Paediatrics/mens health/urinary Flashcards
How can you involve a child in a consultation, and what key observations should you make?
- 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.
- 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 should you be aware of when choosing supplements and a diet plan for children?
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.).
* chewable or powderedsupplements 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 do you adjust the doses of supplements for specific ages of children?
- Infants still breastfeeding: dose the mother
- infants under two: fried’s rule
Why is digestive health paramount in children, and how can you optimise this?
- A young child’s digestive tract is far less developed / matured and hence more sensitive than an adult’s-
Without anoptimally functioning GIT, health can quickly be thrown out
of balance. This can cause significant issues as they age.
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.
5 examples of supplements that are too harsh for children, and what would you do instead?
1) Psyllium husk: Slippery elm powder or marshmallow root;
soaked flaxseed mucilage blends well.
2 Anti-candida diet * Remove sugar, dose with S. boulardii and probiotics. Essential oils, e.g.,
oregano, thyme
3) Avoid essential oils ― use fresh garlic, thyme,
oregano as antimicrobials (i.e. garlic bread)
4) Turmeric * Add to non-spicy curries. Bitterness of turmeric
is too overpowering for jellies or smoothies
5)Spirulina powder * Chlorella liquid with peppermint.
How can an infants microbiome in the first month of life effect them later on?
A lower microbiome diversity increases the risks of obesity, Type II
diabetes and chronic inflammatory illnesses (e.g., IBD, asthma).
* A higher microbiome diversity is linked to healthy
nervous system / brain development and the
appropriate stimulation of the immune system.
* Studies have also found a higher diversity in an infant’s microbiome
helps the body react appropriately to vaccines and other pathogens.
* 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.
What are the health implications of how a baby is born?
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).
Optimise maternal
microflora before birth
and use probiotics asap
post C-section delivery.
How does colonisation of microbiota differ with vaginal and c section birth?
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
What are the benefits of microbiome diversity?
What vitamins do bifidobacterium produce?
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.
Bifidobacterium
spp.:
Predominant vitamins
produced:
B. bifidum
B. infantis
Thiamine, folate, biotin,
nicotinic acid
B. breve
B. longum
Riboflavin, pyridoxine,
cobalamin, ascorbate
What is breastmilk colonised with and how does this happen?
- 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.
How can a child’s microbiota effect the neurodevelopment of a child? How can temperament and cognitive scores be effected?
- 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
Signs/ symptoms/ causes of infantile colic?
Infantile colic = regular prolonged crying of
unknown cause in an otherwise healthy infant.
* Signs / symptoms: 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.
* Causes (hypotheses): Undeveloped digestive
system, trapped gas, food intolerances from breast
milk or formula (e.g., dairy), low GI microbiota
diversity, newborn over-stimulation as it often occurs late
afternoon early evening i.e., predictable times each day.
Natural approach to infantile colic?
1) Burping them for as long as they feed- This reduces trapped air in the intestines.
2) Maternal and baby probiotics. Baby-administered L. reuteri has been shown to reduce colic symptoms in breastfed babies.
3) Place gentle pressure on the abdomen via ‘tiger hold’ Gentle bicycling of infant’s legs or agentle abdominal massage using a chamomile and mandarin
essential oil blend (or lavender) — clockwise only.
4) Fennel seed tea — antispasmodic, carminative
and galactagogue. 3‒6 cups of fennel tea
daily for the mother. Place 1 tsp in 300ml of
water and boil for 10‒15 mins. Drink through the
day. For formula babies — give 1 tsp of boiled
but cooled mixture before feeds or in the milk.
* Chamomile tea (cooled, boiled) — carminative,
nervine, antispasmodic. If administered to the
baby, give an age-adjusted dose of fennel or
chamomile based on an adult dose of 5 ml x
3 daily.
5) Checking for intolerance in breast milk / formula.
Common problem foods: Dairy, chocolate,
eggs, soy, caffeine, lentils and spicy foods.
6) Avoid gas-forming foods e.g., crucifers, fried foods, peanuts, wheat.
7) Remove excess stimulus — loud noises, busy rooms,
flashing lights, screens. Ensure the room is dark (with lights
remaining dimmed when waking); use white noise to aid sleep.
8) Create closeness — swaddling, carrying in a baby sling and
breastfeeding on demand can help. Also feed in quiet surroundings.
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.
What is the effect of the microbiome on infant immunity?
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.
Natural approach to teething?
- Signs / symptoms: Irritability, mild temperature (38° C), 1 flushed
red cheek / ear, constant dribbling, diarrhoea, gnawing and chewing. - Natural approach:
‒ Give them a cold wet muslin to chew. Older babies can
chew chilled cucumber / carrot / celery sticks, frozen banana or homemade frozen lollies (e.g., frozen breastmilk or berry juices).
‒ Rub babies’ gums with a clean finger. - The combination of nervine herbs soothes a baby and eases pain.
