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In surveys, clinicians report a low level of confidence when treating children with behavioral and/or social-emotional issues.¹ In many children, behavioral and social-emotional issues may be related to food and/or reduced by appropriate nutritional interventions.^2-3 Yet even among pediatric residents, knowledge about the relatively well-defined concept of food allergies is lacking.⁴

Taking an accurate patient history, including nutrition, can be challenging with younger patients. In this video, family medicine clinician Marion Owen, MD, shares specific considerations for pediatric evaluations:

Assessing immune function can be useful for treating children with behavioral, social, emotional, and other conditions. Children with ADHD are more likely to have allergic diseases overall,⁵ suggesting an inflammatory component. This is especially important because allergic conditions are common in the overall pediatric population. For instance, a longitudinal study in Australia showed that 40-50% of children had at least one allergic condition.⁶

Other inflammatory contributors also increase health risks for children, including obesity. Childhood obesity has dramatically increased in the past few decades.⁷ In one study, social, emotional, and behavioral problems were prevalent among children being treated for weight management; for instance, 18% had anxiety, 17% had ADHD, and 10% had mood disorders.⁸ A low rate of treatment for obesity in children has also been chronicled,⁹ despite the known health risks. Most primary care clinicians are not consistently tracking pediatric patients’ weight over time.⁹ Since obesity has also been implicated in the increase in food allergies in children,¹⁰  working with younger patients to create an anti-inflammatory diet offers immense therapeutic benefits.

This demonstrates an opportunity to intervene in two of the most important aspects of overall health: pediatric food reactions and nutrition.

Functional Medicine emphasizes the importance of appropriate nutrition and encourages clinicians to be aware of patient food sensitivities. How do you assess young patients to determine appropriate diagnostic measures?

Food reactions can manifest in many ways in children. Understanding the connection between seemingly behavioral and emotional issues and food can help pediatric patients not only immediately, but long-term.

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References

1. Miller AR, Johnston C, Klassen AF, Fine S, Papsdorf M. Family physicians’ involvement and self-reported comfort and skill in care of children with behavioral and emotional problems: a population-based survey. BMC Fam Pract. 2005;6(1):12. doi:10.1186/1471-2296-6-12.
2. de Theije CG, Bavelaar BM, Lopes da Silva S, et al. Food allergy and food-based therapies in neurodevelopmental disorders. Pediatr Allergy Immunol. 2014;25(3):218-226. doi:10.1111/pai.12149.
3. Shanahan L, Zucker N, Copeland WE, Costello EJ, Angold A. Are children and adolescents with food allergies at increased risk for psychopathology? J Psychosom Res. 2014;77(6):468-473. doi:10.1016/j.jpsychores.2014.10.005.
4. Adeli M, Hendaus MA, Abdurrahim LI, Alhammadi AH. The importance of educating postgraduate pediatric physicians about food allergy. Adv Med Educ Pract. 2016;7:597-602. doi:10.2147/AMEP.S112182.
5. Miyazaki C, Koyama M, Ota E, et al. Allergic diseases in children with attention deficit hyperactivity disorder: a systematic review and meta-analysis. BMC Psychiatry. 2017;17(1):120. doi:10.1186/s12888-017-1281-7.
6. Peters RL, Koplin JJ, Gurrin LC, et al. The prevalence of food allergy and other allergic diseases in early childhood in a population-based study: HealthNuts age 4-year follow-up. J Allergy Clin Immunol. 2017;140(1):145-153.e8. doi:10.1016/j.jaci.2017.02.019.
7. Katzmarzyk P, Barlow S, Bouchard C, et al. An evolving scientific basis for the prevention and treatment of pediatric obesity. Int J Obesity. 2014;38(7):887-905. doi:10.1038/ijo.2014.49.
8. MacDonald K, Godziuk K, Yap J, et al. Vitamin D status, cardiometabolic, liver, and mental health status in obese youth attending a pediatric weight management center. J Pediatr Gastroenterol Nutr. 2017;65(4):462-466. doi:10.1097/MPG.0000000000001598.
9. Huang TT-K, Borowski LA, Liu B, et al. Pediatricians’ and family physicians’ weight-related care of children in the U.S. Am J Prev Med. 2011;41(1):24-32. doi:10.1016/j.amepre.2011.03.016.
10. Visness CM, London SJ, Daniels JL, et al. Association of obesity with IgE and allergy symptoms in children and adolescents: results from the National Health and Nutrition Examination Survey 2005–2006. J Allergy Clin Immunol. 2009;123(5):1163-1169.e1-4. doi:10.1016/j.jaci.2008.12.1126.

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