on for their health. They're not able to communicate that with you, versus the teenage patient who really, you're trying to navigate their emotions, and their feelings, and their compliance around treatment plans, and their current health situation. 

So yeah, you do have to wear a number of different hats, maybe change up the language that you're using, the references that you might make to pop culture, or toys, or whatever it might be to get that child engaged. It's a really diverse group of patients, but a really great group of patients to work with.

Andrew: Kate, with regards to milestones, I've come across instances where there's not just a little bit of a delay with a milestone, but quite a significant delay with a milestone, but it ended up not being due to a problem. It was just that, for instance, a sibling did all the talking for this person. So this person didn't speak. How much leeway do you give to milestones? Or do you take it in the relevance of the family situation?

Kate: Yeah, so always taking into account the family situation. And so, for example, if it is an older sibling who's maybe doing all the talking, or even sometimes you see with the physical milestones around movement, children with older siblings will progress much, much faster than babies who don't have any other siblings to be observing.

Andrew: Right.

Kate: With children, I do tend to get quite a team on board. So I'm really fortunate, the practice that I work from is a children's chiropractic centre. So often, I'll have a chiropractor also assessing the child. So they can look very much at those retained reflexes and physical development. They can, with regard to the speech development, be assessing things orally, or you may have a speech pathologist on board for that as well. So I do find that I can have my inkling and my perception of maybe there is a family dynamic that's causing a change, but also have other people assessing those physical elements as well. 

Generally, with children, you want that support team anyway. I think it's great, I mean, with all patients to have that collaborative approach. But with kids, because you may not give as much leeway to things if they're a problem just so you can get on top of it faster, and then allow appropriate development after that. It's good to get many eyes across the case. 

But absolutely, it's a really common scenario to have older siblings doing the talking for the younger siblings. But you may find that that child who may not be very vocal in the home still has the ability, they may still have words available to them, they're just not expressing them. So that could come out in a situation with a speech pathologist or in a closed room without the sibling.

Andrew: Yeah. And temperament. You mentioned that as well. I've seen sadly, even doctors, even specialists judging a child saying, "Oh, there's a real issue with their development." When really, it was the temperament of the child. And when you looked at the temperament of the father, the father was just shy. The child was just shy.

Kate: Yeah.

Andrew: And there was this amazing breakthrough that happened just a little bit later. And it was like, "Oh, well there you go." Had this parent believed that paediatrician, this child would have been treated.

Kate: Yeah.

Andrew: You know? And that's just wrong.

Kate: Yeah, I think it's really important to work with families closely so that not only you're getting to know mum and dad's personality, other siblings' personality, child's personality, but also to form that relationship where you can really encourage mum and dad to trust their intuition a little bit. And obviously, you can have still that professional opinion. And if there is something that needs further investigation, then absolutely, it's warranted. 

But so often mum and dad come in, and they say like, "I just really don't feel like this is normal.” Or it may be the opposite, they may be saying, "I actually feel like this isn't a problem and I'm being told XYZ." So really forming that trust with mum and dad and encouraging them to listen to themselves. Because you as a professional, even for myself, if I'm spending an hour with a family, I'm only getting an hour out of 24 hours in that one day. So behaviour can be very different out of the home, especially if they're in quite a clinical setting. 

Again, I'm really fortunate the practice that I practice from is essentially a playground for children. So kids often love coming in, they really do open up.

Andrew: Yeah.

Kate: But that's not always the case if you're going to a doctor's office or into a hospital situation. So I think remembering that you are only getting just a little tiny snapshot and that mum and dad are going to know the child better than anyone. And at the same time taking on board any flags that may be there, again, so that that child can have the appropriate help.

Andrew: What are some of the challenges that can arise when you're working with families and parents? And how do you navigate these? Do you get many helicopter parents, interfering parents, that sort of thing?

