Dr. Thompson's Blog

Eating Disorders in Children

I was talking with a father a few days ago who was concerned about the eating habits of his little six-year-old. The child would not eat meat or chicken and just wanted fruits and vegetables. The family were not vegetarians. The father said  his daughter would eat a hamburger at McDonald's and loved chicken nuggets and other fast foods. He also said his wife was a very picky eater and would smell food before she would eat it. I asked if the father liked to cook and he said that he did. "Why don't you buy a children's cook book", I suggested, "and cook some of the dishes with your daughter. "That's a great idea" the father said. "I'll go to Barnes and Noble this afternoon and get one." I also suggested he should ask the family doctor or pediatrician  to talk with his wife and if necessary a dietician could talk with the woman.  My concern was that the child was being set up for a possible eating disorder. Children usually mimic what their parents eat. For example, when I see a greatly obese child, I look at the parents and usually one or both of the parents are quite obese. I think parents have to be careful about the eating patterns  they establish.

If you have had to be the doctor for a child with anorexia or bulemia or other eating disorders, you want to nip any problems in the bud before a serious eating disorder occurs.

Are Children What They Eat?

There is an old saying that "We are what we eat". In this day of fast foods, many hard working, extremely busy parents, it is often difficult to provide healthy food. Also, the cost of good food seems to get higher and higher. The emphasis now on obesity in children is good, but trying to get the kids to eat foods without lots of fat  in it, is often difficult. I was visitng a school the other day and saw a small, somewhat overweight child eating carrots, but putting thick salad dressing on each small carrot. I have never seen a child do that and wondered where he learned this or where he got the packet of dressing?

I often tell medical students about the child who was referred to me from an excellent pediatrician. The child was showing signs of muscle weakness and was always tired. He was also quite irritable. I coukldn't find anything, when I examined the child, that made me think of a muscle disorder. In talking to the mother and finding out about the family's life, I discovered she was an extreemly hard  working single parent. I asked her to send me a three-day list of everything the boy ate and she did this right away. The list was primarily composed of fast foods with little fruits, vegetables, or salads. I talked to the mother at length and gave her some ideas about how she could shop on weekends and draw up a menu  plan for the week, as I did when my chidlren were at home and not in college. After about two weeks, I had a call from the mother saying the life of the whole family had changed and the  little boy was full of energy, had no more signs of muscle weakness, and was no longer irritable. I wished I could cure other muscle diseases so easily.

 

 

Additional Thoughts about Stomach Aches in Kids

I didn't have room yesterday on this Blog to add more thoughts about stomach aches in kids. I would never, ever say a child had a "functional" stomach ache unless I was sure that there was not a medical problem. Kids can have ulcers just like adults and they can have ulcerative colitis. One thing that most doctors fail to do is to get or take a diet history. I have been told multiple times by medical students and house staff that I am the only doctor they have ever been around who took a diet history. What I often do is to ask the child's parent to keep a three-day record of everything their child eats and then mail it to me. I have seen some quite amazing and really incredible diet histories! No wonder a child was having stomach aches eating only fast food and lots of fried food with few or no fruits and vegetables.

One of the other reasons that children can have stomach aches is when they they have an unrecognized learning disability.  This can be a reading problem, a writing problem, or an auditory processing problem and it may be combined with hyperactivity. If you can't understand what is going on in school or are always in the lowest reading group or at the bottom of the class academically, you can easily see why stomach aches could result. There are some so-called neurological soft signs that can be detected on a physical examination which can help a physician consider a learning disability. Of course, if a complete physical examination is not done, these will not be detected. If they are, present, a child needs to be tested by an experienced child psychologist to see if a learning disability is present. School psychologists may or may not have adequate time and experience to detect a learning disability.

Stomach Aches in Children

I was bothered by Dr. Perri Klass' article on abdominal pain in children in the 11/23/10 New York Times.  Dr. Klass is a well respected Harvard pediatrician, as well as an author. However, I believe her conclusion that so many cases of abdominal pain in kids are functional is overstated. In  my fifty years of practicing pediatrics and seeing kids from all walks of life, I believe making the diagnosis of functional pain and prescribing sedatives or counseling is not a wise aprproach unless some other problems are considered.

One of the most important problems Dr. Klass failed to discuss is allergy. Many children get stomach aches because they are allergic to specific foods. This is not celiac disease; this is allergy. There may be a family history of allergy and a child may have other signs of the so-called allergic diathesis, such as eczema, hayfever or asthma. A pediatric allergist can often make the correct diagnosis. A doctor friend developed severe headaches and stomach aches and every possible test was done except for allergy tests. Finally, my doctor friend solved the problem by realizing that chocolate was the cause of her headaches and stomach aches.

The other significant omission in the article is urinary infections or problems with the urinary system. Congenital abnormalities of the kidney, bladder, ureters, and urethra are often not considered and urinary infection can be a significant cause of abdominal pain. A urinalysis and urine culture should always be done, as well as a study of the urinary system. I have solved many kids' stomach aches with this approach. There is often a history of urinary malformations and problems in a family.

Sudden Infant Death and Sleep Positioners

I was greatly concerned when I read the article in today's New York Times about the risk of infant sleep positioners. I cannot understand how any pediatrician would recommend these and yet this is what happened. The article by Gardiner Harris and Andrew Martin told of an eight-week-old twin who died when one of these was used in his bed. According to the article, the mother said her pediatrician told her to put the infant on his side "to aid with indigestion". I cannot imagine what the doctor was thinking. If the baby had some medicines or foods that didn't agree with him, there are other ways to handle it. Perhaps the mother was nursing the baby and was eating something that upset the baby. I wonder if the doctor even went over the mother's diet? This seems to be something that doesn't seem to happen very often. I have been told by medical students and pediatric residents that I am the only doctor they have ever heard discuss either a nursing mother's diet or a child's diet. The old fashioned practice of medicine still pays off. Many foods, as well as medicines, go through  breast milk and cause problems for babies. I wonder if the doctor checked on any medicine the mother was taking and also was she drinking herb teas which may cause problems.

I had a mother come into my office one day after Thanksgiving saying her baby was crying a lot and something was upsetting him. On physical examination, I could not find anything wrong, so I asked the mother what she had eaten the last few days. The woman told me about her diet and it turned out that she had had rutabagas on Thanksgiving. I suspected that this was the cause of the baby's crying since the mother  had never eaten that before and sure enough after two days the baby was happier. I don't think I still know what rutabagas is but it apparently caused a lot of trouble.

Fortunately, the FDA says they are going to start "policing the market for infant comfort and sleeping devices more aggressively" according to the article. I hope more pediatricians go back to the basics of practicing pediatrics and talk to their mothers without resorting to artificial means to solve children's problems.