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In this episode of Pathways to Well-Being, Elizabeth Mumper, MD, FAAP, IFMCP, continues her conversation with IFM on the pediatric microbiome, discussing the latest research, clinical tools and insights, and strategies for building healthy adults. Dr. Mumper has been active in the Functional Medicine field for many years, conducts and publishes clinical research, lectures internationally and mentors physicians around the world. Her clinical practice provides personalized pediatric care and includes a specialized practice devoted to the care of children with autism and other neurodevelopmental problems and their families.

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Kalea Wattles, ND:
Today on Pathways to Wellbeing, Dr. Elizabeth Mumper joins us to talk about the pediatric microbiome, discussing the latest research, clinical tools and insights, and strategies for building healthy adults.

Dr. Liz Mumper is the president and CEO of the Rimland Center for Integrative Medicine in Lynchburg, Virginia, which provides personalized pediatric care for children with neurodevelopmental problems. Her general practice is Advocates for Children Pediatrics, and another part of her practice, Advocates for Families, is devoted to the care of children with autism and other neurodevelopmental conditions and their family.

Welcome, Dr. Mumper. We’re delighted to talk with you today on the podcast. I’ve heard you speak before about a rising tide in medicine and how more and more health professionals are recognizing the need for a paradigm shift that really focuses on an integrative and whole-person approach. As a parent and a physician, I’d love to learn more about how a dysbiotic pediatric gut potentially impacts things like immunity, susceptibility to disease, and health recovery and certainly resiliency, which has been a big topic of conversation in 2020.

So I’m hoping we can begin our conversation today talking about the relationship between gut dysbiosis and the development of chronic disease in pediatric patients. How do you believe that the Functional Medicine model is particularly well-suited to address the needs of this population?

Elizabeth Mumper, MD, FAAP:
Well, fortunately, children are usually pretty resilient, so I think that if we get out of their way sometimes, that is probably our most important job. For example, we know we’ve done a lot of harm by overusing antibiotics, and I’m very concerned that many babies get either proton pump inhibitors or antacids for what is probably just physiologic reflux that they will grow out of. Both of those things have really significant downstream effects on the gut.

So in our practice, we’re very aware that a good immune system begins in the gut and that the first thousand days of life are really important for establishing a good gut flora and developing oral tolerance. When we get a new baby in our practice, we look at historical risk factors that put that very precious microbiome at risk; things like being born by C-section or having antibiotics during delivery because the mother was Group B positive, or if the mother isn’t able to breastfeed so the baby is deprived of those Lactobacillus and bifidobacteria that are such a good foundation for a robust gut flora.

We know that chronic inflammation is very much tied to deficiencies in the microbiome. One of the disadvantages of our industrialized society is that it has affected our gut microbiome. We’re essentially suffering from an epidemic of absence, as one of the authors of a wonderful book that is by Manoff talked about. So we don’t have as much Vitamin D as we used to, because we’re not outside as much and we’re working inside and on computers. We’re under this sort of chronic stress of day-to-day business of life, which is very different from the past, where we had these punctuating times where we were under stress, but it wasn’t unrelenting. Then we’re not being exposed to as many natural beetles and parasites as we once were, and one of the effects of that is that we end up being more prone to things like autoimmune disease or chronic inflammation.

I’m really passionate about looking at this first 1,000 days of life as a really sacred time and really trying to look at how not to hurt that emerging microbiome. That’s a big part of what we do in our practice, is to try to nurture and protect that. So one great way to do that is to support breastfeeding so that your parents in your practice have access to lactation educators so that they can hopefully breastfeed for a year or longer, which is one of the best ways to give the child a really good start with a really good set of gut flora.

