Keeping Kids Healthy

1. Keeping Kids Healthy Dr. Emily Maiella Naturopathic Physician 432 Greenfield Rd Montague MA 01351 413.230.4462

2. With pediatric patients Herbal Safety Types of Herbal Preparations Compliance Issues Dosing Specific for Children Childhood Illnesses Parental satisfaction

3. Immune Support(Prevention and Acute) Vitamin D Probiotics Elderberry (Sambucus) Andrographis Be prepared. Have medicines on hand.

4. Cold and Flu Prevention Basic Prevention, try to have the whole family on the following…. Research backs it up!

5. Randomized trial of vitamin D supplementation to prevent seasonal influenza A (H1N1) in schoolchildren. DESIGN:From December 2008 through March 2009 a randomized, double-blind, placebo-controlled trial comparing vitamin D(3) supplements (1200 IU/d) with placebo in schoolchildren. The primary outcome was the incidence of influenza A, diagnosed with influenza antigen testing with a nasopharyngeal swab specimen.

6. Proves really effective! • RESULTS: Influenza A occurred in 18 of 167 (10.8%) children in the vitamin D(3) group compared with 31 of 167 (18.6%) children in the placebo group. The reduction in influenza A was more prominent in children who had not been taking other vitamin D supplements and who started nursery school after age 3 y. In children with a previous diagnosis of asthma, asthma attacks as a secondary outcome occurred in 2 children receiving vitamin D(3) compared with 12 children receiving placebo • CONCLUSION:This study suggests that vitamin D(3) supplementation during the winter may reduce the incidence of influenza A, especially in specific subgroups of schoolchildren. • Am J Clin Nutr. 2010 May;91(5):1255-60. Epub 2010 Mar 10.

7. How Vitamin D works…. In a study published in the journal Nature Immunology, researchers from the University of Copenhagen found that when a variety of white blood cells known as a T-cell comes across a pathogen (virus, bacteria, tumor, fungus) in the bloodstream, it extends a receptor in search of vitamin D. If the WBC encounters the vitamin, the T cell becomes "activated." If there is not enough vitamin D in the blood, the cell remains passive and no immune response occurs.

8. How Vitamin D works.. The body produces vitamin D upon exposure to sunlight. It can also be found in eggs, fatty fish, fortified milk and in supplement form. Once activated, (by vitamin D) a T-cell transforms into one of two kinds of cells. One type seeks out and destroys all traces of the infectious agent, while the other records information about the pathogen and transmits it to other parts of the immune system. These latter ("helper") cells help the immune system respond quickly should infection with a similar pathogen occur at a later date. http://ods.od.nih.gov/factsheets/vitamind

9. Can’t help but to share Side note: all of the other conditions which Vitamin D is extremely helpful for: Colon and breast cancer prevention Auto-immune conditions of all types Multiple sclerosis Osteoporosis/osteopenia

10. Probiotics=for life

11. Effect of Lactobacillus gasseri, Bifidobacterium longum, B. bifidum on common cold episodes: a double blind, randomized, controlled trial The aim of this study was to investigate whether the consumption of Lactobacillus gasseri, Bifidobacterium longum, B. bifidum, during at least 3 months influences the severity of symptoms and the incidence and duration of the common cold. METHODS:A study was performed over at least 3 months during winter/spring periods. 479 healthy adults (aged 18-67) were supplemented daily with vitamins and minerals with or without the probiotic bacteria. Cellular immune parameters were evaluated in a randomly drawn subgroup of 122 volunteers before and after 14 days of supplementation. During common cold episodes, the participants recorded symptoms daily. Stool samples were collected before and after 14 days of probiotic supplementation to quantify fecal Lactobacilli and Bifidobacteria using qRT-PCR.

