Authored by Dr. Pharis

Just like that – summer is over, kids are back in school, and fall & winter is in the not too distant future. Before we know it the constant coughs and sniffles will begin, illnesses will spread through classrooms, and sick days will commence. It can be a dreaded time of the year for many parents.
 
Keep in mind that illness is inevitable. We’ve all gotten sick at some point in our lives, and there’s a really good chance we will all get sick again. Children are no different – in fact their young immune systems rely on exposure to germs to help stimulate and strengthen immune health for a lifetime to come. That said, chronic illness and delayed recovery time are not necessarily normal, and may in fact be a sign of a weakened immune system. As the school year begins now is the time to support your child’s health to keep their immune system strong and robust. Incorporate these daily guidelines into your routine to reduce chances of infection and illness, and to promote speedier recovery times.

• Hygiene: Good hand hygiene is the most effective way to prevent infections from spreading. Even when our hands look clean they still can be carrying germs. This is because germs are so small we aren’t able to see them with the naked eye. Washing hands often and well is the best way to beat these tiny warriors. Remind your child to wash hands often while at school – before snacks and meals, after using the restroom, and at the end of the day when they leave the classroom. Additionally, teach your little ones to cough and sneeze into the arm or elbow of their sleeve. This will further decrease the likeliness of contaminating hands and spreading germs.
  
  
• Sleep: Ensure your child maintains their normal sleep regimen.  Studies show inadequate levels of sleep can suppress immune function, increase chances of contracting illnesses, and decrease recovery time. Recommended amount of sleep: ages 3-5 need 10-13 hours, ages 6-13 need 9-11 hours, ages 14-17 need 8-10 hours
  
  
• Diet: Follow these general guidelines to keep your immune system strong and defensive.
  • Increase vegetable & fruit intake: 2 servings of veggies per meal, and 1 serving of fruit per meal (berries are best)
  • Consume fermented foods daily (kombucha, sauerkraut, kimchi, cortido)
  • Eliminate most sugar, including sugary drinks and fruit juices
  • Eliminate/reduce most dairy including cow’s milk, cheese, yogurt, ice cream
    
    
• Hydration: On average, a child’s body is composed of 65% water! This large percentage of water is required for many functions including flushing waste and toxins from the body. Additionally, inadequate water intake can make mucus membranes parched and dehydrated, leading them to be more susceptible to inflammation, irritation, and infection.
  • Water should be the main (or only) form of hydration for children. Avoid fruit juices and sweetened beverages as sugar can further depress immune function. Help keep your child hydrated by letting them select a personal water bottle they can keep with them at school, after school events, and next to their bedside.
    
    

• Outdoor time: Spending time outdoors has many benefits on health and the immune system. For starters, playing outdoors encourages movement - an important component for circulation, lymphatic drainage, and restful sleep. A moderate amount of exposure to sunlight is also important for synthesis of Vitamin D, a necessary nutrient to fight infection and prevent chronic conditions such as asthma. Encourage your child spend a minimum of 30-60 minutes outdoors after school each day!
  
  
• Nutritional supplements​: While hygiene, sleep, diet, hydration, and outdoor time should be the focus of supporting your child’s health, nutritional supplements can be a great adjunct to prevent and fight infection. As we make the transition into fall and winter months consider supplementing your child with a multivitamin, probiotic, omega-3 fatty acid, vitamin C, and elderberry syrup. Elderberry has both immune boosting and antiviral properties, making it a great option for both prevention and treatment of illness. Consult with your healthcare provider to determine what supplements and doses are appropriate for your child.

References
​Paruthi S, Brooks LJ, D'Ambrosio C, et al. Consensus Statement of the American Academy of Sleep Medicine on the Recommended Amount of Sleep for Healthy Children: Methodology and Discussion. J Clin Sleep Med. 2016;12(11):1549–1561. Published 2016 Nov 15. doi:10.5664/jcsm.6288 
Popkin BM, D'Anci KE, Rosenberg IH. Water, hydration, and health. Nutr Rev. 2010;68(8):439–458. doi:10.1111/j.1753-4887.2010.00304.