Kalea Wattles:
That’s brilliant. I love how you spoke about the first 1,000 days, because this really ties into the Functional Medicine timeline and how we really need to be aware of those both prenatal and early childhood factors. There are so many aspects of the timeline that can impact the development of chronic disease, moving forward. So that’s a very stark example, and I think that’s a brilliant way to lead into how these markers on our timeline, like I said, can predispose us to health outcomes later. What are some clues of gut dysfunction in a child? What can we look for and correlate back to the timeline of what might’ve happened, and can those clues that you’re looking for include things like behavioral or neurodevelopmental issues?

Elizabeth Mumper:
Yeah, that’s actually quite true. So it’s really important to take a good history. One of the adages in pediatrics is that if you take a careful history, the parent or the baby or the child will be able to direct you to the diagnosis over 90% of the time. So I’m concerned about things like C-sections, lack of breastfeeding, getting antibiotics early, and I’m also concerned about getting Hepatitis B at birth, because that vaccine is grown in a yeast protein, and I’m concerned about the potential to dysregulate the emerging gut flora. So when we have babies in our practice that have those risk factors, we look early on at doing things like infant probiotics.

Now, you can look at stooling patterns to get some clues about dysbiosis, and probably one of the best clues is that if the baby has very foul-smelling stools. Stools of breastfed babies are actually not foul-smelling at all. So if you have a formula-fed baby, the odors are going to change, but when they’re very foul, that makes us think that there may be some gut bacteria that are fermenting or otherwise creating metabolic products to make the foul smell.

But one of the things that’s hard to figure out when you’re looking for gut disease in young children is that since they can’t really talk, you have to look at all kinds of physical exam clues and behavioral clues to see when they’re having a problem. So, for example, a classic sign might be a child holding their belly, but a lot of times, we’ll see children who drape themselves over the end of a sofa, or push themselves up to the edge of a coffee table so that they can put pressure on their belly to relieve their pain.

Sometimes they’ll just be real irritable. Sometimes they’ll have trouble falling asleep at night, especially if they have reflux problems. Sometimes with reflux, you’ll see them pushing on their chin, which is an interesting sign that I don’t think we really think about when we’re doing adult medicine, and then the issues of the behavioral changes.

One of the things that’s been most interesting to me, working with a population that includes a lot of kids with autism, is the fact that we now have a bunch of clear scientific evidence about the way that gut pain can affect people’s behavior and immune dysregulation can affect children’s behavior.

For example, one of the abnormalities we often see in children on the autism spectrum is that they have some abnormalities in something called tumor necrosis factor-beta. This work was done by the folks at UC Davis, and they were able to directly show that different levels of tumor necrosis factor-beta correlated with either positive behaviors or negative, dysregulated behaviors.

We also know that things such as allergy spikes will affect children’s behavior. A doctor named Dr. Borres, who was a pediatric immunologist many years ago, did a wonderful study where he looked at his children with ADHD, and he also did the same thing with children with autism. He was able to show this very tight correlation between the children who were starting to have difficulty with needing their ADHD meds changed or having more difficult behaviors if they were on the autism spectrum when the pollen count was spiking. The charts were quite striking in themselves. So we definitely know that there’s this very big communication between the immune system and the brain and that what’s happening in the gut influences the brain.

Kalea Wattles:
This is another perfect example of kind of our Functional Medicine model and nodes of the Matrix, right? As you’re talking, I’m kind of picking up assimilation and digestion, defense and repair, communication, and how all of these nodes are working together. We need to support all of them, many of them in combination. So when I’m working with adult patients and I’m suspecting that there’s gut microbiome imbalance or dysbiosis, I’m often doing comprehensive stool analysis, but I imagine that’s not maybe as common in the pediatric population. I’m hoping to get a little insight from you about what’s your initial assessment step if you suspect that there’s some gut dysfunction happening in a pediatric patient?