12. Probiotics shorten duration • The total symptom score, the duration of common cold episodes, and days with fever during an episode were lower in the probiotic-treated group than in the control group: • A significantly higher enhancement of cytotoxic plus T suppressor cells (CD8+) and a higher enhancement of T helper cells (CD4+) was observed in the probiotic-treated group • The intake of probiotic bacteria during at least 3 months significantly shortened common cold episodes by almost 2 days and reduced the severity of symptoms • Clin Nutr. 2005 Aug;24(4):479-80.

13. How probiotics help…. From the very first breath you take, you're exposed to probiotics. On the way through the birth canal during a vaginal deliver, a newborn gets dosed with bacteria from their mother’s birth canal. This event starts colonization in the infant's gastrointestinal (GI) tract of 'good' bacteria. N New research now shows many caesarean-section infants have less-than-optimal health after birth. This is most likely because they are not exposed to the mother's healthy bacteria in the birth canal which would then serve to populate its own GI tract.

14. Probiotics ( = for life) As you mature, you're faced with many threats to the beneficial bacteria in your gut... from chlorinated drinking water... to overly-processed foods.The 'good' bacteria in your gastrointestinal system can only provide you with optimum health if the proper balance of different types of bacteria is maintained in your gut. This is where probiotics can have a profound effect... not just on your GI health, but on your overall health as well.

15. The intestine is the largest immunological organ in the body and contains 70% to 80% of all IgA-producing cells. When exposed to a virus (etc) by the oral route, a secretory immune response is obtained, which is mediated by secretory IgA. probiotics increase the number of IgA-secreting cells, which migrate from the Peyers patches to distant mucosal sites such as the respiratory glands. This is where the gut and respiratory tracts interface.

16. The Gut and EENT inteface the mucosal barrier also makes up our mouth, throat, eyes, the upper part of our lungs, nasal cavity, the urethra in men and women, and the vagina in women. So those external surfaces are also covered in secretory IgA. • Probiotics also increase T-cell production of TNF-α in response to adenovirus exposure and influenza A (variant of H1N1) exposure

17. For your own research…. probiotics and eczema, allergies and asthma

18. RSV Most common serious acute respiratory illness in infants and young children Can manifest with mild cold-like symptoms Can also be severely acute and can include coughing, quick/short breaths (fast breathing greater than 50 breaths per minute), labored breathing and lack of oxygen. Infants- want to sit up (more fussy laying down b/c they can’t catch breath).

19. COUGH/RSV • INCIDENCE • RSV affects nearly ALL infants by the age of 2, most are not acutely affected. • 125,000 children hospitalized each year, 1-2 % of these will die from it. • Infants less than 1 year of age are most severely affected. • Generally seasonal between Fall and Spring of every year. • Can affect adults as well. • WHO’S AT RISK? • Spread easily by physical contact. Can live for half an hour on hands or five hours on countertops and used tissues. • Infants born prematurely, with chronic lung disease, immunocompromised or with some forms of heart disease are at a greater risk. • Exposure to tobacco smoke, daycare or carrier siblings are also at higher risk.

20. RSV • SIGNS/SX • Nasal congestion • Nasal flaring • Cough (often croupy or barking) • Tachypnea/labored breathing or SOB • Hypoxia (cyanosis) • Wheezing • Fever • Symptoms usually appear 4-6 days after exposure • Sequela • Can be mild cold or lead to pneumonia and bronchitis can set up for damage towards asthma- • Can lead to otitis- drainage more thick mucous than other colds and viruses can lead to separate infection to ear. • Respiratory failure is a concern. • Asthma-may get asthma 6 months later not uncommon

21. RSV TREATMENT Thyme and Eucalyptus essential oil rubbed on chest and under nose. Gaia herbs makes a really nice chest rub, formulated by Dr. Mary Bove • Quercetin powder (1/4 tsp twice a day) opens up airways mildly, mucolytic, and for inflammation, for acute cough. 500mg 2x/day, mix it in applesauce. • Vitamin C 50mg x age in years, twice a day. • Echinacea 1 drop for every 2 lbs. body weight given every 2 hours • Composition Essence Gaia makes it- children - eclectic formula. 5 drops in warm water. Tastes sweet and warming. Put it in drinking water. Use it when things are more severe than in a mild cold.

