Category — The Whole Child

No matter how old I get, September always feels like the beginning of the year to me. Maybe it’s all those years in school that have my senses trained to gear up once Labor Day ends, or maybe it’s the impact of the Jewish year cycle starting over again with Rosh Hashanah each fall. And being a pediatrician and a father, I’m reminded daily about back-to-school rituals.

I’ve noticed, more and more over time, that the focus of back-to-school has a real “back-to-work” feel. Every year in late August and early September, we start to get lots of calls about headaches, stomach aches, trouble sleeping – symptoms of anxiety.  Sometimes the worries are social – starting middle school or high school – but most of the time, it’s nervousness about academics and a busy fall activities calendar that prompts phone calls from parents.

A recent New York Times Well column, “School Curriculum Falls Short on Bigger Lessons,” posed a provocative question, “Now that children are back in the classroom, are they really learning the lessons that will help them succeed?”

That’s really the crux of the issue.  What is the purpose of school?  Child health and development specialists across the country are worried we’ve gone off track.

“What are we really trying to do when we think about raising kids?” asked Dr. Kenneth R. Ginsburg, an expert in adolescent medicine at Children’s Hospital of Philadelphia. “We’re trying to put in place the ingredients so the child is going to be a successful 35-year-old. It’s not really about getting an A in algebra.” (The New York Times, “School Curriculum Falls Short on Bigger Lessons”; September 5, 2011).

What is success? In typical American fashion, we’ve lost sight of the long-term goal. We as a society tend to take the “what-have-you-done-for-me-lately?” approach. It’s true in sports, in politics, in economics and alas, now, in childhood. Starting early in preschool puts us ahead for elementary school, where more and more kids are tutored even if they are on grade-level.  Middle school grades determine high school placements, and college prep begins in 9^th grade, not 11^th as it used to be. And so on.

We are so focused on THIS TEST that we lose sight of the whole child. What about non-academic strengths?  Shouldn’t we be emphasizing “well-roundedness?” The parallels with health care are notable. “Why prevent tomorrow what you can fix today?” is our mantra. We should be concentrating on creating wellness through healthy lifestyles, promoting good nutrition, fitness and sleep/relaxation instead of a pill for each ill.  It is the same for our children as students. The teachers who had the greatest impact on my life were not the ones who gave me the best grades.  They were the ones who connected me with the wider world and challenged me to grow as a person.    Our children will not always remember their standardized test scores—but they will remember those moments when they were challenged, and struggled, and learned, and grew. Success can be defined not by the grade given but by the lessons learned.  We should create a system that values those achievements.

Dominic Randolph, Headmaster at Riverdale Country School, echoes these sentiments in an interview for the New York Times Magazine (“What if the Secret to Success is Failure?”; September 18, 2011;).

“Whether it’s the pioneer in the Conestoga wagon or someone coming here in the 1920s from southern Italy, there was this idea in America that if you worked hard and you showed real grit, that you could be successful,” he said. “Strangely, we’ve now forgotten that. People who have an easy time of things, who get 800s on their SAT’s, I worry that those people get feedback that everything they’re doing is great. And I think as a result, we are actually setting them up for long-term failure. When that person suddenly has to face up to a difficult moment, then I think they’re screwed, to be honest. I don’t think they’ve grown the capacities to be able to handle that.”

Couldn’t have said it better myself.

—Dr. Lawrence Rosen, KIWI columnist

Happy Birthday, KIWI!  You’re almost 5-years-old, ready to start grade school. As a pediatrician, I’m so used to thinking about age this way… what is five years actually in magazine years? I think it’s a very significant milestone, especially in this age of digital media. KIWI is relevant in 2011 because it speaks to the growing number of families interested in natural, healthy, “green” living. You’ve come a long way, KIWI, and I am proud to work with you. In many ways, my pediatric practice and family life have grown in parallel with you.

Five years ago, in 2006, I was approaching my tenth year as a pediatrician out of academic training. My children were 5 and 8 at the time. As a parent and as a doctor, I was in the midst of a transformation that felt like that freight train inevitably barreling down the track. I had no idea at the time that it would eventually lead to leaving my group practice to start my own fully integrative, green practice. I was starting to feel comfortable integrating holistic practices into every day encounters in the office. Families were coming to me because they valued the “greener” approach I was taking. I was also developing one of the country’s first academic pediatric integrative programs at Hackensack University Medical Center and working closely with the Deirdre Imus Environmental Health Center in New Jersey. I was just starting to fully appreciate not only the impact that the environment was having on our health, but also the major impact that the practice of healthcare was having on our environment. Furthermore, working with families in my practice to live healthier lives inspired me to make similar changes at home. Each week, we re-examined some aspect of our daily lives—from the foods in our fridge to the cleaning products in our pantry—replacing what we could with healthier, greener options. It was an exciting and somewhat overwhelming time, but looking back, it was a really important time for me both as a pediatrician and as a parent.

Today, in 2011, it’s easy to look back and trace the routes that brought me to where I am today. Writing for KIWI, heading the Section on Integrative Medicine at the AAP, starting the fourth year of practice at the Whole Child Center, I am fully engaged in green, integrative practice. Professionally, I am so encouraged by the number of families who are joining the crusade to improve our children’s and our planet’s health. Green living is a mainstream way-of-life. Every encounter, from prenatal group sessions to chats with teenagers, focuses on creating wellness and incorporating natural, ecologically sustainable practices in our daily lives. And my children—now 13 and 10—are actively working with their peers to green our community by educating friends about organic produce and chemical-free products. We still work to keep living healthy lives, but it feels less overwhelming and just the way we do things.

What does the future hold? Where will we be in 2016, five years from now? I am looking forward to continuing my work with KIWI, and with families in my community and practitioners throughout the world to make integrative, ecologically sustainable healthcare the mainstream way of living that it needs to be. We face tremendous challenges in the years ahead to make healthcare as accessible and affordable as possible. I am convinced that integrative and ecologically sustainable practices are the best solutions to creating a true HEALTH-care system that both reduces costs and improves health outcomes. If we continue this work together, I believe we can address the health care and environmental challenges we face in the years to come.

–Dr. Lawrence Rosen, KIWI columnist

Bug bites, cuts and bruises, sunburns—sounds like summer! What’s a parent to do that’s safe and natural for these common childhood ailments?

