Michael Tyshkov, MD

New Jersey Office: (908) 273-7745
Staten Island Office: (718) 226-5619
Brooklyn Office: (718) 372-8402


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COLIC

Colic is defined as excessive (frequently inconsolable) crying that lasts for more than three hours at least three days per week, continuing for at least three weeks. Any medical condition causing such a behavior in an infant must be ruled out.

Symptoms associated with colic include pulling the knees up towards a "hard and/or swollen stomach", and excessive gas. Crying occurs most often in the evening. Colic typically ends by the age of 4-5 months.

What causes colic is a debatable issue, although there are many theories, such as an allergic reaction to foods (such as milk), a suggestion that some babies may simply have a sensitive temperament, possibly compounded by a parental inability to respond to the infant's needs. Finally, what we call colic may just be an extreme version of normal infant crying, or an increased perception of normal crying by parents with less tolerance for it.

Principal Proposed Natural Treatments:  www.Consumerlab.com

  • Fennel Seed Oil

Accordingly to the published studies, about 40% of the infants receiving fennel showed relief of colic symptoms, as compared to only 14% in the placebo group. Another way to look at the results involves hours of inconsolable crying. In the treated group, infants cried about nine hours per week, compared to twelve hours in the placebo group.

  • Dietary Changes

Cow's milk can cause an allergic reactions. There is also some evidence that breast-fed infants may have allergic responses to cow’s milk proteins in the mother’s diet.  There are studies which have evaluated the effects of cow's milk or cow’s milk protein in the diet of infants with colic.  Most (but not all) of these found an improvement in crying when cow's milk protein was removed from the diet of formula-fed infants, or from the diet of the mothers in breast-fed infants.  Hypoallergenic formula made from hydrolyzed (processed) whey or casein, may be superior to a conventional cow's milk or soy protein based formulas.  If no improvement is seen through eliminating cow's milk, some experts recommend searching in the breastfeeding mother's diet for other potential food allergens, such as wheat, soy, or eggs. However, it is important to keep nutritional needs in mind: the nursing mother who eliminates certain foods needs to maintain an adequate intake of calcium, protein, and other nutrients.  Milk also contains lactose, a form of sugar that many adults can't digest (see the lactose intolerance article for more information). However, reducing the lactose content of infant formula has not been found helpful in treating colic.

  • Probiotic Supplements

The studies on use probiotic for the reducing of colic are very inconclusive.

  • Behavioral Methods

Many doctors believe that the cause of colic is not physical; rather, that it results from a child's oversensitivity to stimuli in the environment. Over-anxious parents might contribute to the problem by adding more stimulation in an attempt to calm their child. Other parents might under-react in the belief that paying too much attention to the infant's cries will "spoil" him. Either response could set up a vicious cycle leading to long periods of inconsolable crying.  Based on these theories, some authorities recommend counseling the parents of a colicky infant on appropriate coping strategies, including building a personal support system and occasionally leaving the child with a different caregiver to provide a respite.  Studies evaluating the effects of carrying a colicky child more, or using a motion-simulation device, have not found benefit.

 

  • Other Proposed Natural Treatments

One controlled study found that use of a special type of bottle for bottle feeding (Dr. Brown's Natural Flow Baby Bottle) reduced colic symptoms.  Chiropractic spinal manipulation has also been tried for colic. Whether this was a specific effect of the manipulation or a general response to attention and touch is difficult to determine.  In Britain, a preparation called "gripe water" is widely sold for the treatment of colic. Varying formulations exist; however, all include aromatic oils such as dill, spearmint, or caraway, combined with alcohol, sucrose (sugar), and sodium bicarbonate. There is no scientific evidence to show whether or not gripe water works. It should be noted that at the recommended dosage, the infant would receive the equivalent of five shots of whiskey. That would be enough to calm anyone.  Other herbs sometimes recommended for colic include cardamom, angelica, peppermint, lemon balm, rooibos (red tea) and yarrow. However, no scientific evidence as yet supports their use.

