Leslie Solomonian, ND and Zeynep Uraz, ND
Treating children is a special and unique opportunity that most NDs likely will encounter at some point during their practice. With these special patients come special challenges and opportunities.
When parents bring their child to see a complementary healthcare provider, they often have to hear the opinions of others in the child’s community. Everybody in the child’s life, including the medical doctor, grandparents, daycare teacher and babysitter, may feel like they have a say in how the child should be raised. In some cases, a recommended naturopathic therapy goes against the grain and challenges fundamental beliefs about nutrition and proper health. This is when dealing with pressures outside the home can be very trying on the ND-patient relationship. In addition to the challenges coming from the child’s community, obstacles can arise within the family home that can make treating the pediatric patient especially interesting. This may include issues involving setting limits and boundaries, dosing and administering products, and dealing with families that are resistant to change. With education and a little creativity, obstacles both inside and outside the home can be transformed into opportunities that have a positive effect not just on the child, but also on the child’s family and community as a whole.
Empowering Parents
Controversial topics concerning naturopathic care of a pediatric patient always exist. Issues such as fever management, vaccinations and elimination of nutritional allergens such as dairy can create resistance from the parent. Recommending changes that oppose standard medical practice can be an uphill battle. In cases such as these, education is the most powerful tool. In our practices, we find it most useful to work with the parents on their terms. If the parent is most interested in medical research and hard facts, it is best to use research as your source of education. For a parent who is most concerned about what others will think, it can be useful to encourage them to give the recommended therapy a trial run for a period of time and make a long-term decision later.
One example is Michael, a three-year-old boy who was plagued with frequent ear infections. His specialist had scheduled him for a tympanostomy and adenoidectomy three months hence. After explaining the pathophysiology of ear infections and the connection to diet and immune health, we started with some basic recommendations. Concerns were raised around such suggestions as removing dairy from the diet, so we discussed alternate sources of calcium and vitamin D, as well as other factors that contribute to bone health. We agreed that if Michael did not develop another infection before his surgery, it would be canceled. The family was very compliant with the protocol, and he did not get another infection; however, the mother still felt pressure from the surgeon to proceed with the surgery. More information was provided about the risks and benefits of the procedure, as well as the risks and benefits of avoiding it. With discussion and empowerment of the mother, she canceled the surgery and Michael is doing extremely well to date, with no further infections.
In an ideal scenario, an additional benefit of this approach is that the medical practitioner will also witness the efficacy of naturopathic therapies. Empowerment really is the key, as parents can receive an enormous amount of pressure from many directions. A good understanding of your recommendations goes a long way in fueling parents’ confidence in making informed decisions, as well as rationalizing those decisions to others who are concerned with their child’s health.
Help the Patient, Help the Family
When working with adults, responsibility can be laid squarely on the shoulders of the patient; working with children, however, requires an alliance between the practitioner and the care provider(s). The opportunity here often is that in creating this alliance, the habits of the entire family can be improved. Creating a family culture around the principles of health promotion, including sound nutrition and active living, avoids isolating the child in question; that child will feel supported in his or her healing if parents and siblings are on board. Parental role modeling is one of the most significant influences on the development of behaviors in children, so naturally dietary and lifestyle recommendations for children are most effective when applied to the entire family.
It is imperative to teach parents the importance of their own behavior when it comes to modifying that of the child. A parent who realizes this is more likely to make an effort to make changes within the home. Typically, barring unique guidelines, these changes will also benefit all family members, presenting a significant opportunity for the ND to influence the health of more than one individual.
Working with children manifesting symptoms of Attention-Deficit Hyperactivity Disorder (ADHD) is a good example of this. Benjamin is a nine-year-old boy who was diagnosed with ADHD. Although he is very active, he watches a lot of television and his diet is heavy in nutrient-poor convenience foods. Although his three brothers have not received this diagnosis, they too show signs of poor focus and hyperactivity. Benjamin’s parents are obviously obese. In addition to other individual recommendations for Benjamin, working with his parents to plan healthy, whole-food meals has been foundational in improving Benjamin’s behavior and the health of the entire family.