“An ounce of prevention is worth a pound of cure.” If only our children paid heed to Ben Franklin’s famous adage. Parents and pediatricians spend a lot of time counseling young ones to be careful, and we slather them with sunscreen and insect repellent to try and limit the effects of outdoor exposure during the summer months. Short of covering our kids from head to toe in SPF-70 bubble-wrap, there’s not much more we can do. From time to time, children get hurt. Summer is the peak time for bites and stings, cuts and bruises, and sunburns. Conventional options include over-the-counter (OTC) lotions, creams and ointments for pain relief, but it turns out that some of these products can cause unpleasant adverse effects.

For example, a recent FDA warning about benzocaine, a common additive to topical medications for pain relief, urged us not to use these products in young children due to a rare but serious adverse effect called “methemoglobinemia.” Essentially, benzocaine toxicity can result in decreased oxygen capacity in red blood cells, causing respiratory and cardiovascular problems. No sunburn relief is worth that, believe me. Even more alarming, many conventional OTC teething gels for babies contain benzocaine. What alternatives do parents have?

When the FDA warned us about the use of OTC cough-and-cold medications in young children, many parents turned to homeopathic medicines. The same approach is warranted in place of benzocaine products, given the safety record of homeopathics for all of the conditions mentioned above. For example, for teething, parents have several options of homeopathic teething solutions or tablets that include dilutions of chamomile and other soothing herbs. It’s important to remember a basic principle of homeopathic medicine, the Law of Similars or “like cures like.” Simply put but poorly understood, a substance that causes symptoms at “full strength” (i.e. onions cause red and watery eyes and nose secretions) can be used to treat that condition in homeopathic dilutions (highly diluted Allium cepa – a.k.a. onion – is used to treat seasonal allergy symptoms). Typically, in classical homeopathy, specific remedies are matched to individuals for specific constitutions, but in this case, we are discussing homeopathy in a more “user-friendly” symptom-based clinical manner that allows families to develop a home toolbox of remedies for common conditions. There is much debate about the efficacy and mechanism of action of homeopathic medicines, but there is really no argument about safety, even in conventional medical circles.

Here are some specific tips for common summer ailments:

For insect bites and stings, I recommend Apis mellifica, from the honeybee. Remember, like cures like. For acute use, the 30c strength is optimal, and you can give 3 to 5 pellets as frequently as needed for symptom relief. Often for very acute use, remedies are given every 15 minutes for the first hour, then hourly for the next few hours, and gradually reduced as needed over the next day or so. You cannot overdose on homeopathic medicines.

For bruises, try Arnica montana, derived from the daisy family and also known as “wound herb.” Arnica can be applied topically in ointment form or can be taken orally (under the tongue) for more severe injuries. For children who cannot or will not put the tablets under their tongues, you can dissolve the pellets in water and let them sip gradually over a few hours. In general, you can continue to administer the remedy three times a day until healed.

For sunburns and minor skin abrasions, go with Calendula officinalis, which comes from the marigold. I’ve recommended it for many skin rashes and irritations, including baby diaper dermatitis. Published studies support the potent wound healing capabilities of Calendula. You can apply topically as needed, and it comes in ointment, cream and gel formulations.

In the end, remember that prevention is still preferable to treatment, even if we have safe natural options. For sunscreen, I encourage you to check out the Environmental Working Group’s 2011 Sunscreen Guide, looking for products with zinc oxide or titanium dioxide active ingredients and avoiding endocrine-disrupting chemicals like oxybenzone. As for insect repellents, those made from natural essential oils are preferable to those containing DEET, a neurotoxin. The Environmental Working Group’s Skin Deep Cosmetics Database provides helpful information on safer bug sprays. Now go outside and play!

–Dr. Lawrence Rosen, KIWI columnist

Mother’s Day is around the corner, and (at least in my family) chocolate is never frowned upon as a gift. With an increasing number of published studies highlighting its health benefits, could chocolate really be “the food of the gods”?

This moniker was probably first bestowed on chocolate by the Mayans and Aztecs at least 3500 years ago. Though imbibed mainly as a ceremonial drink at that time (mixed with chili and other spices which gave it quite a kick), it turns out that chocolate really does grow on trees. Chocolate historian and connoisseur Mark Sciscenti, who creates ambrosial chocolate brews based on traditional Mesoamerican and Mexican recipes at the Kakawa Chocolate House in Santa Fe, notes, “The chocolate tree was given the Latin name Theobroma Cacao, which means ‘Food of the Gods’, by the 18th century botanist C. Linnaeus in 1753.” If you want to learn more about the history of chocolate, check out Mark’s amazing web site. I will never forget a terrific “tasting” talk he gave on site at the Bronx Botanical Gardens in New York, which grows its very own Theobroma Cacao tree.

What is it about chocolate that inspires such devotion? One study found that certain bacteria in our intestines might in fact be responsible. While not the most romantic concept, it seems that some of us who crave chocolate have different colonies of intestinal bacteria than others. Interestingly, it took researchers over a year to find a control population—people who did NOT crave chocolate.

Of course, there are complex interplays of psychological and physiological factors implicated in chocolate craving. Serotonin, a neurotransmitter linked to mood regulation and deeply connected to hormonal balance, is affected by chemical constituents in chocolate known as methylxanthines. My personal favorite, dark chocolate, is made by mixing cocoa butter with chocolate liquor and sugar and forgoing the added-milk step. Some products are listed by their percentage content of cacao; health aficionados consider greater than 60% to be ideal for maximum benefits. Chocolate contains numerous antioxidants called flavonoids that exert an anti-inflammatory effect. Numerous studies have demonstrated positive effects of moderate dark chocolate consumption on cardiovascular function (lowering blood pressure, for example) and cognitive abilities (like visual sensitivity).

Of course, we must be mindful that too much of any good thing is not good for our health, and too much chocolate may contribute to obesity and metabolic imbalances like diabetes. But in moderation, assuming you are not allergic or have migraine headaches triggered by chocolate, a little dark chocolate a day may keep the doctor away. Oh, and if you can, buy fair trade to support small-scale farmers around the world by directing a greater proportion of economic gains to those who actually do the work to gather and produce the product. For more information on fair trade—which extends to coffee, tea and artisan trades—check out the Massachusetts-based Equal Exchange Co-op website.

Happy Mother’s Day to all the KIWI Moms out there!