Please, go on the linked websites below:

http://www.aboutkidsgi.org/

 

 IBS (Irritable Bowel Syndrome)

IBS is a disorder that affects the large intestine (colon). It is known to cause discomfort, cramping, abdominal pain, bloating, diarrhea and/or constipation. Despite these symptoms, IBS doesn't permanently damage the colon. In terms of treatment, it is often recommended that patient take soluble fiber supplements such as psyllium, guar gum and wheat bran, or anti-diarrheal medicine such as Imodium as needed. Also, eliminating high-gas foods (http://www.med.umich.edu/fbd/docs/Gas%20reduction%20diet.pdf) could help remove the symptoms described above. 

See links for more details: 
http://digestive.niddk.nih.gov/ddiseases/pubs/ibschildren/

Always increase fiber dose gradually over period of 2-3 weeks. Consider Heather's Tummy Fiber if bloating is a prominent problem.  In addition, here is a list of some natural products used by people with IBS: 

Probiotics: VSL#3 and Key biotics are considered to be among most effective. Follow an instruction.

Peppermint Oil: 1-2 caps. Between meals.  Fennel: 1 teaspoon with food for prevention of bloating and gas.

Ginger: As antispasmodic (brew as a tea) or for nausea (chew fresh, minced).

Iberogast: For IBS with dyspepsia. It has a prokinetic effect (improves the gastric emptying). 20 drops before meals.


Below is also a list of foods rich in soluble fiber:

Oatmeal
Potatoes
Barley
Carrots
Flour Tortillas
Yams
Soy
Sweet potatoes
Quinoa
Turnips
Corn meal
Rutabagas
Rice (brown)
Parsnips
Beets Squash and pumpkins
Mushrooms
Chestnuts
Avocados
Bananas
Applesauce
Mangoes
Papayas


Common IBS trigger food:

Milk and dairy products, Cruciferous, Beans and lentils. Soy food Wheat, Whole nuts and seeds.
Citrus fruits Foods high in Corn and popcorn
Insoluble fiber
Raw vegetables High fructose Garlic and onion
Corn syrup
Spicy food Carbonated drinks Caffeinated drinks
Fried fatty foods Condiments (ketchup, mustard, pickle relish,
Mayonnaise, barbecue sauce).


One of the most popular ways of the therapy of IBS with diarrhea is FOODMAP DIET (you may also use a convenient mobile phone application: the low food map diet for IBS).  When celiac disease and wheat allergy are ruled out, gluten free diet is one of an alternative dietary approaches to IBS.

http://www.ibsdiets.org/fodmap-diet/fodmap-food-list/

http://livinghappywithibs.com/2013/04/21/foodmap-food-list/

Gastroesophageal reflux (GER) and Gastroesophageal Reflux Disease (GERD)

 

GER is a common condition in the infancy, less common over the 1-st year, an even less- in older children. It is usually not a disease during first 18 month of age. It only means, that a gastric content (formula, food, gastric juice) returns back, into the esophagus, above the stomach. In some cases it may cause complications, and then it is called GERD. 

Regurgitations or spitting up (GER) are non-forceful events and rarely a sign of GERD or any disease, provided that the baby is well otherwise. It must be differentiated from vomiting - forceful events, and often considered as a sign of a disease. 

Most of infants (and 5-10% during the second year of life) do spit up and sometimes do it often. The common cause of it is overfeeding, but there are other predisposing factors related to an anatomy, physiology, quantity and quality of food (formula). It doesn’t usually mean that they have a disease (GERD). Special tests and medications in the majority of such cases are not needed, but there are some exceptions: 

1) neurologically impaired infants; 
2) infants who do not thrive; 
3) those who have respiratory problems. 

There are some other red flags too, and a pediatric gastroenterologist may need to be consulted in some cases. 

ANY BILIOUS VOMITING EPISODE(S) MUST BE BROUGHT TO THE ATTENTION OF A MEDICAL PROFESSIONAL PROMPTLY!! 

The therapy of GER is a combination of reflux precautions (to be discussed with your primary physician). 

Older children: By the end of the second year of life an occasional regurgitation episodes, especially after large meals or during cry, do not usually mean that the child require any tests, procedures, or medication. Daily episodes of regurgitations by this time do require attention of a specialist in order to rule out GERD, and it is a time to consider special tests and/or procedures. 

Children above the age of toddlers (over the 3-d year of life) should not regurgitate food, and those who do, even occasionally, always require a consultation by a specialist, special tests and often procedures (endoscopy). 