Kate: Yes. So I feel like there's definitely two ends of the scale. You'll either get the parent who knows way more than you and has been on Dr. Google incessantly since the child was born. And they may have their own opinions formed around what the diagnosis is, what the treatment should be, what's appropriate in terms of when you should see some sort of change. And they can be pretty difficult to talk down from some of those views. I find that, I mean, it's amazing that there is such a wealth of information available to us online. But I'm seeing a lot of families find themselves in like parenting forums, and Facebook groups, and those kinds of environments where it's not always balanced or evidence-based advice.

Andrew: Constructive. Yeah.

Kate: And remembering, what works for one family is not necessarily going to be able to be picked up and placed on another family and have the same outcome. A lot of multi-level marketing products that are targeted at families as well. And I find, yeah, mums and dads who are concerned about their child's health can easily be swayed into things like that. 

So on the one hand, yeah, you may have that more helicopter situation where I think going gently and providing plenty of evidence and really easy changes that families can make. But things that will provide a profound enough effect so that they are on board and are willing to persist is really important. 

And then you may have the other end of the scale where a family just feels like it's all too hard. And if they maybe have a child that has a difficult behaviour, or it's really a fussy eater. Or there may be multiple siblings and just really, really busy day-to-day life, it can feel extremely overwhelming if you're suddenly encouraging them to significantly change their diet or try to give their child a supplement that may not very pleasant-tasting, or not very well received by the child, or encouraging them to reduce screen time if they rely heavily on it.

So in that situation, again, just having to be really gentle and find the smallest change that you can make that will have the biggest enough effect to move things forward for that family. But it can be really difficult to navigate. I think a lot of families also can feel a lot of guilt around their child's presentation. And again, hearing then sometimes that maybe diet or lifestyle factors could be playing a role in the expression of whatever their condition is, can feel like a personal attack. So really navigating that gently so that parents don't feel like it's their fault and they haven't created a situation but rather empower them so that they can know that there's really simple things to do within the home that can have that profound change.

Andrew: Well, there's a skill in itself.

Kate: Yeah.

Andrew: So can you give us a couple of examples of just how you'd approach that, very like that we're talking about egg shells here, aren't we?

Kate: Absolutely. One family comes to mind. And it just was very, very clear from my perspective that the child's consumption of dairy was causing some of the problems. So it started when he was a newborn. And he was put on to a cow's milk formula and had, from that moment in time had quite severe colic and reflux, and was medicated accordingly. And then when he was introduced to more solid foods, and weaned off formula onto cow's milk bottles, and plenty of yoghurt, plenty of cheese, like a pretty typical toddler type diet. Suddenly, you're starting to see a lot of their skin issues occur and the constant stream of clear mucus. And to me, it just screams, "Hello, too much dairy."

And, yeah, it was one of his favourite foods, and something that the family was absolutely not willing to remove from his diet, a lot of fears around calcium consumption, and some of those other stories that we can pick up from the media, or the Facebook forums, or whatever it might be.

Andrew: Yeah.

Kate: And so rather than, in an adult client, I might just say, "Work with me, can you give me four weeks off the dairy, let's just do it. I'll give you plenty of resources, we'll make it really easy. Like, I just need you to get on board essentially.” A little bit more tough love. It's okay. So rather than cutting out the dairy entirely, what can we maybe swap? Or what can we start with to see if we get any sort of change or get him adjusted to a new taste. And it may, from my mind, that might not feel like enough. But for them, it's just taking the small enough step so that they can see, "Oh, actually, this isn't quite so bad." And providing them handouts about other forms of calcium foods, and maybe recipes to go alongside that. So that any of the fears or concerns that they have arise along the way you can address and slowly, slowly walk them towards that final change of removing a food entirely, for a period of time providing it's indicated.