Authored by Dr.Sidney Pharis

What are tonsils, anyway?
Let’s begin with a short anatomy and physiology review of the tonsils, and for the sake of being inclusive, let’s discuss the adenoids as well. Tonsils and adenoids are a part of the immune system and the body’s first line of defense. Our tonsils are the two round lumps found in the back of the throat, and our adenoids are located higher up in the throat behind the nose and roof of the mouth. The role of these glands is to sample bacteria and viruses that enter through our mouth and nose and to provide a first line of defense against the external world.
 
Swollen and enlarged tonsils is a very normal symptom for children to experience from time to time, and typically indicates the immune system is on heightened awareness to protect and clear an infection in the upper respiratory tract. In normal functioning tonsils this enlargement and swelling is transient, with their size decreasing after the body clears the insult it has encountered. Unlike adults a child’s immune system is immature and constantly learning, making it normal for children to have more upper respiratory infections relative to adults. That said, chronically enlarged and habitually infected tonsils can be a sign of underlying dysfunction and can pose secondary health concerns for parents.
 
When are tonsils problematic?
Chronically enlarged and swollen tonsils can pose secondary health concerns and symptoms such as snoring, frequent waking at night, or difficulty swallowing. In extreme cases tonsils may be large enough to cause obstructive sleep apnea (OSA) when a child is lying down. If your child suffers from any of these symptoms it’s important to have a health care practitioner assess them in the case of more serious pathology.
 
Uncertain if your child might be suffering from enlarged tonsils? Here are some common symptoms to look for:

• Mouth breathing
• Noisy breathing
• Snoring or snorting at night
• Restlessness during sleep and/or pausing in breathing for a few seconds at night (possible sleep apnea)
• Difficulty eating or swallowing, and reduced appetite
• Chronic runny nose
• Recurrent ear infections
• Changes in the ability to talk, loss of voice

 
Conventional management of enlarged tonsils is limited, with typical recommendations residing at opposite end of the spectrum: watch-and-wait or surgical removal. Tonsillectomies (and tonsilloadenoidectomies, or T&A for short) are one of the most common surgeries performed on children1, however, the number performed has dropped significantly over the past few decades due to the possibility of acute complications from surgery. Approximately one in five children who undergo a tonsillectomy experience a complication such as difficulty breathing or prolonged bleeding1.
 
Additionally, studies have shown long-term health complications as an outcome from childhood removal of tonsils and adenoids. A study published in 2018 by the Journal of the American Medical Association looked at long-term implications of removing tonsils in childhood. More than one million individuals in Denmark who had tonsils and/or adenoids removed between 1979 and 1999 were followed up to age 30. Results revealed a 2- to 3-fold increase in diseases of the upper respiratory tract, a 17% increase in the risk of general infectious disease, and an overall increase in allergies2.
 
Taking this study into account, it seems reasonable to follow a watch-and-wait approach. But if you are a parent of a child who suffers from any of the previously mentioned secondary concerns you know firsthand how hard it is to sit back and watch your child experience any level of discomfort. To all of you parents, you’ll be happy to know there is a lot you can do to help improve your child’s sympomts.
 
Naturopathic management of chronically enlarged tonsils
Every child has a unique set of circumstances contributing to their state of health including birth history, previous illnesses, diet, environmental exposures, sleep, hydration, genetics, and so much more. Each of these elements needs to be taken into consideration when searching for underlying causes of why a child has chronically enlarged and/or infected tonsils. However, one item we can safely assume these individuals have in common is inflammation. Put simply, inflammation is an immune response and the body’s attempt to protect itself. In the case of chronic inflammation, one or multiple persistent immune challenges may exist. Identifying and removing these insults often can provide significant resolution in symptoms.
 