At any age… complaints of a chest discomfort, difficulties to swallow food (usually solids), vomiting, anemia, weight loss, abdominal pain, respiratory distress in association with GER, requires a prompt consultation of a gastroenterologist. 

IN GENERAL, please avoid any "junk foods" and/or fast foods that are greasy, spicy, and processed. 

Reflux precautions: 
a complex of measures, which are used both as 
a prophylaxis and a therapy of GER.

Diet:
Avoid any acidic products, such as citruses and citrus juices, vinegar based dressings and sauces;

Tomato based dressings and sauces;

French fries, raw onion;

Ground beef, Buffalo wings, chicken nuggets;

Caffeine products;

"Junk" food, spicy, greasy food of any type;


• Eating smaller portions of food, frequent feeding of infants with smaller portions of breast milk or formula.


• Position in a bed (in a crib, for infants) 30-degree head side up. Holding an infant for (at least) 30 min. upright after a feeding, and avoiding a horizontal position after a meal for 2 hours in older children, and 30 min. in infants.

Focus on heavy food in smaller volumes rather than large volumes of liquid foods, e.g.: thicken breast milk or formula with a cereal mixing 1 table spoon to 2 oz. in a bottle or 1 table spoon to 1 oz. if feeding by spoons. Give it to your baby before a bottle of a plain formula or breast feeding. 

Surgical therapy of GERD: is rarely needed, but in some cases of severe GERD (gastroesophageal reflux disease), unresponsive to a full range of conservative measures, surgery may be necessary

Nutrition

Please consider the following website as a reference on nutrition: 
http://authoritynutrition.com 

It is important to know.... by reading this: http://authoritynutrition.com/15-health-foods-that-are-really-junk-foods/

Avoid:

All juices and carbonated drinks, including "sport drinks"
Genetically modified (it is almost all!...) and processed wheat, soy and corn products
high fructose corn syrup
Shortenings - is any fat that is solid at room temperature
Any food which is commercially advertised as "diet", "low fat" or "fat free"
Commercial dressings and all types of commercial sauces
Processed vegetable oils except cold press (extra- virgin) olive oils and coconut oil
I certainly would not encourage anyone to purchase any commercial "diet" products or supplements. 

For those who are looking for further scientific analysis of dieting and nutrition, please go to... 
http://authoritynutrition.com/fix-the-hormones-that-make-you-fat/

Please read from the website below on the subject of gluten sensitivity: 
http://authoritynutrition.com/gluten-sensitivity-is-real/ 

Healthy nutrition for infants and children is an essential determinant of a good health. This topic of discussion is often overlooked by primary doctors. The importance of "healthy food" is perhaps one of the most misunderstood concepts for parents. What makes foods "healthy" is also often very ambiguous. 


Below are some helpful sources that should help clarify these concerns: 
www.hsph.harvard.edu/nutritionsource/ 
www.mayoclinic.com/health/nutrition-for-kids/NU00606

 

Constipation 

Chronic constipation accounts for an average of 3-5% of a pediatric office visits. It is common during a child's first year of life, and even more common between the ages 2 and 4. Insufficient fiber and water in a diet, improper toilet training, and an intentional "holding" of the feces by the child,- are the issues which cause this condition, and must be addressed first. Miralax is an excellent, non-addictive, and easy-to-use medication, but it is not always necessary. See the link below for more information:

http://digestive.niddk.nih.gov/ddiseases/pubs/constipation_ez/

Constipation is not only infrequent (less than 3 stools a week in older children and adults), but also hard and painful stools. Some exclusively breast fed infants may have infrequent stool (less than once a week). Formula fed infants in average 3-6 times a day, and 1-4 year old children 2-3 times a day. Painful defecation (e.g. due to an anal fissure) may lead to a fecal retention behavior, and eventually to fecal soiling.

Constipation and Fiber:

American Academy of Pediatrics recommends fiber of 0.5gr./kg/day up 20 - 35gr. a day. After the age of 2 it may be calculated as an age plus 5. Consider Heather's Tummy Fiber or Benefiter. Benefiter is a natural type of soluble fiber that contains wheat dextrin. This substance is tasteless and dissolves completely in soft foods and non-carbonated drinks, allowing it to be used as a food additive. Benefiter is available in powder, chews and capsules. Avoid chewing pills (contain artificial sweeteners). Mix the powder into juice, coffee and other beverages, blend it into foods like yogurt, pudding or applesauce or add it to recipes . Heat and cooking does not damage the Benefiter. Always maximize amount of fluids (water) intake.