Other things may be around, often parents feel a little bit nervous about supplementing their children. There's a thinking out there that if you start giving a child certain nutrients, their body will stop absorbing it from food, which is quite flawed. I'm not entirely sure where that came from. But again, just gently navigating that and rather than maybe, if you see that there's five supplements that may be indicated, which I definitely wouldn't do with children, but just pick one and say, "Can we just start with it every second day, or just once a day at half a dose and let's see what happens." And slowly showing them that there's no adverse reactions.

Andrew: Yeah.

Kate: Again, continuing to educate them around the fact that their fears or whatever their concern is that they initially had isn't going to play out. And then gauging their willingness to change after that. And sometimes families aren't willing to change, unfortunately. And I think all you can do in that situation is let them know that you're there when they are maybe at a point where they wanna look at things, again providing as much information and supportive resources as you can. And then trusting that sometimes it's their own journey to reach in their own time.

Andrew: Yeah, I love your attitude to this, Kate. I must say, patience is a virtue and you have it. I was very interested by something you said at the very beginning, and that was they had a reaction, and yet they were appropriately medicated, i.e., the symptoms were smothered. The initial insult was never looked at. How often do you find that this is the case?

Kate: Oh, very often, and I can just totally understand it from a mum's point of view. Because if you have a screaming baby in your arms, and they may not be gaining weight appropriately, and you're totally sleep deprived, and you're feeling totally guilty, because you can't soothe your baby's pain. And then a medical professional provides you with a solution that actually works to get rid of the crying...

Andrew: The symptoms.

Kate: ...and that immediate pain. I get it that a lot of families are like, "Oh, I just had to do it for my baby's sake, for my sake." And often, they're not really told of any further ramifications, or of any alternatives that may have been helpful. So yes, it happens very, very frequently. And it's just such an emotional time when we're talking newborn babies and toddlers, and probably children of any age. My son's only 18 months old. So that's as far as I've gotten in their timeline, is it being emotional, but I can understand that sometimes families, they just don't feel that they have time on their side to navigate other options.

Andrew: Yeah. But it is such a raw, vulnerable time for new parents, especially. Second born, it's like, "Ah, yeah, this again." 

But I was going to ask about formula changes, how quickly do you tend to say, "Okay, look, let's change formula and try maybe a goat's milk formula or something like that?" I'm not a fan of soy formulas. And how do you actually do that in practice? Do you tend to slowly decrease the amount of the milk formula while increasing the amount of a goat formula? Or do you tend to just swap?

Kate: I tend to just swap, but depending again, on the parent and on the child situation. So I've had a little boy this week, who was projectile vomiting after every formula feed of cow's milk formula. So in that situation, let's just swap and see what happens, and move on to a goat's milk formula and see if it's better tolerated. 

But at the same time, sometimes parents are like, "Oh, I have a huge stash of formula, like, I don't want it to go to waste," they've spent a lot of money on it. So that may be a situation where you're like, "Okay, well, let's, switch out one bottle at a time, or do half, half and see how they tolerate it." And yeah, it can be really challenging from the practitioner's point of view, because if you're seeing that, let's say hypothetically, it is that cow's milk formula that's causing some of the issues. And again, parents aren't willing to necessarily make the change immediately, then in my mind, I'm thinking, "Oh, no, the symptoms aren't going to improve until we make this change." But you just have to work with what they're willing to do and continue, again, to provide that information so that hopefully, they can get on board with your suggestions sooner rather than later.

Andrew: And with regards to what you mentioned about projectile vomiting, is this after they've been assessed by a medical professional for, say, pyloric stenosis, something like that or?

Kate: Yeah.

Andrew: Right. Okay.

Kate: Yeah. So it really is looking like cow's milk protein intolerance in that particular situation. But definitely, if there's any, like, projectile vomiting repeatedly, I want to also think, strange baby things that happen. But if it's repeated projectile vomiting, and again, some of that, like not gaining weight or looking like any failure to thrive, then you're absolutely ascending straight onto their general practitioner, and then usually on to a paediatrician for further assessment. Yeah.