Elizabeth Mumper:

Well, if I can get some sense just from the history and infancy, that’s helpful, because our microbiome changes as we age. In infancy, the normal microbiome classically has a lot of strains of Lactobacillus and a lot of strains of bifidobacteria. So sometimes we will empirically treat infants if they’ve had courses of antibiotics or if they’re starting to have eczema, which we view as a skin window into the immune system to see that there’s a leaky gut, probably. In older children, we will do CDSAs (Comprehensive Digestive Stool Analysis), and that can be very helpful, because it will let us look at the presence or absence of inflammation. It will let us look at the values of the fecal secretory IgA, which can be a very nice clue, and it will look at digestive factors, too, so that we might be able to figure out if we need to give the child digestive enzymes, in addition to probiotics.

So yes, we do use CDSAs. There are labs where the norms don’t really fit under the age of two. So sometimes we have to do our best, using clinical judgment and empiric interventions until the child reaches that age where we can send off those studies.

Kalea Wattles:
That is the perfect lead-in to my next question. So we know we need to do something, and now we need to make a treatment for pediatric patients. Do you have some advice of giving probiotic or prebiotic supplements versus trying to get those in food sources?

Elizabeth Mumper:
Our approach is always that it’s better to do it with food if you can. So when babies are very young, you are typically able to sort of train their taste buds. If you have a parent that starts out giving the child sweetened Cheerios as soon as they can start handling some solid foods, then they’re going to want to continue to get that. But if you’ve got parents like we do, who start giving their kids sauerkraut when they’re nine months old or a little bit of pickle juice or a little sip of the mom’s kombucha, then babies will very much adapt to that flavor.

In our practice, we do introduction of foods a little differently from what I was taught in my pediatric practice long ago, where we were taught to start with rice cereal. We like to start with avocado or a vegetable like sweet potatoes or squash, and we want the baby to have at least three or four vegetables before they ever get the flavor of the sweeter fruits. Then we do like to introduce these prebiotic foods early on.

We also use probiotics. There are probiotics specifically made for infants, which has six strains of Lactobacillus and six strains of bifidobacteria. Then there are other probiotics that are formulated for toddlers and young children that are also pretty heavy on Lactobacillus and bifidobacteria, but sometimes add in some other organisms, such as certain probiotic strains that include a strep. Then adult probiotics are a little bit different altogether.

But in our practice, actually, probiotics are our first treatment for constipation. Most people don’t really think of that first off, but one of the things that probiotics do for children is to help peristalsis, so help them move the stools through the gut so that they don’t become constipated. We also really like the way that they make it harder for pathogens to adhere to the gut wall. So on probiotics, they’re not as likely to get a devastating gastrointestinal illness, and remember that probiotics also help us make really important vitamins.

So we have a pretty low threshold for doing probiotics in infancy for those kids that are at risk, because we really think that if we can spend the first two years of a child’s life giving them really good gut flora and, more importantly, not damaging their gut flora that that sets them up for much less chronic illness as they’re older and a much healthier and happier life.

Kalea Wattles:
Yeah, you’ve definitely highlighted several supplement, dietary, lifestyle interventions that we can take to set children up for success, for health into adulthood. What advice do you have when collaborating with parents on implementing these therapeutic treatments when there needs to be a diet change or adding a supplement? How do we encourage sustainability of these interventions when maybe the whole family might need to get involved to make it work?

Elizabeth Mumper:
We definitely have to meet parents where they are, and the longer we do this, the more we just keep asking for feedback, and we say things like, “If I told you that I thought it would really help your child’s behavior if you went gluten-free, is that something that you would consider doing?” You’ll either get the answer, “Yes, whatever it takes, because the behavior is driving us nuts” or “No, I grew up having a bagel every day for breakfast and a roll at dinner, and that would be really hard.” So sort of an assessment of what their goals are is really important.

For our first step, we typically just try to work on cleaning up the diet. So, typically, I won’t immediately go to gluten-free, casein-free, mitochondrial-specific, or whatever, paleo, pegan, whatever we might be thinking about until we just get them to get rid of the junk. We usually give a little speech about how humans weren’t really designed with the enzymes to break down the preservatives that are in food now and how we’ve all been a part of this really big experiment over the last 50 to 100 years where our food’s now coming from factories instead of from gardens. Our first work is to get them to just give more vegetables and give less processed foods.