Serve whole-grain bread, such as rye, pumpernickel, whole wheat, oatmeal, and bran. Try to avoid wheat. It is genetically modified; contribute to obesity, and one among "junk food to stay away from".
After 12 month of age serve at least 2 whole fruits and 2-3 vegetables a day. Leave the skin on.
Serve beans frequently.
Introduce variety of nuts early in children diet.
Sprinkle bran over cereals, yogurt, ice cream, but too much bran may cause bloating.
Fruit-eze is great natural product. Strongly recommend!!!

RECIPE:

https://leonardva.wordpress.com/tag/vegetarian-white-bean-dip/
http://www.food.com/recipe/magic-black-bean-brownies-gluten-free-37580
http://www.food.com/recipe/cha-cha-chili-53366


This recipe is recommended for chronic constipation:

4 OZ of finely crushed walnuts, boil with 5 cups of milk for 5 minutes over the low heat. When the broth has cooled, - strain. For a taste you can add a tablespoon of sugar. Take 1/3 cup 2-5 times a day in the morning on an empty stomach.

Dr. Boodish's no fail constipation cure:
1 cup of pitted prunes, chopped

1 cup of figs, chopped

1 cup of sun dried (no sulfates) raisins

2 tbsp. chopped apricots

Combined all above ingredients with 1/2 cup of boiling water. Stew for 1 hour, add more water if too thick. It should have a consistency of preservatives. Serve as desired.


IT IS GREAT FOR KIDS WITH CONSTIPATION: 
Juice plus fiber to order...1-800-431-1119.www.fiberjuice.com 

There is currently more date in support of using Probiotics for infants and children with chronic constipation.

Soiling

As a diagnostic consideration, fecal soiling (encopresis) should be considered in children above 4, who pass their stools in places other than a potty or a toilet bowl. It is often associated with constipation, especially due to an intentional fecal retention (holding). An aggressive therapy of constipation, and toilet training are usually sufficient treatments. See links below for details:

http://kidshealth.org/parent/emotions/behavior/encopresis.html

http://www.healthychildren.org/English/health-issues/conditions/emotional-problems/pages/Soiling-Encopresis.aspx

Excellent....Laxin Forte is a natural product (a fiber extract) for a therapy of constipation, and it can be ordered online ( amazon.com).

For any age....one of the best favor you may do for your digestive system, is drinking a full cup of a hot water with squeezed half lemon every morning (as early AM as possible). Try to convince your kids to make it as their habit.

An update on safety of Miralax use:
http://6abc.com/news/parents-say-over-the-counter-medicine-sickening-kids-/1753317/http%3A%2F%2F6abc.com%2F1753317%2F

By looking at a considerable usage of Miralax over many years, most of experts feel that it is safe. But, if the family has remaining concerns since the question has not "technically" been answered, then I give them the option of switching over to milk of magnesia. Magnesium hydroxide has been used for 70+ years and is extremely effective in softening the stools. It can be given as a liquid- straight or mixed into food or milk. There are tablets that can be swallowed or chewed. Start with 400 mg per 5 mL or 400 mg tablet and adjusted based on age and weight of the patient. Is safe to increase or reduce the dose based on your child's response. The only downside to giving too much is diarrhea.
SORBITOL:
Usual Pediatric Dose for Constipation

2 to 11 years: 
Oral: 2 mL/kg (70% solution) once. 
Rectal: 30 to 60 mL (25% to 30% solution) as a rectal enema once. 

Greater than or equal to 12 years: 
Oral: 30 to 150 mL (70% solution) once. 
Rectal: 120 mL (25% to 30% solution) as a rectal enema once.