Andrew: And you mentioned behavioural issues in the children before. So let's discuss some of the challenges that may arise when working with these children, particularly when you want to maintain the actual structure of your clinic rather than being trashed.

Kate: Yeah. So, I mean, one of the things that I really, really find is important to do in working with children is, in the consultation you actually speak to the child as well as the parent and that's no matter the age of the child. It's like if you have a baby that obviously is like maybe not even making eye contact yet then, okay, you can probably not ask them questions. But still, I do find energetically just to address that the baby's there and to you look at the baby, and to have some sort of connection is important. 

But then with toddlers, asking them questions, and just really, you definitely have to change your language to make it age appropriate. And the way that you may word a question. I find with kids, you have to really make sure you ask those open ended questions. Otherwise, if you offer them option A or option B, they'll just pick on other things that you've said, they're not going to go on to appropriately describe their symptoms. Or if I've said to a child, "Oh, what's your favourite food?" And if I say, "Do you like apples, bananas?" They'll just say, "Bananas."

Andrew: Yeah.

Kate: So making sure that you're not putting words into their mouth. And you may need to brush up on some of your kids TV shows and pop culture references so that you have parallels to draw. Or if you're trying to get them to eat more green veggies, think about their favourite TV character and put it into the context. Or sometimes even I've used Minecraft as in a way to explain to children what we're doing. And I'm not at all into Minecraft personally. But like, "You guys, you're wanting to build your houses and your towns. And so you've got to have really good materials to do that. Well, that's the same as the food that we're eating. So if you think about getting like a really good wood for Minecraft, and then you're able to build a much better house, and that kind of stuff." So I don't know, it's possibly not accurate. I've never played Minecraft myself.

Andrew: No. But well, I've seen my - and might I say adult - sons playing Minecraft. But one of the things that might actually be good is, I think in Minecraft actually cultivate plants. I don't know if there's junk food and things like that.

Kate: Yeah. Yeah.

Andrew: I wonder if there's an analogy to say, "Well, you know, even in Minecraft, they have healthy food."

Kate: Yeah. Yeah. And that's actually one of my patients. She's 8-years-old, loaned a book to me this week. It's called the Happy Happy Poo book. I don't know if other people are aware of it. And it's awesome. It's all about gut bacteria, and how you need to eat healthy food in order to feed the healthy bacteria. And it's got these funny little images of the bad bacteria and the different types of bad poo. And it's like, yeah, it's really good. There's heaps of resources out there like that. 

But even just coming up with your own analogies and things that kids will understand, because they're not interested in science and research, and clinical trials, and even some of the language around how the body works. It's just not...they're not going to understand.

So yeah, back to the original question, I'm sorry. I definitely, to kind of control the appointment, do involve the child as best as I can. And if you are planning on working with children a lot, I would highly recommend having a stash of toys and books in your office. 

Andrew: Yeah.

Kate: Because then at least if you are there for an hour chatting and the child hasn't brought anything of their own. And even if they have, they always like something new to look at. So keep them occupied while you have a proper conversation with mum and dad. And then I guess around the behaviour, sometimes the interaction with mum and dad can be quite telling as well. So just watching that family dynamic, trying not to intervene, because as much as there might be language or bribery or other things that don't resonate with you, or that you may be thinking, "Oh, that could be part of what's going on in this health picture.” Just trying to be that fly on a wall and being an observer and the supportive person that's, yeah, can help to positively influence the family dynamic.

Andrew: Yeah. And talking about family dynamic, usually, I'd say it's the mother who brings the child in to see you, at least the majority of the time.

Kate: Yes. Yeah.

Andrew: What happens when you've got a disparity? You've got one parent on board and the other parent isn't. How do you work around that issue with family dynamic?