If we can get them to take away sugar and simple carbs, that typically has a big effect on balancing their blood sugar, and that in itself often really improves their behavioral swings. So we talk a lot with parents about the importance of giving proteins and good fats through the day so that the child’s blood sugar is stabilized.

Another important trick, I think, is to give them specific, concrete examples of what you want them to feed their child. So it’s a total mind shift between “I want you to take out gluten and casein and anything that’s processed and anything that comes in a box” to “This is what is going to really tell your child’s cells what to do biochemically, lots of fresh vegetables. Can you hit at least five today?” We’d love if it was at ten a day. Nutrient-dense foods and good proteins and good fats, like avocado and tree nuts. If you do fruits, we like to really emphasize the ones that are very color-dense, because they have the most phytonutrients. Then, try to cut back on the carbs.

We often will print out recipes right in our notes for our patients. When we have a complicated patient, a Functional Medicine patient, we very much believe in the whole concept of sharing the story with them, and we share our notes. So we’ll often cut and paste some recipes. For example, a lot of kids want to have either cereal or a bagel or a donut for breakfast, and so for those families, we will print out our paleo muffin and paleo pancake recipe so that the child still feels like he’s getting that kind of a treat, but it’s full of good fats and good proteins instead.

We also use the analogy of eating a rainbow every day. IFM developed a nice handout about that, and kids in the two to five age range get very excited about this. So we usually say things like, “Go home. Write a rainbow. Color it in. Put it on the refrigerator, and then, each day, you can check off what colors you ate that day.” I tell them that every check-up from two to seven, and by seven, they’re like, “I know. Eat a rainbow every day.” So that works well, and parents can handle that.

I also would recommend building in social reinforcers for better eating behavior. So a lot of people will give their kids M&Ms if they toilet train, or if my autism patients are at ABA (Applied Behavioral Analysis therapy), one of the reinforcers they love the most that drives me insane is they’ll often give them Skittles, which have a lot of dyes in them. So we say, “If you eat a rainbow every day for five days, then you get to go with your dad to the park,” those kinds of social reinforcers. Or, “You get extra screen time” is a good bribe in the older kids.

Then in terms of giving supplements, the first step you have to do is find out if the kid needs a liquid or will take a chewable or can swallow a pill or a capsule, because you have to give them something that they can do, and you don’t want to give the parents a power struggle if you can avoid it. So the unfortunate thing is that with some of our supplements that we use, the liquid forms of multivitamins, especially if they have relatively high B vitamin content, don’t taste very good at all. Some parents are tempted to put it in the child’s favorite food. We actually discourage that, assuming that favorite food is something that’s good for them, because we don’t want to ruin an otherwise nutritious food. We take the attitude that this is medicine. You swallow it down, and then right after that, you get something that you can wash it down with that you like, sort of swallow first and then chase it with another taste. So those are some of the things that we’ve found helpful. Is that kind of what you had in mind?

Kalea Wattles:
That was perfect. So many clinical pearls, practical advice in there. I love that you mentioned the phytonutrient spectrum checklist, that rainbow handout. I use that with my kids all the time. What I’ve found is that it’s actually really helpful for the adults, too. They say, “Oh, wow, we actually don’t eat very many orange foods, and that’s my responsibility now to get those from the grocery store so that we have that option.” So I love that you mentioned that, and I heard you talk about we’re not eating from gardens as often. So we’re not having as many exposures to those potentially beneficial bacteria that would come from soil and organic gardens. I would love to hear a little bit more about the relationship between the pediatric microbiome and developing oral tolerance, the hygiene hypothesis that we love to talk about, and how does that impact allergy protection from childhood into adulthood?

