15. Paediatrics Flashcards
How to do a paediatric consultation?
Consultations with infants and children must be in the presence of a parent or legal guardian.
* From the age of 2/3 years, engage the child in the consultation. Older children can answer questions with the parent / guardian filling in.
* Consultations will often be shorter for younger clients as a result of a shorter health history.
* Prep the child about what will happen in the consult.
* Include the child in the discussion.
* Give the child time to answer.
* Do not talk over the child.
What observation skills are required in a consultation with children?
- Change descriptions / questions into child-relatable things: “Tell me about your tummy ache? Where is it?”
- Observe any physical cues and appearances:
– How does the child react to their environment? Are they shy, confident, talkative, happy, sad, or tired?
– How do they sit? Do they slump, wriggle or hug their knees to their chest?
– How do they look? Pale, robust, reddish, dark circles under eyes. - Work through the plan with them. If age appropriate, children may respond to ‘fairy potions’, ‘witchy brews’ or ‘green dinosaur drinks’.
What are good nutrients/supplements to use with children? which to avoid?
Infants and children are sensitive to the ingestion of man-made nutrients and supplements.
* Work with organic food. Hide foods if required for ‘fussy eaters’ (e.g. leafy greens in smoothies, sauces, etc.).
* Most kids’ supplements taste good — chewable or powdered supplements are a great choice on their own or in food. Liquids can be disguised in juices, smoothies or jellies.
* Maple syrup, cocoa powder, dates, organic yoghurts and frozen banana / berries are excellent at hiding the taste of supplements that kids won’t take on their own.
* Avoid limiting a child’s diet; focus on adding in nutrient-dense foods.
How to dose supplements for breastfed children?
For infants still breastfeeding — dose the mother.
How to dose supplements for children under 2?
For infants under 2 years use Fried’s rule:
– Calculation: (Age in months ÷ 150) x adult dose.
– E.g.: (13 months ÷ 150) = 0.086 x 3000 ius = 260 ius.
How to dose supplements for children over 2?
For 2 years and above use Young’s rule:
– Age of child ÷ (age of child + 12) x adult dose.
– E.g., child is 3: 3 ÷ (3+12) = 0.2 x 1000 mg = 200 mg.
Take care with children who are noticeably larger or smaller than their average age!
Why support children GIT?
Good digestive health in children is paramount. Without an optimally functioning GIT, health can quickly be thrown out of balance. This can cause significant issues as they age.
* A young child’s digestive tract is far less developed / matured and hence more sensitive than an adult’s. Therapeutics must be gentle and the dose appropriate. Avoid harsh protocols like anti-candida diets or enemas.
* Optimise physiological functions as well as biochemical pathways through organic seasonal food, gentle herbal teas (e.g., chamomile, rosehip and nettle are excellent)
as well as fresh vegetable juices to achieve optimum balance.
Harsh supplement or protocol for children and how to achieve better results and compliance x7
- Psyllium husk => Slippery elm powder or marshmallow root; soaked flaxseed mucilage blends well.
- ACV before meals => Add to salad dressing; lemon juice in water.
- Bitter foods in salads => Make green smoothie, add to sauces or stews
- Essential oils, e.g., oregano, thyme => Avoid essential oils ― use fresh garlic, thyme, oregano as antimicrobials (i.e. garlic bread)
- Turmeric => Add to non-spicy curries. Bitterness of turmeric is too overpowering for jellies or smoothies.
- Spirulina powder => => Chlorella liquid with peppermint.
- Anti-candida diet
The infant microbiome - why the first month of life is key?
- A lower microbiome diversity increases the risks of obesity, Type II diabetes and chronic inflammatory illnesses (e.g., IBD, asthma).
2* A higher microbiome diversity is linked to healthy nervous system / brain development and the appropriate stimulation of the immune system.
3* Studies have also found a higher diversity in an infant’s microbiome helps the body react appropriately to vaccines and other pathogens.
4* There are multiple ways that an infant’s microbiome is established and fostered; prenatally in utero, during delivery, and postnatally through environmental factors and abundance or absence of breastfeeding.
- A lower microbiome diversity increases the risks of obesity, Type II diabetes and chronic inflammatory illnesses (e.g., IBD, asthma).
The infant microbiome - what are the health implications on how a baby is born? vaginal vs c-section
- Vaginal birth: Picks up the mother’s microbiome on passage through the vaginal canal and when passing the rectum.
- Caesarean delivery: Avoids this transmission; a higher rate of maternal antibiotics. Studies are looking to see if maternal faecal transplantation can normalise caesarean-born infants’ microbiomes. Vaginal seeding can be an option on a birth plan if the mother’s microbiome is healthy.