- Ingredients (½ ounce each of): Dried chamomile flowers,
dried lemon balm, dried lavender flowers, dried catnip leaves. - Instructions: Combine all the herbs in a jar.
Infused 1 tbsp in 300 ml of boiling water for
15 minutes. Increase to 30 minutes or use
2 tbsp for a very irritable baby (or mum!).
Can be drunk by the mother or dip a washcloth in tea for
the baby to chew on. Also can be given by spoon or dropper.
Natural approach to coughs, colds and fevers
Natural approach — therapeutic foods:
* Garlic — freshly grated / crushed garlic onto food (e.g., garlic bread)
to increase allicin, which is anti-microbial, immune-boosting
(↑ NK cells and interferons) and mucolytic. Use over the age of 1.
* Finely chop onion and smother with manuka honey.
Leave for 1‒2 hours. The onion’s phenolic compounds
are anti-microbial and anti-inflammatory; the honey’s
anti-microbial properties are attributed to its high levels
of methylglyoxal. Give 1 tsp 2‒3 times per day. Good for sore throats. * Freshly grate ginger in hot water, leave to cool and add lemon
and honey to taste. Sip at regular intervals. Anti-inflammatory
(inhibits LOX, COX and TNF-α) and anti-microbial.
- Vitamin C — effective at preventing
and relieving symptoms of viral respiratory infections.
Up-regulates interferons, natural killer cells and T-cells. - Zinc — increases phagocyte, natural killer cell, T- and B-cell activity. Inhibits viral replication. ↓ inflammatory cytokines such as Il-6.
- Vitamin A — critical for epithelial cells and mucous membranes,
growth and development. Regulates humoral and cellular
immune response, enhancing T-cell proliferation. - Vitamin D — modulates adaptive and innate immunity.
Deficiency is associated with decreased immunity.
28 - Probiotics — regulate adaptive and innate
immunity as well as immunomodulatory function. - Iron — include iron-rich foods and consider checking
ferritin — required for immune cell maturation and proliferation. - Selenium — important for T-lymphocyte proliferation and activity,
antibody production and regulating excessive immune responses. - All foods high in antioxidants — they can protect
and minimise damage from infection. Use
antioxidant foods in juices, smoothies, add to
salads, sauces or roast them into edible hot chips.
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Coughs, Colds & Fevers
(Soyano et al.1999; Cherayil, 2010 ; Yan
et al. 2011; Huang et al. 2012; Cronin et
al. 2019; Zhang et al. 2020)
© CNM: Nutrition Year 2 ― Paediatrics, Urinary Health & Men’s Health. RD.
Natural approach — herbal medicines: - Echinacea purpurea / angustifolia adult dose 20 drops tds —
immunomodulatory through actions of alkylamides. Be careful of use
in those under 3 years and discontinue if any child develops a rash. - Thymus vulgaris [thyme] adult dose 10 drops tds — antimicrobial
(↑ cell membrane / wall permeability), expectorant, antispasmodic. - Verbascum thapsus [mullein] adult. dose 10 drops tds, expectorant.
- Sambucus nigra [elder] adult dose 20 drops tds — antiviral,
expectorant, anti-inflammatory, antioxidant. Syrup can also be used. - YEP tea [yarrow, elderberry and peppermint] adult dose 1 cup tds
— diaphoretic, immune-supporting blend. 1 tsp of each herb in a pot
of 200 ml water and bring to the boil. Simmer for 15 min and strain.
30
Use Young’s
rule to find age Coughs, Colds & Fevers appropriate dose
Drops of tincture 1:3
© CNM: Nutrition Year 2 ― Paediatrics, Urinary Health & Men’s Health. RD.
Natural approach — practical solutions: - Vaporiser in room at night with essential oils of tea tree, chamomile
and cajeut (lemon and lavender when under 6 months). - Ensure room is dust free and adequately ventilated.
- Older children can use a saline nasal spray to help clear sinuses.
Tissue salts: 3 x daily for as long as the symptoms improve. - Ferrum phos — if there is inflammation.
- Nat. mur. — at the start of a cold where there is a clear runny nose.
- Kali. mur. — wet cough with thick and white discharges.
- Kali. phos. — wet cough with thick golden yellow discharges.
- Kali. sulph. — wet cough with yellow-green discharges.
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Coughs, Colds & Fevers A salt pipe can also be
used by older children.
© CNM: Nutrition Year 2 ― Paediatrics, Urinary Health & Men’s Health. RD.
32
Coughs, Colds & Fevers
How can fevers be benificial?
Fevers are an essential component of the immune
system. Fever in children — benefits (if 38‒40° C):
* Beneficial in developing T-cell differentiation. In fact,
T-cells that were exposed to hyperthermia prior to
differentiation were found to be better able to respond
rapidly and effectively in future immune responses.