Elizabeth Mumper:
In our practice, we actually like to tell parents that their kids need to eat some dirt, and I know that sounds kind of crazy, but it comes back to this idea of we know from a bunch of different studies now that children who are raised on farms, who go out and feed the chickens, who have dogs lick them in the face when they’re babies, that those kids are much less likely to have allergies and asthma later on. There have been some really huge studies in Europe looking at 23,000 people, where they were able to show that kids who got probiotics and attention to their gut microbiome in the first two years of life or in pregnancy were about 50% less likely at the age of two to have either allergies or asthma.

So those are all really big payoffs. I really regard this concept of oral tolerance as fundamental. Basically what that means is that in the first year of life, we have to teach a baby’s immune system that just because something goes into their mouth doesn’t mean that their immune system needs to panic and react to it. So part of that is making sure that we don’t have reason to have a leaky gut. Even a gastroenteritis in infancy can dysregulate the digestive enzymes for a while, and chronic inflammation is going to make it more likely, especially chronic fungal infection, that the child does have a leaky gut. So if that happens, we can do the four or five R steps to work on that. But we want babies to get nutrient-dense foods and to not have their immune system react so much to things like peanuts or gluten or casein.

This has prompted a bit of a controversy about how we should feed kids in the first year of life. It used to be that we would delay introduction of peanut, because we thought that there were so many people having peanut allergies that that would make sense to avoid a bad reaction in a really young baby. But now the evidence suggests that we should give very small amounts so that they are able to develop over time oral tolerance to that. It’s also helpful if they can start gluten at a time when they’re still breastfeeding. That seems to be very much protective against having problems with gluten later on.

We just know that it’s not only the sort of infectious disease immune aspect of the gut flora, but there’s also a whole metabolic aspect to it where our gut floras are influencing our behavior. It influence how we can metabolize our drugs. One of the examples is your ability to detoxify acetaminophen, which is Tylenol, or paracetamol, for people from Europe and Australia, is very much dependent on how good your gut flora is at helping your body metabolize that.

So lots of good reasons to work hard on that. It’s important to realize that there are a lot of things that happen in public health that decrease the prevalence of infectious diseases, things like having refrigerators and having sewage plants and better sanitation practices, all those things. That has decreased the amount of acute illness, but we’ve seen this sort of swap between we don’t have as many acute childhood illnesses, but we have more chronic illness. The very sad statistic is that more than 50% of American children now have at least one chronic disease.

So this idea of doing a garden with your kids, letting them dig in the dirt, having a dog in the first year of life to lick your child, all those things sort of help you not react so badly with overdeveloping your Th2 immunity, the part of your immune system that gives you allergies and autoimmunity.

I think that in terms of doing really nutrient-dense diets, it’s really important to think about how that helps your innate immune system. So the innate immune system is sort of your first-line defense. It’s very nonspecific. It’s going to help you in a variety of situations, as opposed to very specific targeted interventions that aren’t as helpful in a global way. So does that make sense?

Kalea Wattles:
That makes great sense. You’ve really highlighted and we talk all the time about the importance of fresh, healthy, whole foods. But I think you’ve really highlighted how that’s actually very important for how your immune system is developing, and my question to you is we’ve had so many conversations lately about access, right? Access to Functional Medicine, access to fresh fruits and healthy foods. When we consider potential barriers that our patients might be facing, whether that’s financial, cultural, social, time constraints, all of that, do you have any clinical pearls of, for practitioners, how we counsel patients on overcoming some of those barriers to have access to these treatments and interventions that you’ve highlighted for us?

Elizabeth Mumper:
Yeah, it’s really a very difficult situation, because in pediatrics in particular, the insurance industry reimburses best for very short acute visits, and if you can do four or five short acute visits in an hour vs. me spending an hour and a half with a patient, literally it’s three times the reimbursement if you’re doing the short, quick stuff. So the incentives in a typical practice that is driven by the insurance agency is for in and out quickly, high volume. The work we do is not quick, and it takes some counseling.

So there are financial barriers, and I feel terrible about that, because I see my patients who have Medicaid, and I would like to give them a probiotic, but sometimes the parents can’t afford that. Medicaid will pay for six or eight seizure medicines, anti-inflammatories, prescription medicines for reflux, asthma medicines, allergy medicines, but they don’t pay for things like probiotics or a good multivitamin.