–Dr. Lawrence Rosen, KIWI columnist

April is here, once again marking the return of Autism Awareness Month. This month will be filled with numerous events reminding us that the autism is still more prevalent than ever, and that more families are still struggling with what’s frustratingly termed “the mystery of autism.” To these families, autism is something they live with every day, not just one month a year, of course—but the increased focus is important.

Unfortunately, over the years I’ve been taking care of families with autistic children, several trends have gone in the wrong direction. First and foremost, more and more children are diagnosed every year. It’s now estimated that, in my home state of New Jersey, one in sixty boys is diagnosed with an autism spectrum disorder. And we still have no conclusive idea why. Yes, we have a growing amount of research elucidating the various environmental triggers that, under the wrong genomic influence and predisposition, lead to a biological unraveling presenting as a complex neurodevelopmental, gastrointestinal, and immunological disorder. That’s a mouthful, but at least we are starting to accept that autism is not simply a brain disorder. As neurologist Dr. Martha Herbert has noted, “The brain is downstream,” meaning that what we see—the impairment of communication, behavior, and social skills—is the result of many of other physiological processes going awry. This view of autism is encouraging in that it provides new avenues for evaluation, treatment, and—the holy grail—prevention. Yet, I must say, the pace of treatment developments has been excruciatingly slow. Parents often turn to alternative therapies (over 90% in one study I co-authored) because they are so frustrated by the lack of progress they perceive while devoting hours and hours to conventional therapies. Don’t misunderstand me—I definitely believe in mainstream therapies (speech, occupational, and physical therapies; behavioral therapies including but not limited to applied behavioral analysis or ABA). But these therapies do not always adequately address many of the important functional impairments, like sleep and gastrointestinal problems, common in autistic children. I have found that an evidence-based integrative approach is most effective in helping these families and children evaluate root causes and coordinate the comprehensive multi-system care needed.

More and more children will soon be teenagers and then adults with autism. Our society has never witnessed anything like this, and the emotional and economic impact due to educational and medical needs will soon force us to develop a more effective plan to hopefully stem the tide of new diagnoses. I urge you to take some time, especially this month, to think about how we can work together to make this a reality.

–Dr. Lawrence Rosen, KIWI columnist

How many millions of families have virtually journeyed around the world courtesy of Disney, serenaded by the memorable melody of “It’s a Small World”? I know that prior to these past two weeks, it’s the closest I’ve been to the wondrous lands of Southeast Asia. I write this to you from the air, on my way home from visiting Cambodia, a long journey back, but one full of memories that will linger much, much longer.

My family and I were graciously invited to accompany a small group of educators and other families on this adventure, mainly to visit and bring supplies to several groups of school children in Cambodia. I read as much as I could about the country’s history, most notable in recent times for the Khmer Rouge atrocities in the 1970’s in which nearly 2 million people were killed by Pol Pot and his followers. Any Cambodian now over the age of 40 likely lost multiple family members during these horrific years. But all of my book learning could not prepare me for the physical and emotional realities of this hauntingly beautiful yet ravaged country. And most amazingly, I did not anticipate the incredible warmth and vitality evident in the children we met.

Astonishingly, almost half of the Cambodian population is under 15 years old. As we’re seeing with many developing countries, it’s this “youth bulge” that is bringing Cambodia slowly but surely into the 21^st century. Nearly all of the children live in poverty, many having lost parents and siblings, yet they display immense curiosity and spirit. Some were street kids, formerly scavenging the dumps of Phnom Penh for scraps of food and supplies for their families. Others traveled via broken-down bicycles to attend school in a rural village, where they learn English and Khmer and can now eat fresh produce from a garden they plant and cultivate. The few hours we spent with these children—learning from each other, playing soccer and yard games with them, watching them sing and dance—was the greatest gift we could receive. To see my kids and our friend’s children laugh and play with the Cambodian kids was something that none of us will forget. Yes, we did of course do some sight-seeing, too, while there—exploring the spectacular ruins of Angkor Wat, haggling with merchants in the capital city’s famous Russian Market—but what will most remain fixed in our minds will be the moments we spent with these incredibly inspiring children. I encourage anyone who is able, whether in this country or abroad, to take at least one journey in your lifetime to realize how connected we all really are.

–Dr. Lawrence Rosen, KIWI columnist

Every winter I am reminded of the great “Fever Phobia” that plagues parents everywhere. In the Northeastern U.S., where I practice, we’re up to our necks in snow, ice and viruses. Cough and cold viruses, stomach viruses, and flu viruses—you name it, we’re seeing it. And the number one reason by far parents call us is—you guessed it—fever. On an average weekend on-call during the winter, 95 percent of the phone calls I receive are directly related to fears about fevers.

Dr. Barton Schmitt, a well-known primary care pediatrician, first popularized the term “fever phobia” in an article published in 1980. He noted that a majority of parents believed that moderate fever can cause serious neurological side effects and therefore treated fever aggressively with medications. He encouraged pediatricians to do a better job educating families about the “normality” of fever. Over the past 30 years, have we been effective in doing so? Not so much. Despite rising concerns about the overuse of over-the-counter anti-fever medications like acetaminophen and ibuprofen, “fever phobia” is alive and well. An updated report in the journal Pediatrics found that, compared with the Schmitt study, “more caregivers listed seizure as a potential harm of fever, woke their children and checked temperatures more often during febrile illnesses, and gave antipyretics or initiated sponging more frequently for possible normal temperatures.” The authors’ conclusion? “Fever phobia persists. Pediatric health care providers have a unique opportunity to make an impact on parental understanding of fever and its role in illness.”

Dr. Janet Serwint, a professor of pediatrics at Johns Hopkins and co-author of the aforementioned study, was recently quoted in a New York Times article on fever phobia by pediatrician Perri Klass:

“I personally think there should be much more education about (fever) at well visits,” says Serwint, adding that parents need to understand “the helpfulness of fever—how fever actually is a well-orchestrated healthy response of our body.”

I try very hard during both well and sick visits to counsel parents about the realities of fever. Most children will have a fever at some point in their lives. In fact, they should! I try to reframe fever as a positive sign that a child’s immune system is doing what it should. Fever is a sign that our body is doing what nature intended it to do when faced with an infectious intruder. Some studies have suggested that rectal temperatures over 106 degrees may more likely suggest a bacterial focus versus a viral infection, that is true. And a fever over 100 degrees in any baby under two months should be taken very seriously. Some children—less than 5 percent—will have a seizure with a rapidly rising fever, but these febrile seizures, while scary to parents, are not associated with any lingering neurological damage. In fact, there is no specific height of fever associated with brain damage.