Kate: I really do see this a lot. So you're right. It is most of the time mum who's bringing the child in for the appointment. So if parents are still together, and it's just that dad really doesn't have maybe that more open view of health, or he's very much into junk food himself, or whatever it might be. I really encourage both parents to come to any follow up appointments because I find that once you can talk one-on-one to the dad, it's Chinese whispers, mum may have the best intentions of explaining what you've said to dad. But she might not be able to answer any questions that he has or she might explain it slightly incorrectly, and that could be enough for him to completely just not be on board with any of the concepts.

So having both parents there can be really useful. And then if there are any challenges or fears, you can address that in person rather than having it simmering away in the home. Another situation is if parents aren't together anymore, so you may have the child spending half the time with mum, half the time with dad, and they can have a very, very different diet at either house.

Andrew: Right. Yeah.

Kate: And I had a little girl comes to mind who every time she came back from actually it was her mum's house, it was dad who was very much on board with whole food diet and natural health. And every time she came back from mum's house, she had a flare of her eczema. And this persisted for quite some months, actually. And it was basically all they could do, because the relationship was very bad between mum and dad. And the more that dad tried to encourage changes to the diet and continuing supplements in that situation, the worse it got, really. 

So essentially, all we could do was have this really good plan of attack to mop up the effects of what happened in the week at mum's house. And as the girl got older, she was able to have a little bit more control around what she chose to eat as well. So she was in high school by the end of when I was seeing her. So yeah, able to actually purchase some things for herself, catching public transport, could pass a supermarket and dad was really supportive of that.

So yeah, it can be really, really challenging. And there's not a hard and fast rule. And I think, where with an adult patient, it's just one person responsible for their own health. And you can, if it gets to a point, give them a bit of tough love. And just say like, "You've got to do this and I'm going to support you. And here's the resources." But that's not always possible when you're working with two people who are caring for one other person's health. So yeah, finding where you can make that change. And then having support in place for perhaps areas that you can't change.

Andrew: And what about also, when you've got, you've initiated a dietary change with the child, parents are on board, you've got to also consider siblings that may not have that same issue. And secondarily to that, you've got to also think about what about the child's peer group?

Kate: It's really, really interesting. So firstly, if there are siblings, and maybe you do have one child who has a lot of food sensitivities, or a therapeutic need for a particular diet, and it might be quite restrictive for a period of time. So it's not always appropriate to put the whole family on it, if it's a simple change. So if, for example, we've got a child who needs to be, let's say, gluten free, I would really encourage the whole family to be gluten free, at least within the home. Because then I mean, it's easier for the parents, one, a lot of meals for everyone, theoretically. And then when out and about the other siblings who maybe can tolerate some bread, or pasta, or whatever it might be, can go ahead and do that. And the child who needs to stay gluten free isn't going to feel so out of place.

But if it's something a little bit more strict, so let's say you've got a child who you want to put on the GAPS diet, then that's very, very restrictive for an entire family. So depending on the age of the child, that's where you're really educating them as best you can around why you're making the changes you're making and explaining that no dietary change, unless it's a food allergy, should really be a forever thing. So putting some kind of reference points for them around how long this is going to happen, and what it's going to make them feel in their body. I find that with kids, find the thing that they are most passionate about. So if they're really into sport, or they're really into music, or they're really into Minecraft, or whatever it might be, finding that thing for them and explaining the changes in terms of how it's going to support that passion for them. It tends to get them on board a little bit more even when it is quite challenging.

And kids also, they feel it within their own body. So if there is that therapeutic need and you've found the diet that works for them, they want to feel better, so they're often okay with it. Actually, the little girl who loaned me the poo book, she had quite a few food intolerances show up in some testing. And she was really distressed when we were going through the results like about bread and about the thought of not being able to have...well, for her it was actually just wheat, so she was fine with spelt, but about not being able to have just normal bread and got quite emotional. And then I just followed up with her. So it was four weeks down the track of avoiding the foods. And she was like, "Oh, it was actually fine," and was really quite happy. 