So we do have a very divided system in our country, and I think that’s become even more clear over the last six months. A couple ideas that we try to do, one is if you can create smart text that explains concepts that you pull into your note, then you can send the patients home with that, and you don’t have to spend as much time in the office, going over that, which is time and therefore costs money. We do a very long intake form, and we still sort of tell the story back to the patient.

But by having all that information ahead of time, it allows me to sort of formulate my concept of the case, and then I go through and say, “Now, I want to clarify this point here. Tell me more about this reaction” or “Tell me more about the antibiotics that your child had.” Then at the end of that, you tell the story back and say, “What I see is a child that, because of being born by a C-section and having a lot of ear infections in the first year of life got a lot of antibiotics, and I think we really need to work on your baby’s gut. We need to make it a high priority to give them probiotics or prebiotic foods.”

Parents understand that. It’s very important that they feel like you understood their concerns. So doing as much as you can with either written information that you give or using health coaches or nutritionists is very important. I’ve had the same autism coordinator and nutritionist for 20 years now, and when we were in the room, she can sort of tell what I’m going to say before I say it to the parents. So I will often delegate it to her to do a lot of the nitty-gritty counseling, and patients really like specifics. We will give specific brand recommendations in the room based on the particular patient. Again, some of that’s depending on does the child need a liquid or a pill, or can they do a capsule? But I think that’s better than just sending them to the health food store and say, “Pick out a Vitamin D” or “Pick out a probiotic.”

So food deserts are horrible. I really lose sleep worrying about kids in the inner city that have all the socioeconomic challenges, sometimes racial challenges, and their access to food is the 7-Eleven. I just watch their health get worse and worse over the years, and I wish we had a good solution for that. I know that there are a lot of good people in this country trying to really look at the whole idea of food as pharmacy and food as your medicine. I hope that they’re successful, because that is so fundamental.

Kalea Wattles:
Yeah, I love how you always bring it back to the importance and the power of retelling the story just so that a patient can kind of understand how the events of their life or their child’s life have influenced their health trajectory. So when I’m thinking about the timeline and thinking about some common themes that you’ve talked about for how we can prevent chronic disease, I’m hearing the birth, the method of labor and delivery is one consideration. Access to lactation support and breastfeeding guidance, maybe some microbial exposure, a diverse microbial exposure in early life, certainly phytonutrient density and diversity in the diet. In that early childhood part of the timeline, are there any other themes that we should be really aware of, thinking about disease prevention into adulthood?

Elizabeth Mumper:
Yeah, so those are all really good things, and to just take the breastfeeding a little bit farther, remember that if you were breastfed, you have less chance of getting inflammatory bowel disease, less chance of getting certain cancers, last chance of getting Type 1 diabetes, less chance of having celiac disease. You’re much less likely to have GI or respiratory illness that lands you in the hospital, and you’re less likely to have allergy and autoimmunity. So that’s why we devote so much time to breastfeeding support.

The other thing I think is really important in looking at a timeline is to look at the frequency of prescription medications, especially PPIs or antacids early on, especially multiple antibiotics, especially recurring steroid doses for kids that have a lot of asthma exacerbations. So the medication history in childhood I think is crucial.

I would also for adults look for any traumatic childhood experiences. So, for example, a lot of people now are adopting children from Russia or Romania or Korea, where they may have attachment disorders that are a result of being in an orphanage and not being touched for the first few months of life. Even if those kids come to America and get nice homes and a loving family and good nutrition, that is something that is sort of psychologically imprinted and can have really long-term effects into adulthood.

I also would look at family history of different illnesses that run in the family, especially looking for the themes of things that are either autoimmune or chronic inflammation or mental health issues. I think all of those have important bearings on your life as an adult.