Can fevers make children miserable? Sure. I’m not advocating letting a child suffer, but I do encourage parents to treat the child, not the fever. For example, a child with a 101-degree temperature who’s calm and playful and staying well hydrated does not necessarily need medication to reduce his fever. In fact, hydration may be one of the single best ways to help a child feel more comfortable. And that’s one of my other main points. Reaching for acetaminophen or ibuprofen does not have to be your first choice when confronted with fever. Consider a sponge bath with luke-warm water and towels. (Do NOT dunk you baby in a cold bath or sponge them down with alcohol.) Think about rubbing cooling essential oils like mint or eucalyptus mixed with massage oil on your child’s feet. Explore homeopathic belladonna (usually the 30c strength for acute use) if it seems appropriate and comfortable to you. I like to provide families with options, and then we can work together to find what works best for them and their children. I understand we all feel a need to actively “do something” when our kids are sick. It’s how most of us were raised and it’s how the medical system works in our country. Got a symptom? Treat it! That is the “disease-care” system we have, rather than a true “health care” paradigm focused on prevention and wellness.

–Dr. Lawrence Rosen, KIWI columnist

New Year’s is in part about resolutions: wishes for the year to come. On everyone’s list is usually something about eating healthier, exercising more, and being less stressed. These are often cited as personal goals, but more importantly, they are core integrative principles that we can use to chart a course towards a healthier future for our children. In this month’s post, I wanted to profile three real-life examples of model programs that are helping families live healthier lives.

Eating Healthier

January is the perfect time to reconsider old habits. It is the rare family that doesn’t indulge throughout the December holidays, culminating in some sort of grand display of eating on that final weekend (or two, or three…) of the year. So we all promise to set a better example for our kids as the new year begins—but how? It’s not about the latest quick-fix fad diet, but more about sustainable nutritional plans that focus not simply on weight, but on health. A shining example is HealthBarn USA near my home and office in Northern New Jersey. Stacey Antine, founder and CEO, has developed the “ultimate farm-to-fork experience” for families interested in helping their children develop an interest in food—“real” food—and how it’s cultivated. Imagine your child growing brussels sprouts, picking them, and eating them right there in the field. Stacey is one of those rare, gifted educators who can motivate children (and their parents!) to change their ways.

Exercising More

Many children do get physical activity at younger ages, but unless they’re involved in organized, structured sports, by middle school, they spend more time in front of screens and less outdoors engaged in active play. One solution? The Tenafly Nature Center in New Jersey is one of a growing number of organizations committed to helping families rediscover the natural environments in their own backyards. Programs are geared towards different ages of children and most are fun for the whole family. If you’re interested in learning more about the flora and fauna in your neck of the woods, or even if you’re just looking for a quick hike, there are many options, all supported by national organizations like the National Environmental Education Foundation, which trains health care providers to work with families and with nature centers in their communities to promote fitness for children via their Children and Nature Initiative. To find out about programs in your area, go to neefusa.org.

Being Less Stressed

The less stress part is not simple. While we’re working on making the world less stressful, we all could use help coping with the stress in our lives. Children need to learn these skills early in life, and they are wonderful at using their imaginations to do so. I am a big believer in the concept of mindfulness. Simply defined, mindfulness is just paying attention to the moment you’re in. Noticing it, valuing it for what it is. Mindfulness should be part of parenting and educational initiatives everywhere. One of the most innately appealing paths to mindfulness for children in particular is the practice of yoga. It’s great to see more and more schools, including preschools, featuring yoga as a regular part of the curriculum. What better way to help kids cope with the stress of the increasingly tasking school experience? Karen, the holistic nurse and clinical coordinator of our Whole Child Center, works with families regularly to help them incorporate yoga into their weekly routines. She also volunteers for a fantastic organization, Kula for Karma, to bring yoga to “those who have been challenged by difficult circumstances,” including children with autism and cancer. Kula, which can be translated as “community,” is a concept of which we all can be more mindful as the New Year evolves.

–Dr. Lawrence Rosen, KIWI columnist

“All I am I owe to my Mother. I attribute all my success in life to the moral, intellectual and physical education I received from her.”                    –George Washington

“All that I am, or hope to be, I owe to my angel mother.”                                          –Abraham Lincoln

Turns out that both Washington and Lincoln were more right than they knew. Our two most celebrated presidents were referring to the effect their mothers had on them after birth, of course, but recent scientific discoveries have shed light on how important a baby’s first environment—the womb—truly is.

The idea that mothers are crucial factors in their children’s health is not new. We have long understood that both parents’ genetics and the environment in which they raise their children have a synergistic effect on health outcomes. From the mundane (eye color) to the bafflingly complex (intelligence), our physical and emotional traits are the results of complex interplays between nature and nurture. What we are just starting to comprehend, though, is how complicated these interactions are. For example, the new science of epigenetics is shining a bright light on gene-environment relationships.

“At its most basic, epigenetics is the study of changes in gene activity that do not involve alterations to the genetic code but still get passed down to at least one successive generation. These patterns of gene expression are governed by the cellular material—the epigenome—that sits on top of the genome, just outside it (hence the prefix epi-, which means above). It is these epigenetic “marks” that tell your genes to switch on or off, to speak loudly or whisper. It is through epigenetic marks that environmental factors like diet, stress and prenatal nutrition can make an imprint on genes that is passed from one generation to the next.”  –Why Your DNA Isn’t Your Destiny (Time/CNN)

Let’s look at nutrition as a specific example. I was recently presenting a talk with my associate, Dr. Heather Jeney, at the 2010 Holistic Moms Network national conference, a gathering attended by hundreds of moms (and several dads, to be truthful), including quite a few pregnant ones (the moms that is). I was curious about what they must be thinking, nurturing life already in their bodies, listening to what they should and shouldn’t be eating. Of course, the “should” and “shouldn’t” changes depending on who’s talking and who’s listening. In any case, the concept of “eating for two” was made very present and palpable. This process is eloquently presented in Annie Murphy Paul’s stimulating book, Origins: How the Nine Months Before Birth Shape the Rest of Our Lives. The author explores the current science on “fetal origins of adult disease” through the lens of her own pregnancy. In essence, to some degree, what and how a woman eats during her pregnancy determines how healthy (or unhealthy) her child will be not only at birth or during infancy, but as an adult as well. There is a growing literature describing the effects of maternal obesity during pregnancy on the development of obesity and diabetes in her grown children. Wow. Think about that for a moment. It appears that there are controllable factors influencing the baby’s first environment and subsequent health outcomes, like nutrition and obesity. Changes in mom’s health affect the expression of the genetic code she passes on (of course, with the baby’s father) and these changes in genetic expression (the epigenetic phenomena) may carry forward now from generation to generation.