So sometimes it's just like the thought of the changes that are problematic. But if you do provide enough resources of how those changes can be made within the family, the execution is not necessarily quite as bad.

Andrew: Right.

Kate: The peer group. And even sometimes, like day cares and schools can be a bit more challenging. I've had a number of day care centres ask parents for a letter from their medical practitioner before they're willing to make dietary changes for the child. Which really perplexes me because I just feel like it...I mean, I understand they’re preparing food for a large number of children, and it's definitely more challenging. But mum and dad should have some say around what they want their child to eat. And it shouldn't necessarily…like if mum and dad say, "No, that food's not for our family," then in my mind, that should be enough. But oftentimes, yeah, they do want some sort of communication. Some day cares will accept that from me. Others will require it to come from a medical professional.

Andrew: Isn't that interesting? Because I'll bet you any money that if it was due to a religious restriction, there would be no issue.

Kate: Yeah, it's interesting. And I'm not sure what the reason is, I mean, some day care centres do allow, or the families have to pack the food for the children. So I think that's great. But in the centres where they provide the food, yeah, they're not always on board. And then even if they are on board, they can't always keep a really close eye on what the kids are doing.

Andrew: Yeah. Very true.

Kate: So often they'll serve it on like a different coloured plate so that their carers are aware of children who do have those dietary needs. They'll try as best they can to watch. But yeah, kids are pretty quick and sneaky. So there can be some food sharing.

Andrew: Yes.

Kate: And then same at school, like no child wants to be the odd one out or different to their peers. I do find that in some schools, and whether it's to do with level of awareness or socio-economic demographic, but some schools, all of the kids will have fairly healthy lunch boxes, like they've all got those beautiful bento boxes, with their chopped up veggies and hummus, and leftover meats. And so then the kids are on board, because that's what all their friends are eating. 

But in the schools where kids maybe are turning up with a number of packets in their lunchbox and that's what they want, then, yeah, it can be a bit harder if the child has to make some changes. Thankfully, there are so many options available to us now. So while, yes, ideal would be everyone's cooking everything from scratch, it's not the reality. So having a look in your health food stores, or even in the major supermarkets, there's a lot of products that will tick a lot of the boxes. So at the very least you can find great gluten free, great dairy free, great egg free, great nut free options, that look like a packet food, but mainly has some slightly better ingredients.

Andrew: And do you enlist things like childhood heroes, for instance, sports heroes that might, let's say, have chosen to go vegetarian, that sort of thing, to say, "Look, it's not just you, there are other great people out there that are doing this as well?"

Kate: Definitely. And particularly in more that teenage age group where they might be on social media quite a lot, there's some really good, very inspirational people on social media, who perhaps are portraying the right message around diet and nutrition with lots of healthy meal ideas. So that can be a great resource as well. Just yeah, making sure that you're picking the ones that aren't then also posting a million photos of them in bikinis on the beach. And not that there's a problem with that, but I feel that that cannot be the appropriate message for impressionable teenagers.

Andrew: Yes. You know, we'd love to work with diet 100%, every now and again, you are going to have to use supplements. And this can be particularly challenging for especially younger children, but also that defiant, young teenage era as well. So how do you work differently in terms of prescribing supplements and also testing?

Kate: So I might kind of break this into the different age ranges because it really does change quite significantly.

Andrew: Okay.

Kate: So, starting with babies, where possible, I would avoid supplementation. So just often times it's if you've got a little baby and before they've had the introduction of solids, you might be looking at mums diet and if there's things there that are causing aggravations. There's some supplements that I would feel 100% totally comfortable all the time. So things like cod liver oil is really safe from birth. That can be great depending on what it is that the child's presenting with. And I personally feel very comfortable prescribing herbal medicines to babies and to children of all ages. And I know that's something that a lot of practitioners feel uncertain about because, unfortunately, it is a demographic that there's not a lot of good quality evidence per se, around the use of herbal medicines. So you're very much having to trust your intuition and your clinical judgement around how you're prescribing and the dose that you'd be prescribing there. 

