Paediatrics

Question 1

Paediatric Dosages

Answer 1

• For infants still breastfeeding - dose the mother.
• For infants under 2 years use Fried’s rule:
  – Calculation: (Age in months ÷ 150) x adult dose.
• For 2 years and above use Young’s rule:
  – Age of child ÷ (age of child + 12) x adult dose

Take care with children who are noticeably larger or
smaller than their average age!

Question 2

Paediatric GIT Health - Swaps

Answer 2

• 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 -> 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.
• Anti candida diet -> Remove sugar, dose with S. boulardii and probiotics.

Question 2

Infant Microbiome

Answer 2

• 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.

Question 3

Paeds: Benefits of microbiome diversity

Answer 3

• 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.

Question 3

Microbiome: Breastmilk

Answer 3

• Breastmilk is heavily colonised with Bifidobacterium spp. and Lactobacillus spp.
• The breastmilk microbiome is fostered via translocation of the maternal gut microbiome to the breast tissue via dendritic cells and macrophages via the lymph.
• These bacteria are evident before breastfeeding begins.

Question 4

Infant microbiome: Immunity

Answer 4

• Infants are born Th2 dominant = ↑ IgE production + sensitivity to allergens.
• Alterations in the infant microbiome can drive intestinal permeability, as well as GI and systemic inflammation.
• Lactobacillus spp. prevents inflammatory bacterial spp. from colonising.
• Staphylococcus aureus elevates inflammatory cytokines, suggesting that dysbiosis increases an infant’s tendency to inflammation.

Question 5

Colic

Answer 5

Infantile colic = regular prolonged crying of unknown cause in an otherwise healthy infant.

Question 6

Colic: Signs and symptoms

Answer 6

Infant appears in pain, crying for long periods and often stiffens their body / curls their legs upwards. It usually occurs within weeks of birth and usually resolves itself by 3-4 months of age.

Question 7

Colic - Causes

Answer 7

Undeveloped digestive system, trapped gas , food intolerances from breast milk or formula (e.g., dairy), low GI microbiota diversity

Question 7

Colic: Natural approach

Answer 7

• Burping them for as long as they feed. This reduces trapped air in the intestines.
• Maternal and baby probiotics.
• Place gentle pressure on the abdomen. Gentle bicycling of infant’s legs or a gentle abdominal massage
• Fennel seed tea, chamomille tea
• Checking for intolerance in breast milk / formula.
• Avoid gas forming foods
• Remove excess stimulus
• Create closeness