22. RSV/COUGH TREATMENT Wet or dry cough formulations with antivirals • Glycyrrhiza (wet or dry) • Melissa officinalis • Lobelia (wet) • Prunus serotina • Viburnum spp. • Verbascum • Hyssop • Thymus vulgaris • Inula • Anise

23. COUGH/RSV TREATMENT • Homeopathic Treatment (Spongia, Pulsatilla, Drosera, Ant-t for barking cough) Antimonium and carbo veg (likes to be fanned)-hypoxia and blue • Humidifiers-humidifying room, and essential oils on stove in water, can get oils in air with humidifier but may get germs into air. Use hot-air humidifiers. • Hydrotherapy • Steamy bathroom • Constitutional hydrotherapy -Wet/warming sock treatment (for warming sock treatment, go to my website for print out)

24. Syrup of Thyme and Ivy Leaves 1234 children and adolescents (623 boys and 611 girls) ages 2-17 with acute bronchitis and productive cough Non-interventional post-marketing surveillance study Treatment days: 0, 4 and 10 Acute bronchitis with productive cough in children and adolescents can be treated safely and effectively with the thyme and ivy syrup. A ten-day treatment using age-appropriate dosages led to a clear improvement in the symptoms or cure with very good tolerability. Marzian O. “Treatment of acute bronchitis in children and adolescents. Non- interventional postmarketing surveillance study confirms the benefit and safety of a syrup made of extracts from thyme and ivy leaves” MMW Fortschr Med (2007 Jun 28) 149(27-28 Suppl):69-74

25. Andrographis Treatment of acute infectious viral or bacterial diseases of the respiratory, urinary and GI systems. • Randomized, double-blind, placebo controlled clinical trial • •152 Patients with acute pharyngotonsillitis • •6 grams daily for a week • •Relief of fever and sore throat • equal to paracetamol (over the counter pain reliever) • Lower doses found not to be as effective • Thamlikitkul V., Dechatiwongse T., Therapong S, et al, J Med Assoc.Thai 1991;74(10);

26. Andrographis: Acute and PREVENTATIVE • 107 healthy children • 200mg /day of andrographis ( 11.2mg andrographolides) or Placebo for 3 months (equals 1 gram herb) • By the 3rd month –significant decrease in the incidence of colds in the andrographis group compared to the placebo group. • The relative risk of catching cold was 2:1 times lower for the andrographis group. • (Caceres DD, Hancke JL, Burgos RZ, et al. Phytomed 1997;4 (2) 101-104)

27. Andrographis • This is a great herbs to initiate for prevention if your child has a history of ear infections, chronic bronchitis • Increase the dose, triple it if on a preventive dose if child gets sick. • Andrographis treatment can significantly shorten the course and duration of the common cold • Hancke J., Burgos R., Caceres D., Phytother 1995: 9:559-562

28. Andrographis Pediatric Dosing • Prevention use .5-1 gram powder, .5-2 mls liquid extract daily • Acute infection use 2 grams powder or 4 mls 1:2 liquid extract • Combine with warming herbs such as ginger, cinnamon, and astragalus • Safety, toxicity and contraindications; • No significant adverse effects have been noted. • High doses may cause gastric discomfort, anorexia, and vomiting. • Contraindicated in pregnancy (animal studies)

29. Andrographis • Acute bacterial infections of GU, GI and respiratory systems. • Good for an alternative long term antibiotic.

30. Long used in both Chinese and Ayurvedic medicine, this intensely bitter herb has powerful antiviral activity. Bitter tonic, immune stimulant, anthelmintic, antihepatotoxin, cholagogue and anti-inflammatory. It can be used for colds, influenza, sore throats, Lyme disease, hepatitis and other viral infections. In India it is considered superior to quinine for malaria. It is also used for infestations of intestinal parasites such as Giardia, Blastosistus hominis and Dientaoeba fragilis.