But what about other environmental epigenetic influences that are not as personally controllable, such as airborne toxins? What are we to do about those factors? Take, for instance, tobacco smoke. First, it was established that smoking negatively impacts one’s own health. Next, we learned that “second-hand” smoke—a parent smoking in the presence of a child—can lead to asthma. Now we are discovering the dangers of “third-hand” smoking: Researchers in Greece have found that “passive exposure of pregnant women to environmental tobacco smoke (ETS) during the third trimester is positively associated with asthma- and allergy-related symptoms in their preschool age children.” Simply put, pregnant woman exposed to ETS—women who did not smoke themselves—had children who were more likely to develop asthma and allergies. This is epigenetics in action. And it’s pretty frightening.

What are we to do about this? What are our options? Well, as I’ve written before, I’m an optimist. Complex challenges are opportunities that call for complex solutions. One woman I greatly admire for taking on this challenge is doula Debra Pascali-Bonaro, President of Mother-Love, Inc., CD (DONA), LCCE, Lamaze International childbirth educator, co-chair of the International MotherBaby Childbirth Initiative, and mother of five children. Debra’s film, the provocatively titled, “Orgasmic Birth,” encourages women to reclaim birth as a joyous, natural experience, not the fearful, medicalized process it has become. I was interviewed for the film several years ago because Debra’s vision made room for the revolutionary concept that the birth process affects the baby’s physical and emotional health as well as the mother’s. Follow me through this, now. More women, especially in the United States, are undergoing caesarean sections, and it’s likely that many of these procedures are not strictly medically necessary. A baby born via c-section is not introduced the same protective flora (probiotic bacteria) as a baby born via vaginal delivery. A baby born via c-section is less likely to be breastfed and therefore deprived of many healthful immune constituents of breast milk, a second strike against the development of a normally functioning immune system. These babies, it turns out, are therefore more likely to develop allergies. Is it plausible that the increasing rates of C-sections in our country are in some way related to increasing rates of chronic diseases in our children, such as food allergies and asthma? I’m just connecting the dots, here. What Debra and her colleagues are seeking to do is change long-term health outcomes by addressing the system as a whole. What’s best for a mother’s well being is likely what’s best for her baby’s.

As a pediatrician, it is increasingly clear to me that I, too, need to care about family health. I need to help families understand that what they do—even prior to conception—can play a role in their babies’ lives. They need to be counseled about this as adolescents so that they hopefully become happy and healthy young adults who hopefully some day have happy and healthy babies. And so on. We are starting to realize what the animals in Disney’s ‘The Lion King’ already know. And not a moment too soon.

–Dr. Lawrence Rosen, KIWI columnist

There’s lots of coughing and sneezing going on at the Whole Child Center—and probably every other pediatric office in the world—this month. “ ’Tis the season to be wheezin’ ” we used to lament back in my residency days. I would spend hours in the ER asthma room—yes, a dedicated room for kids with asthma—administering oxygen and nebulizer treatments until MY head was spinning from all the medication floating around in the air. I kept thinking, “There has got to be a better way.”

It turns out there is. While medications can be life-saving and do have their place in acute treatment, there are a number of natural approaches that can help prevent and soothe many common childhood ailments. A lot of the questions I’m asked are about these natural ways to prevent and treat viral illnesses and symptoms, and I really try to help families focus on the prevention aspect: Staying well. An ounce of prevention…Well, you know how it goes. What I primarily counsel parents is that fever, cough, and runny nose—these things we think of as “sickness”—are not necessarily evils to be completely suppressed and stamped out. Human bodies, especially children’s, have a marvelous tendency to rebalance when left alone.

That is not, however, how most of us were raised. (I’m always amazed when I encounter adults whose parents raised them in the 1960’s and 1970’s with a focus on natural health remedies.) The “one ill – one pill” solution of modern healthcare depends on finding a quick and easy short-term solution to all ailments. Our health care system, which I have come to think of as a “disease-treatment” system for the most part, has promoted the use of over-the-counter (OTC) cough-and-cold pharmaceuticals for many years. Most parents are taught to treat every condition aggressively to suppress symptoms. I’ve noticed that parents (and, it seems, especially grandparents) have tremendous fear about fever in particular. Fever, my friends, is not our enemy. It is simply a sign that the body is fighting infection or inflammation. While I am not in favor of children suffering, there are times where the body is best able to heal in the short- and long-term without aggressive pharmaceutical intervention.

Many pediatricians and parents have known for quite some time that cough-and-cold OTC treatments are questionably effective. What works for little Jane or Johnny one time may not work the next, and what works for one child may be of no use for another. What has come to light more recently is the dubious safety record of typical OTC preparations. The FDA has issued strong warnings urging parents to be careful about the use of these OTC meds in kids, especially for those under 2 years of age. Many ER visits per year and calls to poison control centers are due to adverse effects from OTC cold-and-cough medication use.

So parents are rightfully left to ask, “What is safe and effective for me to use for coughs and colds?” I start with simple, inexpensive and common-sense lifestyle approaches: Washing hands, changing clothes, getting plenty of fresh air and exercise, eating healthly foods, drinking plenty of water, and getting enough rest and sleep. I cannot overestimate the importance of these deceptively simple measures. But what other natural therapies are potentially helpful?