Going Gluten-Free

While you and your child may feel unlucky to have celiac disease, you should at least feel lucky to know that your child's  condition is not overlooked. A lot of cases (the great majority) are undiagnosed, and it causes a variety of symptoms, complications, and associated maladies. Celiac Disease is a common genetic condition, presented as an inability to tolerate gluten, a protein found in wheat, rye, and barley. The treatment of Celiac disease is a strict avoidance of a food made of or contaminated with any of these three "toxic" products. Contaminants may be found in medications, cosmetic products, vitamins, toothpaste, etc. There is also a lot of conflicting information about "gluten sensitivity", gluten allergies, the role of gluten in irritable bowel syndrome, and some other conditions as well. Many studies are trying to answer those questions, but the best piece of advice I may offer at this point is: Do your home-work, build your knowledge using reputable scientific and medical journals, and use your best judgment. The good news is that:

Strict avoidance of gluten leads to a fast recovery
Certified gluten free products are easy to find, and they are both tasty and healthy.
Below are some helpful websites, books, and the support groups:

http://www.gastrokids.org/content/3/en/Celiac-Disease
http://www.celiac.org/
http://www.celiac.com/categories/Celiac-Disease-%26amp%3B-Kids-by-Danna-Korn/
Korn, Danna: "Kids with Celiac Disease". A Family Guide to Raising Happy, Healthy, Gluten-Free Children. Woodbine House.


Please, read my recent article.....Gluten-sensitivity: A Growing Problem?

There is a significant degree of confusion when it comes to recognizing the difference between three conditions: celiac disease, gluten sensitivity, and wheat allergy. The basis for all three is a reaction to gluten- a protein component of wheat, rye, and barley. Gluten sensitivity (GS) may be defined broadly as a spectrum of disorders, which include celiac disease and wheat allergy. In both, gluten has an adverse effect on the body.

The symptoms of GS include, but are not limited to abdominal pain, bloating, diarrhea, weight loss or failure to thrive, joint pain, muscular disturbances, headache, and fatigue. Celiac disease is a more clearly defined condition within the spectrum of GS, where the genetic and immunologic essays for it are well developed. Along with these essays, a biopsy of the intestinal mucosa must be conducted as the ultimate diagnostic test, whenever celiac disease is suspected.

Non-celiac disease GS can be defined as a combination of symptoms usually shared by celiac disease, wheat allergy, and irritable bowel syndrome, but celiac disease and wheat allergy are eliminated as possible diagnoses, based on an appropriate work up. This work up may be done through your child’s primary doctor, pediatric gastroenterologist, or a pediatric allergist service.

While both celiac disease and wheat allergy represent adaptive immune responses (auto-immune in the case of celiac disease), and may be classified as delayed hypersensitivities by nature, non-celiac GS is an innate response, e.g. a reaction which is congenital (children are born with it), immediate in nature, and lacking an immunologic memory. Non-celiac GS is less severe in its expression, and does not produce any morphological changes in the gastrointestinal mucosal lining (a feature of celiac disease). Children with non-celiac 1

Allergies, particularly those to wheat, are recognized by a positive immunoglobulin serologic essay, and/or a skin prick test usually done by a pediatric allergist. While all patients with celiac disease and non-celiac GS must restrict their diets of any source of gluten (wheat, rye and barley), those who only have a wheat allergy should avoid wheat only.

Currently, there is no reliable test to detect non-celiac GS. If the clinical picture reflects that there is possible gluten sensitivity, the only way to prove or disprove this is through a strict gluten elimination diet. Conditions such as irritable bowel syndrome, chronic headaches, chronic fatigue, and arthralgia’s can justify a high index of suspicion of GS.

A clear differentiation of these three clinical entities within the spectrum of GS is the first, important step in the approach to your child’s health problem, which is possibly related to sensitivity to gluten. There is a significant growth in the incidence of celiac disease. At least two recent immunological studies have compared samples obtained 50 years ago from military recruits to a matched group of modern-day young people. There was a 400-450% increase in prevalence of celiac disease in the latter sample. The cause of this increase is debatable. Possible triggers include modern changes in the bread-making process, plant breeding, breastfeeding trends, rise in cesarean birth, and the excessive use of antibiotics, which could result in a change of intestinal microflora.

It is also estimated that close to 1% of the US population has celiac disease, but only 10% of those who have it are diagnosed. On the other hand, because there are no biomarkers for non-celiac GS and wheat allergy, it is impossible to conduct any retrospective study to compare the prevalence of either of these two conditions.