31. SAMBUCUS NIGRA(Elderberry) • Elderberry Extract Inhibits Several Strains of Influenza • Controlled, double blind study • 6 day outbreak of influenza B • Significant improvement of symptoms in 93% of group in 2 days • In vitro studies have shown inhibition of influenza types A and B • J. Altern. Comp. Med 1995

32. Sambucus/Elderberry • The fruit has always been an anti-flu remedy, but don’t forget about the flower parts too! Great fever herb. • Keeping it in mind for all chronic viral infections, herpes etc. • Start in September, end in January for prevention.

33. Anti-viral Action of Berry • Constituents neutralize the activity of the hemagglutinin spikes found on the viral surface. When these hemagglutinin spikes are deactivated the viruses can no longer pierce cell walls, enter the cell and replicate. • Influenza viruses A and B, Herpes simplex virus type 1 (HSV-1) • Zakay-Rones Z, Varsano N, et al. Inhibition of several strains of influenza virus in vitro and reduction of symptoms by an elderberry extract (Sambucus nigra L.) during an outbreak of influenza B Panama. J Altern Complement Med 1995;1:361-369. • Zakay-Rones Z, Thorn E, et al.Randomized study of the efficacy and safety of oral elderberry extract in the treatment of influenza A and B virus infections. J Int Med Res 2004;32:132-140.

34. Elderberry • The berry helps to colonize good gut flora b/c of the phytophenols. High Anti-oxidant and anti-inflammatory qualities. • Indicated for those respiratory infections that have a lot of mucus, b/c kids swallow the mucus, and that alters the flora. And remember what happens when the flora gets altered…trouble!!

35. Not just anti-viral! 2011 Elderberry Study • Inhibitory potential of the extract on the propagation of human pathogenic H5N1-type influenza A, influenza B virus, and clinically-relevant human respiratory bacterial pathogens • RESULTS: a standardized elderberry liquid extract possesses antimicrobial activity against both Gram-positive bacteria of Streptococcus pyogenes, group C and G Streptococci, and the Gram-negative bacterium Branhamella catarrhalis in liquid cultures

36. Not just anti-viral! 2011 Elderberry Study • The liquid extract also displays an inhibitory effect on the propagation of human pathogenic influenza viruses. • CONCLUSION: elderberry liquid extract is active against human pathogenic bacteria as well as influenza viruses. Krawitz C, Mraheil MA, Stein M, et al, Inhibitory activity of a standardized elderberry liquid extract against clinically-relevant human respiratory bacterial pathogens and influenza A and B viruses. In: BMC Complement Altern Med (2011) 11:16

37. Elderberry Dosage • Minimizes those post-viral bacterial infections! • Elderberry fruit syrups- standardized to 30-38 percent elderberry • Powdered extracts- 500 mg (capsule) 2-3 times daily for 3-4 days • Liquid form, dosed at one tablespoonful (15 ml) three times daily • Acute viral infections- treat at least three days

38. EARACHE Pain and or discomfort in or around the ear. An earache develops when the tissue lining the middle ear or eustacian tube swells. Immature Eustachian tube (the tube that connects the middle ear to the throat). In infants and young children this tube is much shorter and is angled. It is therefore much easier for bacteria to migrate from the nose and throat up into the middle ear space. As the child grows this tube becomes more vertical, so germs have to travel "up hill" to reach the middle ear. This is one-reason children "outgrow" ear infections.

39. Otitis Media Inflammation of the middle ear with the development of a bacterial infection. Immune response to this infection causes a collection of fluid in the middle ear space or a rupture of the tympanic membrane due to the fluid build-up.

40. EARACHE Earache may be due to acute ear infection (otitis media), water or fluid in the ear (swimmers ear/ otitis externa) or inflammation/ blockage of the eustacian tube due to allergies, associated respiratory infections (eg. colds), travel (air or to higher altitudes) and sometimes accompanies teething and physiological obstructions.