For Prevention:

1.  Vitamin D: Now linked to many acute and chronic health conditions, deficiency of vitamin D is also connected to a higher incidence of respiratory tract infections. It has been speculated that the higher prevalence of influenza in winter months corresponds to a decrease in the population’s vitamin D levels as sunlight exposure decreases. Approximately 70 percent of children have been found to be vitamin D deficient in recent surveys. It is possible that those individuals with vitamin D deficiencies are at higher risk to contract flu and develop complications from these infections. Historically, the most common sources of vitamin D are sunlight and supplemented dairy products. Sunlight may be tough to come by in the winter (and sunscreen use during the summer has limited our exposure, too), and a rising number of children cannot tolerate dairy products. One alternative is a vitamin D supplement given on a daily basis. The AAP recommends 400IU of D3 per day, but some children will need more than that to optimize vitamin D levels. Check with your health care practitioner if you want to test your child’s level.

2. Probiotics: Probiotics are bacteria and other organisms that colonize our gastrointestinal systems during, and shortly after, birth. They regulate important immune and digestive functions. One recent study demonstrated that daily probiotic supplementation was a safe and effective way to reduce fever and cold symptoms, as well as reduce the number of antibiotic prescriptions and missed school days due to illness. This is a major finding, and if a conventional OTC product could do this, I’m sure we would be reading about it in every major media publication. So how can you get probiotics into your children? Yogurt and other cultured foods can be helpful. For those who cannot eat dairy or choose not to, there are an abundant number of good quality probiotic supplements in the refrigerated section of your local health food store.

For Treatment:

1. Elderberry: These dark berries rich in antioxidants come from the Elder tree (Sambucus). In one study, adults with flu symptoms who took elderberry syrup for five days had a significantly reduced length of illness. Another study found that elderberry was particularly effective against the H1N1 flu strain in a laboratory setting. How those studies translate to children is still a topic of debate, but as elderberries are essentially a highly concentrated antioxidant food, I recommend a dose three times per day to those suffering from flu-like symptoms—along with chicken soup (or a vegetarian option), of course!

2. Homeopathics: These are my first choice for OTC symptom relief. Finding the right homeopathic remedy for each individual child can be tricky, but the good news is that homeopathy is extraordinarily safe. If you pick the wrong remedy, nothing—good or bad—should happen. But if you hit on the right one, voila! It’s magical how quickly these remedies can work. Oscillococcinum is the most well-known flu remedy, but I am also a fan of Boiron Chestal for cough and Boiron Coldcalm for cold symptoms. Follow the manufacturer’s directions if you choose to use any of these remedies.

There are many other options in the natural world for cold, cough and flu prevention and treatment. Some families rely on traditional, cultural practices like Chinese Medicine or Ayurveda while others swear by Reiki or other energy healing modalities. Sometimes doing nothing is absolutely the right thing to do. As the popular medical aphorism goes, “Primum non nocere” (first do no harm). Obviously, check with your pediatrician if your child shows signs of dehydration, breathing distress or just doesn’t seem right to you. Trust your intuition. That’s the best advice I can give any parent. OK, now bundle up and go get some vitamin D!

-Dr. Lawrence Rosen, KIWI columnist

“Best to believe there will be happily ever afters all the way around – and so there may be; who is to say there will not be such endings?” - author Stephen King

Quoting a horror writer about happy endings may seem odd, but one of the things I’ve always loved about Stephen King is that he ultimately allows the good strand in humanity to triumph, no matter how bleak the circumstances.  I’m a pretty optimistic guy, trying to fill up the glass so it’s always at least half-full.  I work really hard to avoid propagating the doom-and-gloom health and environment messages we are force-fed daily from the media.  Which is why, I am delighted to report, one weekend in San Francisco has renewed my hope for our children, for our future.  And for all you KIWI families out there, it should do the same for you.

Children First: Promoting Ecological Health for the Whole Child is the title of a ground breaking event I co-hosted with the Collaborative on Health and the Environment (CHE)  and the University of California – San Francisco Osher Center for Integrative Medicine.  Elise Miller, the Director of CHE and Dr. David Becker, an integrative pediatrician and Assistant Clinical Professor in Pediatrics at UCSF, worked closely with me to develop the symposium, described as follows:

Pediatric Integrative Medicine embraces a holistic, whole-child approach, specifically examining the context – the ecology – in which optimal health and wellness is promoted. This groundbreaking one-day symposium will highlight a range of interacting factors that influence child health and development, including nutrition, education, socio-economic status, exposures to toxic chemicals, and access to preventive health care. Leaders in these fields of expertise will also describe model programs and concrete steps toward creating optimal and sustainable environments in which children can thrive and reach their full potential.

Here’s what I envisioned: one room packed with forward-thinking people of all backgrounds – personally and professionally – committed to making the world a better place for our kids.  Dedicated to or at least interested in the concept of an integrative approach to nurturing the “whole child” – based on ecological sustainability concepts.   In short, a gathering focused on greening our children through the presentation of real-life models by health and environment leaders from around the country.  The day, happily, exceeded even my lofty expectations.  Perhaps most amazing was the incredible synergy evident in the work of our speakers, and echoed in the passions of our audience.  Education, nutrition, nature, greening healthcare, family-centered and culturally sensitive care, collaboration among practitioners and families of all types – these themes ran through everyone’s presentations.  There were too many bright moments to profile them in detail here, so I hope you go to the Children First web page and explore the resources in detail.  These programs are all models of what we can achieve and they give me great hope for the future.  Needless to say, I left the day feeling energized and inspired.   I feel so lucky that I experience this, too, in my day-to-day interactions with families; not everyone can say that, I realize.  But on a more global level, it was incredible to connect with others around the world doing like-minded work.

I awoke the next morning to attend the national American Academy of Pediatrics (AAP) conference.  My position within the AAP, a vast network of over 50,000 pediatricians, is as chair of the Section on Integrative Medicine.  We work hard to nurture young physicians interested in a more holistic approach, many of whom come to use because the families they are caring for are asking for “greener” pediatric care.  With this in mind, KIWI and the Whole Child Center, my practice, partnered to bring a green flavor to the AAP’s Pediatric Office of the Future exhibit, the first time this futuristic showcase included ecologically sustainable concepts.  After all, the office of the future should be green, right?  You can find out more about how KIWI is leading the way in this arena by checking out the new Green Pediatrician page featuring a five-minute video profile and resources so you can help your pediatrician go green.

Sadly, children don’t always come first.  But they should – you and I know that.  It is neither a luxury nor a choice; it is a moral imperative.  By working together, we can make it so.

-Dr. Lawrence Rosen, KIWI contributing editor

Ulcers. Migraines. Panic attacks. Are today’s pressures slowly killing our children?