In conclusion, the three types of GS should be recognized and distinguished based on a clinical presentation and an appropriate work up. A gluten free diet is becoming easier to uphold now due to a wide availability gluten free products and public awareness.

Discuss the possibility of your child having GS with your primary doctor as soon as possible, for a simple solution to your child’s medical condition may be achieved by dietary modifications. 

Please read from the website below on the subject of gluten sensitivity:   http://authoritynutrition.com/gluten-sensitivity-is-real/

Crohn's Disease & Ulcerative Colitis (Inflammatory Bowel Disease or IBD)

There are two serious chronic inflammatory conditions of the gastrointestinal tract, both classified under the umbrella of "Inflammatory Bowel Diseases" (IBD). One is called Crohn's Disease (CD), and the other, Ulcerative Colitis (UC). Both may cause symptoms ranging from mild, where it may take months or even years before feeling the need to ask for professional medical advice, to severe, where initial presentation requires immediate hospitalization. The severity of later (chronic) episodes may or may not correlate with the severity of the initial presentation. 

In general, there are three recognized groups of IBD patients:

1) Those that have severe disease, often with involvement of an extensive segment of the bowel

2) Those that have a mild disease

3) Those that have an intermediate disease course

At times, aggressive management, using advanced "biological" and immunosuppressive therapy is necessary, and (though rarely in children) surgery may be a last resort.

Any child who has any of the following symptoms: chronic episodes of abdominal pain, blood in the stool, chronic diarrhea, weight loss or inadequate weight gain, or delay of sexual development, must be seen by a pediatric gastroenterologist as soon as possible.

 

Below  are also a helpful websites:

http://www.gastrokids.org/content/7/en/IBD

www.pedsibd.org

www.justlikeme.org

www.ccfa.org

 

Nutritional Aspects of IBD:

 

There are some clinical situations, when the diet (e.g. elemental formula, tube feeding) may become essential as the only available therapy. Most specialists agree (I want to be optimistic), that the diet, as well as the life-style in general, must be addressed in each case.

Food to be encouraged: Whole food (organic in many instances is important too), free of a processed and "junk" food. It is best to prepare food yourself, and avoid fast food as much as possible.

 

Focus on high protein sources, such as organic chicken and turkey, fish, legumes, and soy. Homemade soups, using a variety of vegetables, and high quality protein sources are particularly helpful during a flare-up.

Drink vegetable juices, particularly from Cabbage. Stay well hydrated. Organic yogurt or kefir should be a part of a daily meal (especially, breakfast).

 

Food to be avoided:

All products (especially packaged) with:

-Refined carbohydrates e.g. white rice, brown and white sugars

-Food high in saturated, hydrogenated, and partially hydrogenated fat

-All greasy foods

 

During flare-ups, stay on low fiber diet. Stay away from fruit juices, caffeine, carbonated drinks, and spicy food (irritating effect on the intestinal mucosa).

Blood levels of vitamins (B12 in Crohn's, Vit. D, Folic Acid), Iron, some micronutrients should be checked regularly, and a daily dose of a potent multivitamins with Iron is usually the rule.

 

There are some preliminary studies, showing an anti-inflammatory effect of Flankicense (Boswellia) as 1,200-1,500 mg of standardized extract 2-3 times a day.

Probiotics: (VSL#3) appear to be beneficial for patients with Ulcerative Colitis, but so far, there is no proof of their benefit in cases of Crohn's.

There some published studies (adult population with Crohn's), which show a benefit of elimination of both dairy products and wheat.

 

Useful references:

Dietary modification has always been in the focus of attention, especially for the majority of families of IBD patients.

www.NIMBAL.org ... this is the whole book on nutrition focused on a Specific Carbohydrate Diet.

 

Celiac Disease

While you and your child may feel unlucky to have celiac disease, you should at least feel lucky to know that you have it. A lot of cases (the great majority) are undiagnosed, and it causes a variety of symptoms, complications, and associated maladies. Celiac Disease is a common genetic condition, presenting as an inability to tolerate gluten, a protein found in wheat, rye, and barley. The treatment of Celiac disease is a strict avoidance of a food made of or contaminated with any of these three "toxic" products. Contaminants may be found in medications, cosmetic products, vitamins, toothpaste, etc.