Setting Limits
Treating a child through the parent brings up issues of limit setting within the home. Many parents have said that children won’t eat certain foods or cooperate with protocols or recommendations. However, it is a parent’s responsibility to teach and model patterns of healthy living and to reeducate the child around dysfunctional patterns. It is our responsibility as NDs to help parents define these patterns and create reasonable choices for their children within acceptable limits. A successful pediatric practice is contingent on the ability of the ND to help the parent set limits within the home. Without providing this support, compliance is far less likely and outcomes are less effective. When done effectively, setting limits is invaluable to a child’s emotional and mental development, and contributes to the success of the intended protocol. Teaching a parent these skills is in line with the principles of tolle totem and tolle causam.
Get Kids to Participate in Their Healthcare
As important as limit-setting may be, however, as NDs we do not want to establish conflict between the parent and child. In this sense, it is equally important to create an alliance directly with the children. Educating them about healthy options; empowering them to notice changes in their symptoms; depending on the age, giving them the responsibility to be “grown-up” enough to call and discuss a protocol with the ND as opposed to giving mom or dad a hard time; these are useful strategies in obtaining compliance. Kids are keen for responsibility and choice; allowing them to play an active role in creating their healthcare plan goes a long way in achieving a desired outcome. This most obviously applies to nutrition. I habitually encourage young patients to participate in meal planning and preparation as one method for giving them power and pride in the process.
Dosing of medicines can be a delicate situation, and requires creativity as well. Typically, kids love to play scientist to find ways to make unpleasant herbs taste better (without resorting to chocolate sauce, of course). These activities should be age appropriate, and this strategy requires parental alliance to allow kids to take on more responsibility for their own health. A great method for inspiring kids to take their supplements is in the form of shakes; encouraging them to try a variety of ingredient combinations can be interesting and successful. I encourage NDs who work with kids to employ the use of homeopathy; not only do children tend to respond exceptionally well to homeopathy, but who would turn down sugar that’s good for them?!
Treat the Child, Treat the Parent
A major principle in the five-element theory of Chinese Medicine advises that “if the son is deficient, treat the mother.” We have found this principle to be invaluable in understanding children’s health. More often than not, we are made aware that the parent needs our care as much as, if not more than, the child. Parents often have unrealistic expectations of their child; equally often, the parents may be unable to set the stage for the child’s healing because of their own health challenges. Certainly, some health concerns span generations, whether genetically, environmentally or energetically inherited. Naturopathic medicine excels at treating these concerns from a counseling, homeopathic or physiological perspective. Regardless of the individual approach, it is next to impossible to treat a child outside of the context of the family unit; parental (and sibling) well-being should always be explored as a determinant of the health of the child.
For example, consider Manuel, who was six years old when I began treating him. His mother, Maria, had brought him in because of a diagnosis of ADHD. We worked to create better nutrition for him, as well as more appropriate lifestyle patterns regarding sleep, television and activity habits. It was difficult for Manuel and Maria to comply with the recommendations; the suggestions created a lot of tension at home, and Maria found it challenging to cope with the conflict. I encouraged Maria to visit me for herself, and discovered that she was coping with her own health issues: a diagnosis of bipolar disorder and a history of abuse. She was not in a good position to empower her son in a constructive way. Over time I worked with Maria and Manuel individually. As Manuel got older, he became more willing to take on the responsibility of his own self-care, and Maria was in a better position to support him in that process. Had she not cared for herself, she would not have had the resources to effectively care for him.
Naturopathic medicine is incredibly powerful when it comes to treating children; however, the nature of our work requires investment and effort both on the part of the patient and his or her family. Due to forces within the family and in the community at large, challenges can arise in pediatric practice. With creativity and compassion, apparent obstacles often can be reframed as opportunities – not only for the children’s health, but also for those around them.
Leslie Solomonian, ND has a general family practice in Toronto. As a faculty member of CCNM, she delivers instruction in women’s health, pediatrics and other clinical courses. Dr. Solomonian also is mother to a busy and vital four-year-old boy who has taught her deep lessons about caring for children’s health.
Zeynep Uraz, ND is a resident physician at CCNM. She is an instructor and coordinator of the women’s health course there, and is a supervisor at the college’s Robert Schad Naturopathic Clinic. She also maintains a private practice in Toronto, with a special focus in women’s health and pediatrics.