* Increases heat shock proteins (HSP), which are immune
chaperones. They appear to regulate viral infections by
influencing host cell entry, viral replication and gene expression,
folding / assembly of viral proteins and apoptosis regulation.
* Unless the fever starts creeping above 40° C, it is generally best
to let it be and support as needed. Do not suppress this process.
How can you naturally support a fever in children?
Tepid bathing — not cold bathing as this can
induce seizure. This should encourage mild peripheral vasodilation.
* ACV socks — soak socks in warm ACV, squeeze excess
out and then place onto the feet. This encourages peripheral
vasodilation to help reduce the core body temperature.
* Homeopathics: Taken every 30 mins, up to 6 doses.
‒ Aconite 30 C: When a fever, cold, sore throat or
earache comes on rapidly from cold exposure.
‒ Belladonna 200 C: High temperatures of 40° C.
Child is red in the face and may start to hallucinate
What is otis media and what are some causes/ risk factors?
Otitis media = infection of the middle ear often accompanied
by cold and flu symptoms and child holding or rubbing their ear.
Otitis media with effusion / glue ear = collection of fluid in the middle
ear without signs of acute inflammation. Often follows acute otitis media.
* Causes / risk factors:
– Common between 3 months and 4 years of age
(when the eustachian tube is more horizontal).
– Under-functioning immune system (e.g., poor nutrition, dysbiosis).
– Non-infective causes, e.g., food allergies, environmental irritants,
GORD, dental problems, temporomandibular joint misalignment
Natural approach to Otis Media?
Natural approach:
* If a bottle-fed infant, encourage parents to bottle feed in
an upright position to reduce eustachian tube compromise.
* Reduce or remove dairy (increases mucus production).
* Hot or cold compresses on the ear using a flannel or cloth.
* Mix 1 drop of tea tree oil with 5 ml olive oil and gently rub around
the opening to the ear. Garlic oil can be used in the same way.
Take 50 ml of EVOO and chop 1 garlic clove into it. Let it sit for
24 hours+. Rub onto the opening of the ear (not into the ear canal).
* Remove possibly allergens, e.g., dairy, gluten, citrus.
* Explore potential dental / TMJ issues as appropriate.
36
Otitis Media Use all therapeutics
in Cold and Flu
section above
Provide
warm foods
to promote
warmth in
the body & ↓
congestion.
© CNM: Nutrition Year 2 ― Paediatrics, Urinary Health & Men’s Health. RD.
37
Natural approach — homeopathy:
Ho
Aconite: Outer ear is hot, red, swollen and very sensitive to noise.
Comes on from cold wind exposure.
Belladonna: Throbbing or pulsating pain in middle and external ear with
accompanying high fever.
Chamomilla: Acutely painful earache from heat exposure, wind exposure or
emotional upset. One cheek red, the other pale.
Merc. sol: Earache at night, typically of the right ear with thick yellow-green
offensive discharge. They feel better with a cold compress.
Pulsatilla: Every cold develops into an earache. Fullness or bursting
sensation. Feels better in open air and needs constant affection.
Silica: Main remedy for constant catarrh, ‘glue ear’. Thick and
purulent discharge. Child bores their finger in their ear.
Causes and risks for childhood anxiety?
1) nutritional deficiencies:
* EFAs — deficiency is linked to neuroinflammation, lower
dopamine and reduced neuroplasticity,
myelination sheath functioning. Pre-teens and teenagers are
especially vulnerable to EFA deficiencies due to hormonal
changes and developmental growth requirements.
* Magnesium def. — HPA dysregulation and ↓ monoamine levels.
* Zinc def. — increases cortisol, reduce neuroplasticity,
alters hippocampal synaptic transmission.
* Selenium — thyroid dysregulation and ↑ oxidative stress.
* Vitamin D — alter neurotrophic factors and monoamine levels.
Also consider the role of B vitamins
as NT co-factors
Natural approach:
* Focus on principles of the CNM Naturopathic Diet.
Remove caffeine, sugar, and food additives which
can drive anxiety. Focus on nutrient-dense foods.
* Stabilise blood glucose levels and make sure they are hydrated.
Probiotics and support the gut-brain connection (previous content).
* Address any nutritional deficiencies accordingly.
* Herbal nervines (e.g., chamomile, lemon balm, lavender,
passionflower, ashwagandha) which influence GABA
receptors. Use drop doses in water or dose as herbal
teas 3 x day (adult dose 1 cup) hot or Causes / risk factors:
* Bullying, social media, friendship issues are common.
* Poor teaching at school causing irritability.
* Blood sugar dysregulation (e.g., high refined sugars, poor sleep, etc.)
— associated with hypoglycaemic effects impairing cognition.
* Chronic stress – ↑ cortisol leads to periods of hypoglycaemia and can
result in altered neurotransmitter functioning. Also disrupted sleep