Investigation of immune challenges includes looking at both dietary and environmental exposures. Common dietary culprits include dairy and refined sugars, but in some individuals the removal of only these two food sources may not be enough. Looking at an IgG/IgA food sensitivity panel is helpful in these cases as it can target specific foods contributing to an individual’s chronic immune response. Similarly, investigating and removing specific environmental insults such as mold, dust mites, and animal dander can provide significant improvement. Using a HEPA filter in the child’s bedroom and home can be useful to help remove these environmental irritants.
 
General immune and upper respiratory support through diet and supplements is also necessary. In addition to limiting inflammatory foods it’s important to consume a whole-foods diet rich in vitamins, minerals, antioxidants, protein, and healthy fats. Supplementation with items such as larch arabinogalactans, elderberry, vitamin C, zinc, probiotics, and various homeopathic remedies help support normal immune function and decrease inflammation.
 
** The above information is for informational and educational purposes only, and is not intended as a substitute for medical professional help, advice, diagnosis, or treatment. If you have concerns about your child’s health, please consult with your doctor for proper assessment and treatment.
 
RESOURCES:

1. C McCarthy. Harvard Health Publishing, Harvard Medical School. March 20, 2018.  Does your child need a tonsillectomy?
2. S. Byars, S Stearns, J Boomsma. Association of Long-Term Rick of Respiratory, Allergic, and Infectious Disease With Removal of Adenoids and Tonsils in Childhood. JAMA Otolaryngol Head Neck Surg. July 2018; 144(7):594-603.
3. American Academy of Otolaryngology; 2018. Tonsils and Adenoids, Patient Health Information; https://www.entnet.org/content/tonsils-and-adenoids.

Authored by Dr. Barrett
With summertime right around the corner I want to address some fears about sun exposure. First of all we need sunlight. Sunlight regulates our sleep wake cycle by affecting the melatonin levels in our brain. Sunlight also converts cholesterol into vitamin D when our skin is exposed to UVB rays. For people in Minnesota it will take at least 30 minutes of exposure without any SPF to make vitamin D. The more pigment your skin has, the more time it will take to make adequate vitamin D. 

Let's address skin cancer fears. Cancer is a big problem and it is only getting worse. Sun is just one piece of the puzzle. When we are exposed to sunlight it can damage the DNA in our skin cells but we have many protective mechanisms in place to make sure that damage either doesn't happen or it is quickly repaired.  These mechanisms are fueled by- you guessed it- what we eat. The following is a list of compounds that help prevent DNA damage (not just in your skin cells). Of course there are many more than this short list but it is a starting point.

• Vitamin C: Berries, broccoli, Brussels sprouts, cantaloupe, cauliflower, grapefruit, honeydew, kale, kiwi, mangoes, nectarines, orange, papaya, red, green or yellow peppers, snow peas, sweet potato, strawberries, and tomatoes
• Folate:  dark leafy greens, asparagus, broccoli, citrus fruits, berries, beans, peas, lentils, avocado, okra, Brussels sprouts, seeds and nuts
• Carotenoids: especially orange and green vegetables
• Vitamin D: sunlight
• Vitamin E: Broccoli, carrots, chard, mustard and turnip greens, mangoes, nuts, papaya, pumpkin, red peppers, spinach, and sunflower seeds

Despite the fact that we have sunscreen to "protect" us from the sun, skin cancer rates are on the rise.  I believe it has more to do with a weakened defense system rather than sun exposure.  If you want more information read this article about the rise in skin cancer rates.

Keep in mind sun exposure is part of a healthy lifestyle and like everything else must be done in moderation.  If you are going to be exposed for extended periods of time, cover up after 30-60 minutes (depending on skin tone) and/or seek shade.   

Skin cancer can form on skin that has not been exposed to the sun! The Skin Cancer Foundation recommends doing self exams once per month. When doing self exams learn the ABCD's to properly evaluate your skin. I recommend annual checks by a dermatologist who records your mole sizes and can help monitor your skin health. 

Sometimes accidents happen. You fall asleep in the sun, forget to bring your hat, don't realize your SPF clothing has shifted exposing some skin etc. Try to avoid burns but if you get one, give sunburn tea a try!