Tara Parker-Pope, in her New York Times “Well” column, recently profiled the phenomenon of “back-to-school” headaches.

“For kids around the country it’s back-to-school time. But for many of them, it’s also the return of headache season,” laments Parker-Pope.

While going back to school is nerve-racking for many kids (and their parents), it’s not the only time of year I hear complaints about headaches and stomachaches severe enough to cause families to bring their kids in to see me. Every day in my practice, I see at least one child suffering from physical symptoms of stress. Teens with chronic headaches, eight year-olds with recurrent abdominal pain, a three year-old with a bleeding ulcer. What’s going on?

Some have blamed our society’s new obsession with over-scheduling young ones. Judith Warner’s treatise on turbo-charged moms, “Perfect Madness,” takes parents to task for pushing their children too hard as a side-effect of martyred motherhood. School and travel sports teams have year-long seasons now, kids are booked several weeks ahead for play-dates, and kindergarteners have homework every night. While we work on addressing these societal ills – see my piece last month on the value of “free play” – we’ve got to find ways to help our kids build their virtual toolbox of mind-body skills to help them cope with life’s worries.

A few of my favorite mind-body relaxation therapies for kids? One of the most promising and appealing modalities is Mindfulness-Based Stress Reduction, developed by Jon Kabat-Zinn. Jon and his wife Myla have also published a wonderful book to teach parents how to work with their kids from this perspective: “Everyday Blessings: The Inner Work of Mindful Parenting.” Yoga, guided imagery, biofeedback, music therapy – these too have solid evidence supporting their use in the pediatric population to help children cope with stress. Another favorite resource is Dr. Amy Saltzman’s CD, “Still Quiet Place.” Amy does a wonderful job creating a variety of mind-body experiences for children and families, and the recording is a terrific tool to engage youngsters in the practice of mindfulness.

One of my favorite ways to bring the concept of mindfulness into my kids’ lives has been through reading stories. Since they were very young, my children have loved listening to stories we tell them about “the old days.” Though they’re getting older now, we still try and make time to read stories together before bed. There is magic in telling and listening to stories.

Hans Christian Andersen, the bard of Copenhagen, was immortalized as a master storyteller, played by Danny Kaye, in my wife’s favorite movie of all time. I’d like to think we’ve all been mesmerized from time to time by storytellers. Stories are a way many of us pass on tales of our past, our culture, and moral lessons to our children. Native American storytelling, an integral part of American history, teaches children about the ways we interact with nature and about the importance of ancient wisdom. There are modern-day storytellers as well. Jim Weiss is one – I heard him a few years ago at a children’s health fair; he had the kids in the palm of his hand after two minutes. I also had the privilege of meeting Vered Hankin at an integrative pediatrics conference. If you think there’s no one around today weaving tales “like they used to” – you’ve got to listen to Vered’s work. Her stories come alive – they’re almost 3D. The power to me is the hypnotizing transportation to other places. This is truly mind-body therapy. And it is a very useful tool to help young children (and us old kids too!) cope with stress.

And what better way to help our children learn about mindfulness than through stories? Not just via the act of storytelling and listening but through the telling of specific stories that weave in messages about mindfulness. Jon Muth’s “Zen Shorts“ is one of my all-time favorites. On the surface, the author introduces three contemporary Western children to a decidedly-Buddhist giant panda, Stillwater, but along the way, he gracefully weaves in three Zen philosophy tales. My personal favorite (though not my kids, of course!) is about letting go. Karl, the youngest child, goes to visit Stillwater, but he’s quite mad at his older brother, Michael. Karl spends the day being mad at Michael, as Stillwater tries to educate him about enjoying the moment and releasing his anger. The parable Stillwater shares with Karl to illustrate the point goes something like this:

Two monks are walking along a country path. They soon are met by a caravan, a group of attendants carrying their wealthy and not-so-kindly mistress and her possessions. They come to a muddy river, and cannot cross with both mistress and packages – they must put one down and cannot figure out how to do so. So the elder monk volunteers to carry the woman across the river, on his back, allowing the attendants to carry her things, and then all can go on their way. The woman does not thank him, and rudely pushes him aside to get back to her caravan. After traveling some way on their own, the younger monk turns to his master, and says, “I cannot believe that old woman! You kindly carried her across the muddy river, on your very own back, and not only did she not offer thanks, but she actually was quite rude to you!” The master calmly and quietly turned to his student, and offered this observation: “I put the women down some time ago. Why are you still carrying her?”

The story resonated with me as I read it, and both kids asked many questions about the literal events and about their meaning. We spoke about different religions – Judaism, Christianity, Islam, and Buddhism. They understood at a basic level the similarities and differences – though they interestingly both focused on the similarities. But it was the very nature of questioning that struck me as so apropos. I was reminded of a verse (15) from the Tao Te Ching:

Do you have the patience to wait

till your mud settles and the water is clear?

Can you remain unmoving

till the right action arises by itself?

This concept of mindfulness, of being in the present, is so important to both children and adults. I think children mainly do live in the moment. Both the past and future are strange concepts until they age a bit. Perhaps we should learn to keep more of this “now” with us as we age. It would serve us all well.

-KIWI columnist, Dr. Lawrence Rosen

Imagine a treatment that would improve your mood, make you smarter, keep you healthier and improve your relationships.  How much would you invest in that therapy? 

Turns out there is such a thing, and best of all – it’s free.  It’s called “nature.”

How many of you were told as youngsters by a parent or grandparent – “Just go out and play”?  And then you did just that.  You’d go out for hours after school, just exploring the backyard, or the woods, or the playground, with your friends until it was dinnertime. 

I am afraid we have lost touch with the value of free time and play, especially for our children.  What better time than summer to re-focus on the lost art of simply playing outside?

We have overscheduled children frantically trying to keep up with their overscheduled parents in our 21st century world where relaxation time must be planned as well.  Play-dates have replaced free play, often booked weeks in advance as parents link up their PDA’s to ensure kids can hang out together.

I know, I know, it’s a different world now.  The ability to pay “partial continuous attention” is a highly valued skill these days. Parents feel the pressure to prepare their children for the “real world” they’ll face. Globalization forces us to compare our educational systems not only to those of neighboring towns but to those of other countries half-way across the world. I am not so naive as to believe we can turn back the clock and remove all stress from life. Indeed, as researcher Hans Selye noted, stress is not necessarily a bad thing; it is simply “the nonspecific response of the body to any demand.” So we must focus on teaching our children not how to avoid demands per se but how to develop better coping mechanisms.  One of the best ways, it seems, is to promote free, unstructured play – especially in natural, outdoor settings.