So when you look at all that, one of the themes that often emerges, if you can’t think of other things to do, is to treat oxidative stress and to do things that are anti-inflammatory, because there’s so many different conditions that will benefit from those types of interventions that it’s almost like you don’t have to have exact diagnostic specificity. So those are my ideas about carrying forward to the adult world.

Kalea Wattles:
Yeah, absolutely. We always talk about pattern recognition in Functional Medicine, and I’m wondering if when we’re thinking about – you mentioned family history, but in terms of the microbiome specifically, do you see patterns in families, for example, with siblings, that multiple siblings in a family might have gut dysfunction? We know that everything is individualized and that each individual will respond differently to things like stressors and antibiotic exposure and dietary exposures, but is that something you see commonly?

Elizabeth Mumper:
Yeah, so I would say that when we’re giving a food intervention or a diet change to a family, we really try to have the other siblings make the same changes. It’s really not fair to have little Johnny eating broccoli and Brussels sprouts and his sisters having cupcakes all day. Typically, parents feed all their kids pretty similarly. So there may be some changes, but usually the whole family can benefit. If both parents are obese or have eating disorders, that makes it an order of magnitude harder to do things.

We’ll often see patterns like, for example, one of the things that people are always surprised to find out about are kids that have phenol sensitivities and cannot break down things like bananas and red grapes and red cherries, and their behavior goes berserk. We will say, “Think about what your child ate before this behavior went berserk. Could it be that it had high phenols or high salicylates?” Often, we’ll have several kids in the family that can’t tolerate salicylates or phenols.

So the patterns do emerge, and, again, we have an identified patient, but really who we’re working with is the whole family. That should, ideally, include the siblings.

Kalea Wattles:
Yeah, that’s great. From a practice implementation standpoint, once you have identified that a patient needs some support with their microbiome, you would initiate treatment. So with pediatric patients, what does the follow-up schedule look like? Are you giving all of your educational materials and your supplements and then kind of setting them free, or what’s the follow-up schedule? How long do you anticipate it will be before they see improvements in things like behavior?

Elizabeth Mumper:
So as in all Functional Medicine, it’s all individualized, but as a general rule, I would say that at the first visit, when I have all the information in front of me and I’m thinking through the timeline and the Matrix, that’s when I feel like I know the most about what I want to do for this kid. So I’ll often write a lot of that down. But over the years, we’ve learned that just because I thought of it doesn’t mean we should do it at the first visit.

We actually try to pick three interventions at the first visit and then do a follow-up, which can either be by phone or telemedicine or in person, depending on if the patient traveled to see us. Somewhere in the one-month to three-month range, if we get the idea that they’re going to have trouble implementing our recommendations, we err on the side of doing it earlier. If they have financial constraints and we feel like they understand and are going to be able to keep going without support, then maybe we would do it in about three months.

One of our biggest successes in getting people to do what we say is when they do follow-up, we always look for something to compliment them on that they were able to do and use phrases like, “It’s harder to change what you feed your kid. It’s harder to change that diet than it is to change their religion. So getting him or her to eat broccoli was huge, and I realize I gave you a lot to do. It’s hard for anybody to take a supplement every day. It looks like you really did a nice job with that.” So those kinds of things are helpful.

Kalea Wattles:
Dr. Mumper, thank you so much for taking time to talk with us today and sharing your insights about the pediatric microbiome and tools and insights, how we can create and build healthy adults. We really appreciate all of your time, and it’s just been a joy to talk with you.

Elizabeth Mumper:
Thanks. I really enjoyed it, too. Thanks.

Dr. Mumper recently co-presented at IFM’s 2020 Annual International Conference (AIC) on pediatric clinical applications and previously spoke to IFM on The Pediatric Intestinal Microbiome discussing the restoration of a dysbiotic pediatric gut and the connections between intestinal dysbiosis and autism spectrum disorder.

If you have attended AFMCP or an APM we are offering a pediatric mentorship hosted by Dr. Elizabeth Mumper.  learn more