- Also consider excessive pressure from an assisted birth (i.e., forceps, ventouse) — can interfere with breastfeeding through compression of cranial bones (e.g., occipital, parietal) and cranial nerves (e.g., hypoglossal). The jaw can also be impacted.
Optimise maternal microflora before birth and use probiotics asap post C-section delivery.
what is the microbiome difference between a child born vaginally vs via c-section?
Infants born vaginally have a higher microbiome diversity.
* Vaginal-born infants have a high abundance of Bacteroides spp., Bifidobacterium, Lactobacillus, Enterobacter and Streptococcus.
* Caesarean-born infants have good levels of Lactobacillus, but lower levels of Bifidobacterium and higher levels of Clostridium and Staphylococcus.
* Low levels of Bifidobacterium in early life have been correlated to higher rates of atopic disease later in life.
* Colonisation rate of gut microbiota in vaginal-born infants is higher in the first week of life compared to C-section-born infants.
Bacteroides spp. are important commensals. They are SCFA producers and assist with the maturation of Peyer’s patches
what are the benefits of The benefits of microbiome diversity (esp. of Bifidobacterium spp.)? x6
The benefits of microbiome diversity (esp. of Bifidobacterium spp.) include:
* Enhanced lactose digestion.
* Intestinal wall integrity (via short-chain fatty production).
* Innate immunity development.
* Peristalsis stabilisation.
* Production of organic acids and bacteriocins.
* Production of antimicrobial and iron-scavenging compounds.
what are the vitamin produced by Bifidobacterium spp.?
- B. bifidum B. infantis => Thiamine, folate, biotin, nicotinic acid
- B. breve B. longum => Riboflavin, pyridoxine, cobalamin, ascorbate
breastmilk role in Developing a healthy infant microbiome?
- Breastmilk is heavily colonised with Bifidobacterium spp. and Lactobacillus spp. including B. breve, B. bifidum, B. adolescentis, L. gasseri, L. fermentum, L. plantarum, L. rhamnosus, and L. salivarius.
- The breastmilk microbiome is fostered via translocation of the maternal gut microbiome to the breast tissue. Dendritic cells open the intestinal tight junctions and sample the mother’s GI microbiome. Macrophages then transport bacteria to breast tissue via the lymph, thus colonising the breast milk. These bacteria are evident before breastfeeding begins.
how is The neurodevelopment of a child is heavily influenced by the status of the infant microbiome?
- A diverse microbiome colonisation is essential for the development of the CNS and ENS.
- Absence of an established microbiota has been linked to:
‒ Underdevelopment of the myenteric plexus.
‒ Hypersensitivity of the HPA-axis stress response. - Normalisation of the microbiota has been shown to reduce the stress response in young children.
- The critical window for optimising the gut-brain axis connection through diverse microbiome colonisation is from birth to 3 years.
myenteric plexus = nerves in the GIT that controls peristalsis
ENS = enteric nervous system
impact of the gut microbiome on child temperament ?
Temperament and cognitive scores are also influenced by the infant microbiota.
* Fox et al. (2020) looked at the infant microbiome at 1–3 weeks and then tested
temperament scores at 12 months. They found that a microbiome high in Bifidobacterium spp. and Lachnospiracea had a positive effect on temperament whereas an abundance of Klebsiella, and Ruminococcus-1 had a negative impact on all temperament scores.
* Tamana et al. (2021) found that an abundance of Bacteroides spp. in infants aged between 4–12 months had positive affects on language and cognitive scores between the age of 1–2 years.
Why does A healthy microbiome has a positive influence on infant immunity.
- Infants are born Th2 dominant; environmental bacteria and the microbiome are needed to normalise immune function.
- Th2 dominance = ↑ IgE production + sensitivity to allergens.
- Alterations in the infant microbiome can drive intestinal permeability, as well as GI and systemic inflammation.
- Lactobacillus spp. produce lactic acid and bactericidins that alter the environment to prevent inflammatory bacterial spp. from colonising.
- Staphylococcus aureus colonisation in the infant gut has been associated with elevated inflammatory cytokines, suggesting that dysbiosis increases an infant’s tendency to inflammation
why are Pre and probiotics are vital for the microflora of any infant or child, especially if born via C-section and formula fed:
- Prebiotic — colostrum and breastmilk in infants and prebiotic foods in children; use a variety of vegetables, beans, lentils, kefir, yoghurt, kombucha, miso for mother and for children once weaned.
Prebiotic formulae containing GOS ↑ Bifidobacterium spp. - Probiotic — focus on age-appropriate species / formulas i.e., Bifidobacterium spp. if dosing an infant or if digestion has never been fully established in a young child.
- Supplementation 0–4 months — can be via the mother, probiotic powder rubbed onto the nipple before feeding, or powder gently rubbed inside the infant’s mouth with a clean finger.