 

There is also a lot of conflicting information about "gluten sensitivity", gluten allergies, the role of gluten in irritable bowel syndrome, and some other conditions as well. Many studies attempt to answer those questions, but the best piece of advice I may offer at this point is: Do your home-work, build your knowledge using reputable scientific and medical journals, and use your best judgment. The good news is that strict avoidance of gluten leads to a fast recovery. Certified gluten free products are easy to find, and they are both tasty and healthy.

 

Below are some helpful websites, books, and the support groups:

http://www.gastrokids.org/content/3/en/Celiac-Disease

http://www.celiac.org/

http://www.celiac.com/categories/Celiac-Disease-%26amp%3B-Kids-by-Danna-Korn/

Korn, Danna: "Kids with Celiac Disease" ...A Family Guide to Raising Happy, Healthy,  Gluten-Free Children. Woodbine House.

 Gluten-sensitivity: A Growing Problem?

There is a significant degree of confusion when it comes to recognizing the difference between three conditions: celiac disease, gluten sensitivity, and wheat allergy. The basis for all three is a reaction to gluten- a protein component of wheat, rye, and barley. Gluten sensitivity may be defined broadly as a spectrum of disorders, which include celiac disease and wheat allergy. In both, gluten has an adverse effect on the body.  The symptoms of gluten sensitivity include, but are not limited to:

  •   Abdominal pain,
  •   Bloating
  •   Diarrhea
  •   Weight loss or failure to thrive
  •    Joint pain
  •   Muscular disturbances
  •    Headache
  •    Fatigue 

           Celiac disease is a more clearly defined condition within the spectrum of gluten sensitivity, where the genetic and immunologic essays for it are well developed. Along with these assays, a biopsy of the intestinal mucosa must be conducted as the ultimate diagnostic test, whenever celiac disease is suspected.  

           Non-celiac disease gluten sensitivity can be defined as a combination of symptoms usually shared by celiac disease, wheat allergy, and irritable bowel syndrome, where celiac disease and wheat allergy have been eliminated as possible diagnoses, based on an appropriate work up. This work up may be done through your child’s primary doctor, pediatric gastroenterologist, or a pediatric allergist.  While both celiac disease and wheat allergy represent adaptive immune responses (auto-immune in the case of celiac disease), and may be classified as delayed hypersensitivities by nature, non-celiac GS is an innate response, e.g. a reaction which is congenital (children are born with it), immediate in nature, and lacking an immunologic memory.   Non-celiac GS is less severe in its expression, and does not produce any morphological changes in the gastrointestinal mucosal lining (a feature of celiac disease).

          Allergies, particularly those to wheat, are recognized by a positive immunoglobulin serologic essay, and/or a skin prick test usually done by a pediatric allergist. While all patients with celiac disease and non-celiac GS must restrict their diets of any source of gluten (wheat, rye and barley), those who only have a wheat allergy should avoid wheat only. 

          Currently, there is no reliable test to detect non-celiac GS. If the clinical picture reflects that there is possible gluten sensitivity, the only way to prove or disprove this is through a strict gluten elimination diet. Conditions such as irritable bowel syndrome, chronic headaches, chronic fatigue, and arthralgias can justify a high index of suspicion of GS.

            A clear differentiation of these three clinical entities within the spectrum of GS is the first, important step in the approach to your child’s health problem, which is possibly related to sensitivity to gluten. There is has been a significant growth in the incidence of celiac disease. Two recent immunological studies comparing samples obtained 50 years ago from military recruits to a matched group of modern-day young people reveal a 400-450% increase in prevalence of this disease. The cause of this increase is debatable. Possible triggers include modern changes in the bread-making process, plant breeding, breastfeeding trends, rise in cesarean birth, and the excessive use of antibiotics, which could result in a change of intestinal microflora.

            It is also estimated that close to 1% of the US population has celiac disease, but only 10% of those who have it are diagnosed. On the other hand, because there are no biomarkers for non-celiac GS and wheat allergy, it is impossible to conduct any retrospective study to compare the prevalence of either of these two conditions.