After a family member got pretty severe burns from the sun we didn't have any aloe on hand so I got creative and made a sunburn tea.  We were very pleased with the results!  I made a large pot of tea with bags of the following:

• Black tea
  
• Green tea
• Mint leaves
• Chamomile
• Tzao Passion

Once the tea was cool I soaked large gauze pads in the tea and applied them to the burned area. It was immediately soothing. Every 30 minutes we put the gauze back in the tea and reapplied them to the burn to keep it moist. The burn did not blister and after two days of using the tea the pain was gone. I hope you don't get burned this summer but if you do, give tea a try!  

PS- If you are a science nerd like me keep reading-  this idea came to me after reading this article about iron's role in sunburn damage.  Black tea has tannins which bind iron. The rest of the ingredients were added for soothing and antioxidant action.

Authored by Brittany Corwin

What does your lunch look like? What does your child’s lunch look like?

Takeout? Leftovers? School hot-lunch? Packed from home? Eating out?

Lunch is the one meal that almost never goes from kitchen to plate. It makes pit stops along the way in storage containers, sandwich bags, the fridge, and sometimes the microwave. It is definitely a difficult meal to have good, nutritious food and be conscientious about what is going into your body, let alone worry about how much waste we make with all of that packaging.

With school starting up again, we wanted to give parents some tips for making healthy school lunches possible, especially because students consume up to half their calories for the day at school (1). Of course if you don’t have school age kids, these tips can be helpful for you to pack your own healthy lunch!

In recent years, we have made some important steps forward in improving school lunch. For example, over the past three years, public schools across America have begun to offer more fruits and veggies and meals with less sodium (1).

These steps are great, especially for families that need to take advantage of free lunch programs, but even with fruits and veggies offered there is no guarantee that students will choose these options over a big slice of pizza or the other hot lunch offerings.

School lunches can also create a lot of waste. Certain school districts have been trying to combat this lately, but one way we can eliminate waste for our planet and improve our nutrition for ourselves is to start packing our own lunch! (2) So how can we make a healthy, sustainable option also a convenient option? We’re here to help with a couple ideas.

1.    Pack your lunch!

Take a minute the night before to prepare lunch or wake up just a few minutes earlier to put something together. Being prepared and filling lunches with healthy foods can make a big change in your family’s nutrition. When you pack your own lunch for the day you have control over what food is available, and how it is prepared and stored, so you can take your health into your own hands and make some yummy, nutritious choices. If daily food preparation is too much work for your family trying picking a day or two during the week to prepare food in larger quantities.

When packing lunches include:     

• Fresh fruits and veggies: Carrots, grape tomatoes, clementines and berries are just a few easy to pack, nutrient dense, and delicious options. Try to fill about half of the lunch box with these food groups, especially vegetables.
• Whole grains: Start training your kids to swap out that white wonder bread for whole grain on sandwiches and include other healthy grains like oatmeal, brown rice, and even plain popcorn!  
• Legumes: Peas and beans pack protein and dietary fiber so they are satisfying and will keep the kids full. Black beans, lentils and chickpeas are examples of this group and are great protein options for both vegetarian and non-vegetarian families.
• Protein: Keep the kids energized long after lunch by including proteins like hard-boiled eggs, turkey, and shredded chicken. Proteins provide many vital minerals, B vitamins, and act as building blocks for muscle, bone, and other tissues that are growing fast in school-age kids.
• High quality fat: Avocados, nuts, and cheese add healthy fats that your body needs. A little bit of healthy, natural fat gives your body vitamin E along with essential fatty acids and is a much better choice than processed foods with artificial trans fats.

2.    Eliminate the plastic containers.

We all know the dangers of BPA in our plastic Tupperware, water bottles, etc., thanks to it being a hot topic in the media in recent past. Although BPA has been eliminated from most plastic products, it has been replaced with BPS, a plastic that may be just as bad for our health. We just can’t be sure of the safety of any plasticizer. Studies have shown that old, worn containers that have been microwaved are the worst culprits for leaching chemicals (3). No matter how nutritious your meal is, if it has been stored in plastic and possibly even re-heated in a plastic container it may contain endocrine-disrupting chemicals, and not to mention probably taste a little like plastic too.