Again, it's something that you'd work with mum and dad. So some parents are like, "Oh, absolutely, yeah, let's do some herbs," particularly if they've had experience with herbal medicine themselves. But some are like, "Oh, I really don't feel right about giving something to my tiny baby.” So in that situation, you might more be supplementing mum. We know that there's some transmission of the active constituents and nutrients as well through the breast milk. It's not really entirely measurable. And again, there's not a lot of really strong research around exactly what is transferred through the breast milk from a herbal medicine point of view. 

But I also believe very much in the energetics of the herbs that we're working with. So I'm happy for mum to take something and trust that the baby will have some benefit. And anecdotally, we do see that. In terms of how I would work out dosage for an infant. There's really no hard and fast rule, I feel it's not an exact science. So I don't know how evidence based that is to say that I use my intuition. But often, I am using my intuition, and I do tend to feel aligned with drop dosing a lot of the time with my patients.

So that works really beautiful for babies. Babies tend to be quick responders, which can be good and bad, I guess. You’ll know if something's not working very quickly, but you'll know if something's working very quickly. And I always, always err on the side of caution and start with the lowest dose possible. And that could be one drop of a herbal formula mixed in with a little bit of breast milk, or depending if it's in an alcohol base, or maybe you're doing like a herbal tea as a way to administer those herbs, but like, you might pop it straight onto mum's nipple, or you could give, diluted in a bit of filtered water. It just really depends on what mum and dad feel most comfortable with there as well.

Andrew: Yeah. I was just going to ask with regards to herbs coming through breast milk. We do know culturally that babies that are attuned to certain tastes from their mother's dietary intake, i.e., Mediterranean diet equals much higher doses of garlic. And that comes through the breast milk. So they're attuned to that, and the babies accept that. Whereas if you have a mother who doesn't eat garlic and then suddenly eats it, the baby can very quickly taste that. So it's really interesting.

Kate: Yeah.

Andrew: You know, these herbs definitely, at least in part come through that breast milk.

Kate: Yeah, absolutely. And we do, we see that when you administer herb to mum, there is a flow on effect in bub. I know that there was some research around mums taking Senna, which is not something that I would recommend for breastfeeding mums.

Andrew: Sure. Get ready for that one.

Kate: Or really for too many people, but they did find, like measurable levels of those active constituents coming through in the breast milk. But to my knowledge, there's not a lot of quality research around other...

Andrew: No. No.

Kate: ...herbs and the active constituents. Yeah. But I guess dropped dosing of herbs. It's such a small amount to the point where some people may say, "That's not going to have any effects from that." It's certainly not going to have a negative effect. And from my experience, I've only seen it have positive effects for bub.

Andrew: Yeah, like we're dealing with, when we're talking herbs, we're dealing with things that have been imbibed by humans over eons. So it's not something like a new drug.

Kate: Yeah. And you're going to pick and choose the types of herbs that you may be using with a baby, like not going for things that are overly stimulating or not going for things that are overly hormonally active, and that sort of thing. So generally, it's things that will help to clear mucus or support their immune system or support their nervous system. So you're looking at the very gentle herbs to begin with anyway.

Andrew: Then you've got different age groups, the older ones.

Kate: So if we're thinking more now in that toddler or young child age group, often the issue there is with taste compliance. And also, they generally can't swallow tablets. If a child can swallow a tablet, that is awesome. And I would absolutely be encouraging trying to do like capsules or tablets where possible, because then that whole issue of taste is completely removed. But if we're thinking, we're using more powders and liquids, then yeah, it can just be that taste refusal. Or the other problem is sometimes mum and dad who may be a little bit too busy to remember to administer the supplement, and the child can't take control of that themselves at that age.