Please read from the website below on the subject of gluten sensitivity: 
http://authoritynutrition.com/gluten-sensitivity-is-real/

 

Eosinophilic Esophagitis (EoE)

Eosinophilic Esophagitis (EoE) is a common condition in children, occurring more frequently in boys than in girls. It is usually associated with any of the following symptoms:

Nausea
Problems swallowing (dysphagia)
Vomiting
Stomach pain
Chest pain
Heartburn
Food impaction
Such symptoms are not very specific and often not easy to interpret. Thus, the diagnosis of EoE is rarely, if ever, may be done without an endoscopic exam.

A pediatric allergist must be closely involved with treatment, which is usually focused on dietary eliminations and/or a topical steroid therapy.

The website below may be helpful to you: 
http://www.gastrokids.org/content/5/en/EosinophilicEsoph/agitis

 


Introducing the Concept of a Healthy Lifestyle

An excellent site on a subject of a healthy nutrition is: 
www.authoritynutrition.com

No doubts, a poor quality of food is contributing to a large degree to a rapid spread of obesity, both types of diabetes, and a broad spectrum of gastrointestinal ailments. A "quality of food" is a category, which must be clearly defined to a consumer. There is no acceptable universal definition of it, and such aspects as "taste", "availability", "nutritional values", "hygiene ", "whole ", "organic", "healthy"...are not well defined, and any control of those aspects by producers, distributer, and consumers, is only partial at best.

In my view, food, as a minimum, must have no harmful effect on a body, and that fact must be proven scientifically. The other aspects may be subjective, cultural, etc. For example: it is possible to cause harm, eating the "healthiest" food by overeating it, or using some dietary restrictions resulting in malnutrition. A consumer has the right to have a full guarantee that any food product, legally purchased, can not be damaging for her/his body. There is a plenty of evidence, that in many cases, food processing and preservation methods, modern agriculture, meat and fish industry, are inadequately controlled, and, therefore, the products available for consumers, may have potentially harmful effects.

Please take the fact, that the food industry is a huge for - profit operation, very seriously. Making food "entertaining" and "fun" for your children, the last thing this industry would be concern about is "quality of food".

For an unbiased review of "naturopathic" products: vitamins, probiotic, supplements, etc., usewww.consumerlab.com

Please make every attempt to buy this produce only organic even if you are on a budget: (highly contaminated with pesticides or antibiotics):

Apple
Grapes
Celery
Spinach
Sweet bell pepper
Leafy greens
Peaches
Cucumbers
Strawberries
Nectarines
Domestic Blueberries
Imported Nectarines
Potatoes
Corn
Cherry tomatoes
Dairy
Meat
Poultry
A tip of the day:

For any age....one of the best favor you may do for your digestive system, is drinking a full cup of a hot water with a squeezed half lemon, every morning (as early AM as possible). Try to convince your kids to make it as their habit.

 


Diarrhea

There are several common causes of both an acute and chronic diarrhea in children. It is not a purpose of this website to guide on a diagnosis. It has to be done by a medical professional only.

Please understand, that diarrhea is... a physiologic response of the body exposed to a toxic substance directed to expulsion, and intestine has 2 goals to accomplish: one is to secrete an extra fluid to the intestinal lumen, and the second is to increase the frequency and intensity of the intestinal contractions. For that very reason you have to resist the temptation to use over-the-counter anti-diarrhea medications unless directed by a physician.

There are some basic recommendations: The most important dietary strategy is to stay well hydrated.

Follow hygienic precautions. Infectious diarrhea is highly contagious.

Avoid... milk products (except yogurt with life culture), caffeine, greasy, spicy foods and sugars.

Eat... bananas (slightly under ripe), boiled potatoes, cooked carrots, cooked chicken, boiled rice, toasts, apple sauce.

Carob powder start with 1 tablespoon mixed with some honey and applesauce for the taste on empty stomach. Take probiotics ( e.g. Culturelle, VSL#3, Keybiotics) 2 times a day with meals.

Boil 1 teaspoon of rice with 7 cups of water till the rice is soft, strain, drink 1/3 of a cup every 2 hours.

Blackberry root bark (Reebus Macropetalus), containing tannins, 1 teaspoon every 2 hours.

Peel pomegranate, dry the peels well (on a sun), cut to pieces and store them in an air-tight container. Make a tea from the dry peals, strain and drink as a remedy for diarrhea.

Have a medical professional to examine your child early. Both an acute and chronic diarrhea may require a workup, aggressive therapy and hospitalization.