Traditionally home lunches are packed in paper bags, or insulated lunch boxes with many plastic baggies, and pre-packaged foods inside. This creates a lot of unnecessary waste and encourages us to eat individually wrapped processed foods rather than yummy fresh fruits, veggies and homemade meals; a habit we’d rather not pass on to our kids.

There are multiple options for plastic alternatives; glass, stainless steel, and aluminum and they each have their own pros and cons (4).

•    Glass

   Glass is a wonderful alternative for plastic, although many do have plastic lids. As long as the lids are not touching your food, or being left on during microwaving, your chances of chemical leeching are small. However, leak-proof stainless steel lids are also available and will be more durable over time. Glass is a bit heavier than the other plastic-free options, and can sometimes break when dropped. For those reasons, glass might not be the best option for your small child to carry to school in their backpack. However for you, your older children, or at home, glass can go from oven to table to fridge and you will be able to easily see what leftovers you have.

•  Stainless Steel

   Stainless steel is a good option because it is so lightweight, and there are many leak-proof options. Stainless lunch boxes are even available that have built-in compartments that will keep food groups separated and help you determine serving sizes for each food group. The downside to stainless steel is that the metal containers are not microwavable or transparent. This isn’t really a problem for kids bring their lunches to school, but if you like to be able to store leftovers in the fridge and then grab them for lunch, glass may be a better option.

•    Aluminum

   Aluminum has a similar look as stainless steel and is also lightweight, however, aluminum reacts with acidic compounds and must be coated to prevent this from occurring. Protective coatings can be an enamel or epoxy layer that may contain as much BPA as an old plastic container. Because of this be sure to distinguish between stainless steel and aluminum

3.    Have the kids help

Packing lunch is another great opportunity to talk about nutrition with your kids and help them learn how to create a healthy and well-balanced lunch. If you get a stainless steel lunch box with compartments or something similar, they can help you fill each compartment with different food groups and different colors to create a healthy lunch. Start teaching your child healthy habits they can carry in to adulthood.

If you need ideas for ways to fill up your sustainable lunchbox with healthy and delicious foods take a look at this blog for 40 days of ideas!
http://thepaleomama.com/2013/08/40daysofglutenfreelunche/



References:
1. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6433a3.htm?s_cid=mm6433a3_w
2. http://www.washingtonpost.com/local/education/six-of-the-nations-largest-school-districts-dump-polystyrene-trays/2015/05/24/3abb5636-00b4-11e5-8b6c-0dcce21e223d_story.html
3. http://www.dailymail.co.uk/health/article-3207138/Don-t-clingy-Amid-mounting-evidence-plastic-food-wrap-harbours-host-toxins-doctors-urge-people-stop-using-it.html
4. http://www.thekitchn.com/container-battle-steel-vs-glass-food-containers-165409

By Dr. Pharis

It’s likely you’ve heard stories about that poor child who has suffered from chronic ear infections, was on multiple rounds of antibiotics, and eventually had ear tubes put in. Or perhaps this is the story of your own child. Sadly, this is a common scenario that is often preventable.

Second to well-child visits, ear infections (otitis media) are the most common reason parents bring their children to the pediatrician. Approximately 30 million doctor visits per year are due to childhood ear infections, accounting for almost half of all antibiotic prescriptions.

Additionally:

• Nearly 90% of children have otitis media some time before school age

• More than 60% of kids have one before the age of 2

• 30% - 40% of children have recurrent ear infections lasting for 3 months, with 10% lasting as         long as 1 year (2)
  

So, why are children highly prone to ear infections?

Otitis media is generally a result of two factors: fluid accumulation within the inner ear, and the anatomy of a child’s ear canal.