41. EARACHE/OTITIS MEDIA Ear pain or discomfort, with or without respiratory symptoms Fever Drainage from ear if tympanic membrane bursts Sleeplessness (ear pressure increases while lying down) Irritability Change in eating habits Change in hearing Refusal to nurse on side that hurts, pain worse when lying down. vomiting

42. EARACHE/OTITIS More frequent in the winter Teething- assoc. with fluid production consumption of cows milk in early childhood feeding position (bottles while lying down) smoking in household fetal alcohol exposure genetic predisposition (eg. Children with Downs Syndrome) Family predisposition decrease in IgG2 or IgA prior episodes of otitis media poor nutritional status daycare setting early introduction of solid foods Underlying viral infections (RSV or Influenza), Underlying food or environmental allergies Association with pacifier use

43. EARACHE Have your child seen immediately if…… • Ear pain accompanied with fever >105.0 F (R/O severe infection, mastoiditis) • Any fever in infants < 12 weeks old. • There is pus, blood tinged or other abnormal colored fluid draining from ear. • Pointed object was inserted into ear canal (eg. Pencil, stick, etc>) (R/O perforated eardrum) • Child is in severe pain and cannot nurse, sleep, etc. • Stiff neck or headache ( R/O meningitis) • Vomiting or Chills

44. EARACHE AT HOME Keep child in upright position (when sleeping prop up on pillows. Use heat to help bring circulation and soothe the area. Warm onion treatment: cut onion in half or in very slick slice. Bake for 15 minutes or microwave for about 2 (until steaming) Wrap onion in gauze or clean cloth (should feel warm but not too hot!) Apply to ear area until relief is felt. Repeat as necessary. Warm olive oil infused lavender essential oil or commercially prepared eardrops infused with garlic and mullein. (Never place anything in ear if a ruptured or perforated eardrum is suspected)

45. EARACHE Keep child well-hydrated and decrease sugar intake Give immune support teas made with herbs such as lemon balm, echinacea, chamomile, garlic, and astragalus. Zinc, Vitamin C, Essential fatty acids (omega 3 and 6) If antibiotics are used or have been used in the past supplement with probiotics to help restore normal gut flora.

46. Homeopathics for EARACHES • Homeopathy: Some of the more commonly used to treat ear infection include: • Pulsatilla- weepy, clingy, wants to beheld, extremely changeable mood, better in open air, fever 100 to l02, little or no thirst, refusal to drink • Belladonna- earache comes on suddenly with intense pain, may have fever up to 104, hot and flushed face, dilated pupils • Chamomilla- extremely irritable and changeable, does not know what he wants, worse in the evening, needs to be carried back and forth

47. EARACHE • Antibiotic treatment is most likely indicated if there are signs of systemic bacterial infection, mastoiditis, or other complications. • Antibiotics: risk of resistant strains, increased risk when child has been treated with antibiotics in the last 3 months. The absence of overt symptoms does not mean bacterial infection is cured.

48. EARACHE • Pain reliever and anti-inflammatories (ibuprofen or acetominophen. are often given to reduce pain and fever. But I usually recommend riding the fever out. • New research is suggesting that 80% of uncomplicated ear infections will resolve within 4 to 7 days without antibiotics. • Aspirin and salicylate containing compounds should never be given to children.

49. Myringotomies • Surgical techniques are often done to treat children who have chronic recurring incidence of ear infections. • before undergoing such extreme measures underlying causes such as food allergies or nutritional deficiencies should be ruled out. • Myringotomies can cause permanent scarring and thickening of the eardrum.

50. Playing more, Breast-feeding less • Common in early childhood, greatest risk age 2-5. b/c stop breast feeding, put everything in mouth, and increased socialization. • Increased incidence in the pre-school setting due to exposure to increased number of bacterial serotypes at a time when structurally the eustachian tube is most at risk for congestion.