I do find that there's a lot of good products on the market that have been geared towards children, and the taste is fairly palatable. But you never know, there's always children who will love or hate different tastes, even when you think they might really, really love it. So often, then I'll be looking at other ways of getting it into them. So you might actually find that you have to mix it with a little bit of yogurt, or mashed fruit, or some supplements might actually taste better in a bit of a savoury puree. So it might be like mashed potato, or tomato based sauce, or something like that. Obviously, not heating the supplements, but putting it into the final product.

I find that you can dilute things quite a lot to reduce the taste, and then just ensuring that over a day, the child's having whatever that liquid is that it's been diluted in. Or sometimes you may need to have something mixed with a bit of honey. So picking a Manuka honey, for example, that will have some therapeutic action alongside the sugar that is present. 
And even making things like gummies. So it can make the dosage and being exact around dosage a little bit more tricky. But I do encourage families to make little gelatine gummies with buy some fresh fruit juice, some gelatine, you may need to add a little bit of sweetener to that. And you can often hide supplements in there as well. So kids think that having a little bit of a lolly or a treat. But yeah, it's actually got some therapeutic value there.

Andrew: Well, you know what, I'm really glad you say make the gummies because some of the gummies I've seen on the market are laced with sugar.

Kate: Oh gosh, yeah, definitely don't buy the retail vitamin gummies, they're often not the best forms of nutrients, the best dose of nutrients. And what they're made with can be questionable as well. So homemade gummies, it's really, really easy. And that's actually quite a fun activity for kids to get involved in as well.

Andrew: Oh, cool.

Kate: Sometimes you may have to not let them see their therapeutic stuff go into it. Otherwise, they might refuse it just on principle. But yeah, they can get involved in some of the elements of that.

Andrew: Right. Okay, so I mentioned testing earlier, what about testing? Because we'd like to avoid invasive testing as much as possible, that's got to be done by an appropriate practitioner. But what non-invasive tests are there? And what can they tell us?

Kate: So I would, 9 times out of 10, avoid any blood draws for children, just really depends on the situation. If you do have a child that's quite complex, or maybe they've had a really fast decline, then sometimes it is necessary. And there are some really good practitioners or nurses out there who can do a very, very gentle blood draw for children. Again, you may need a bit of bribery and a lot of talking around what's going to happen to get them on board. But as much as possible, I would avoid that and instead opt for things like an organic acids test can be really insightful. And that's just a urine collection. 

Often with kids, you're doing things like a stool test, which is maybe a little bit gross but they might actually be on board with that, and not an invasive collection. Even things like urinary pyrroles assessment. So again, urine testing, food sensitivity testing can be a blood spot, which that often is not that well received, but it's such a small little finger prick. And if you get it right, it's just one finger prick that you need to do to get a bit of blood and you can get a lot of information out of that.

I do find that with kids, in some ways, they can be more complex and in other ways, they're really, really easy. I guess we don't have as many layers as the adult patients. So they haven't got a year they've accumulated stress, whether that's emotional stress or environmental stress. It's usually like if parents are bringing them, they've got the condition that they're presenting with. And there may be some other comorbidities. But I do find that you don't necessarily need to do so much digging as you may do with an adult patient. 

So if you can find one or two tests that are non-invasive, then it can be really insightful and really change things. And also, I mean, I personally, unfortunately, don't use iridology in my practice, but iridology can be amazing and completely non-invasive, and great for children. So yeah, there's definitely ways of assessing without doing that blood draw.

Andrew: Kate, there's so much to learn and so much I've learnt today. I mean, you've obviously got a gift. Not just with naturopathic practice, but also dealing with people, and having the patience, and the acceptance to work with them at their own time pace. I’ve got to thank you so much for joining us on FX Medicine today. We're definitely going to be putting up the link to the Happy Happy Poo book up on the FX Medicine website. 

I've loved chatting with you today. Thank you so much for joining us today on FX Medicine.

Kate: Thank you so much for having me.

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

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