In the case of otitis media, fluid accumulation within the ear is not due to pool water, bath water, or any other external source. This fluid is produced by the body due to an immune response. Similar to mucus production, this fluid is a natural response to irritants and intruders, and is a mechanism through which the body protects itself. In the face of chronic immune irritants, such as allergenic foods, environmental allergens, or even recurrent colds, the body defends itself by increasing these protective fluids and barriers.

Another significant contributing factor to the prevalence of otitis media during childhood is the difference in anatomy and structure of the ear canals. A child’s ear canal is positioned horizontally, making drainage of fluid much more challenging. As we grow older, these canals begin to slant vertically toward the nose and mouth, helping facilitate fluid drainage.

The combination of increased fluid production plus difficulty draining is the basis for many ear infections and can become a chronic state. In addition to the increased pressure and discomfort from fluid accumulation, it is also a warm and inviting environment for pathogens (bacteria, viruses, yeast) to thrive.

And while some ear infections may have a bacterial component, this frequently is not the case. Antibiotics are often not necessary for the treatment of otitis media, and their recurrent use can predispose individuals to future infections and immune system dysfunction. Utilizing natural treatments addresses the root causes of the problem and helps prevent future occurrences by strengthening the immune system so it can fend off future infections.

While ear infections present differently among individuals, here are some common signs and symptoms to look for if you suspect your child has an ear infection:

• Irritability & crying

• Difficulty feeding or sleeping

• Pulling on the ear

• Complaints of ear pain or fullness

• Fever

Naturally you may be wondering what you can do as a parent to help prevent and decrease the recurrence of otitis media. Here are six natural approaches to consider:

1.    Prevent ear infections in the first place:

• Breastfeed, if possible! Studies show breastfed babies are at least half as likely as formula-fed cohorts to get ear infections

• Have child avoid drinking fluids while lying on their back

• Avoid exposure to smoke (tobacco, smoke from wood stoves, etc)

• Avoid environmental allergens (pet dander, dust mites, molds) and consider using a HEPA filter in the child’s bedroom

2.    Avoid food sensitivities and inflammatory foods:

• Refined sugars (including fruit juices, candy, soda, etc): Sugar depresses overall immune         function, increases inflammation, and feeds pathogens

• Dairy: Increases congestion, inflammation, and mucus production

• Other common food sensitivities: eggs, soy, wheat, corn, tomatoes, & citrus

3.    Immune supportive nutrients & herbs:

• Consider using a quality multivitamin along with additional Zinc, Vitamin C, Vitamin A,             Omega-3 Fatty Acids, or probiotics (*Please consult with one of our Naturopathic Doctors for specific recommendations)

• Elderberry syrup (Read about the benefits of elderberry syrup here)

4.    Garlic-Mullein Oil Ear Drops:
These drops provide natural soothing and antimicrobial effects
Note: In the case your child has a ruptured ear drum, do not place anything in the ears without         first consulting with your doctor.

5.    Onion ear muffs:
A warm onion ear muff provides both soothing and antimicrobial effects. See below for                     specific instructions

6.    Chiropractic care and lymphatic massage:
Manual therapies can be extremely beneficial to facilitate drainage of fluids within the ear, and         assist in relieving pressure and discomfort.

Homemade onion ear muff: (see image above)

• Cut a whole onion in half (Scoop out a couple inner layers to create a cup to surround the ear)

• Heat onion in oven (250 – 300 degrees) for approximately 15 minutes or until the onion is      warmed and juices are visible on the surface.

• Wrap onion in a cheese cloth and allow onion to cool to a temperature that is comfortable to place over the ear

• Cup onion over the affected ear for 15 minutes

• Repeat as necessary to reduce pain and inflammation

** The above information is for informational and educational purposes only, and is not intended as a substitute for medical professional help, advice, diagnosis, or treatment. If you suspect your child has an ear infection, please consult with your doctor for proper assessment and treatment.


Resources:

1.   http://www.webmd.com/cold-and-flu/ear-infection/understanding-otitis-media-basics
2.   http://avivaromm.com/ear-infections-part-1-6-sure-fire-tips-for-preventing-kids-earinfections-and-antibiotic-overuse-naturally