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Where is Superman when you need him?  If only it were that easy.  Facing one of the greatest environmental disasters of our time, the citizens of New Orleans could sure use a caped superhero capable of turning back time by spinning the world in the opposite direction.  While he’s at it, why not go back five years, before the onslaught of Katrina, which plunged families in the Gulf into a dark abyss that has destroyed lives and continues to ruin both homes and health.  One of the dark truths made evident by the response to Katrina and to the Gulf oil spill is that there is a sector of the American population – specifically poor children –increasingly victimized by what is termed environmental injustice.

What is environmental justice?  It is one of the top priorities of the U.S. Environmental Protection Agency (EPA), defined as follows:

“Environmental Justice is the fair treatment and meaningful involvement of all people regardless of race, color, national origin, or income with respect to the development, implementation, and enforcement of environmental laws, regulations, and policies. EPA has this goal for all communities and persons across this Nation. It will be achieved when everyone enjoys the same degree of protection from environmental and health hazards and equal access to the decision-making process to have a healthy environment in which to live, learn, and work.”

Environmental injustice, then, is done when there exist health disparities based on these same factors.  The National Environmental Justice Advisory Council, in response to the BP/Deepwater Horizon oil disaster, challenged the EPA to “do a better job of targeting communities that have historically been underrepresented in disaster response, including people of color and Native Americans.”

Children, in fact, are a unique population susceptible to unfair treatment based simply on one factor – their age. As noted in a recent editorial by Dr. Philip Landrigan, Director of the Children’s Environmental Health Center at the Mount Sinai Medical Center in New York, “Infants and children, because of their unique biological vulnerabilities and age-related patterns of exposure, are especially vulnerable to the health impacts of environmental injustice.”  And certain children – victims of poverty and often those of certain racial groups – are particularly at risk.  They are the most vulnerable of the vulnerable.
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KIWI’s Dr. Rosen on day-to-day courage:

When my daughter was only three or four years old, she was obsessed with the “Wizard of Oz” movie. We must have watched parts of it daily for the better part of a year. I know this is not unusual based on the numbers of preschoolers I see in my office wearing ruby red slippers. While I am not a big fan of TV for kids, the fun we had watching clips here and there only served to stimulate her incredible imaginary play the other waking hours of our days.

One of my favorite parts is the following interchange:

Cowardly Lion: …What makes the elephant charge his tusk in the misty mist, or the dusky dusk? What makes the muskrat guard his musk? Courage! What makes the sphinx the seventh wonder? Courage! What makes the dawn come up like thunder? Courage! …What have they got that I ain’t got?

Dorothy, Scarecrow, Tin Woodsman: Courage!

Cowardly Lion: You can say that again!

Courage, of course, comes in many sizes. Big and small. What I’m writing about here is the day-to-day courage to stand up for your way of life no matter how much others in your life and community may disagree with you.

A recurring theme has developed lately in my conversations with families in my practice. Even though “green” is everywhere, there are still many challenges families face when they adopt a more natural lifestyle. As I noted last month, there are many baby steps to going green that make it easier to move in that direction. Sometimes cost and access can be significant barriers. But the biggest challenge may be trying to convince others in our communities that what we’re doing for our own kids is what’s best for them. One mom told me a story about how, when she politely declined a junk food snack for her toddler in a playgroup, she was not-so-politely requested to find a new playgroup. Mind you, she wasn’t trying to convert anyone to her way of life, just stating a preference for her child. Another parent has been working for years to introduce healthier hand sanitizer options in her local elementary school. Her main challenge? Not convincing the school administration to look at other options – they’re on board. It’s other parents who remain convinced that commercial alcohol- and chemical-based products are the only effective solution, regardless of safety concerns. A family considering non-pesticide lawn care was ambushed one weekend by neighbors, calling them “bad citizens” for possibly exposing their yards to weeds. Weeds?!? What about the exposure of the children and their pets to the toxic pesticides drifting and running into the family’s yard? Sometimes these battles take place within families. In one home, a mom is constantly fighting her own mother, forever scouring the medicine cabinets and tossing out the artificially-dyed and sweetened cold medicines that the grandmother insists her 8-month old grandson needs for his teething-related mild stuffy nose.

These are just a few of the daily examples of those I think of as “parent warriors,” fighting for what they believe in. It takes a lot of courage to stand up for what you think will best serve your child – for what you know intuitively is right – when it seems that the world is against you. I still maintain the best path to enlightenment is through education – of other families and of children. I have witnessed several instances of children encouraging other children to recycle or reduce waste or eat organic food. It’s a marvelous transformation to behold. Fortunately, these acts of childhood courage are often met with more openness and less resistance than their grown-up counterparts. Maybe we should all pay more attention to our kids.

Courage doesn’t always roar. Sometimes courage is the little voice at the end of the day saying, “I will try again tomorrow.”- inspirational author, Mary Anne Radmacher

—KIWI columnist Dr. Lawrence Rosen

KIWI’s Dr. Rosen on how to start going green:

I love what I do.  One of my favorite things about being a pediatrician is developing relationships with families and children over the years.  These connections are what keep me going and make me happy to go to work each day.  What a privilege it is to earn the trust of parents and, especially, of children – many of whom have had experiences which have severely tested their trust in the medical system.  These relationships grow and deepen over years of visits, but it is often day-to-day moments that stay with me most vividly.  

Recently, one such encounter has been resonating with me.  A mom of two (a toddler and a newborn) – experienced yet still learning about parenthood as a second-time mom – asked me a question that cut to the core of my daily practice as a green pediatrician.  “Dr. Rosen – I know you speak to parents all the time about ways to keep our families healthy.  If you were to share three top priorities for ‘going green,’ what would they be?”

“Aha,” I replied.  “You’ve just given me the topic for my next Kiwi blog.”

Honestly, it’s not easy to come up with a “best-of” list for changing your life towards a more toxin-free existence.  I love those top-10 books- or albums-of-the-year pieces that come out each December, but this answer depends on so many individual family factors.  Where do you live?  What is your economic situation?  How old are your kids?   So, I will temporarily suspend the luxury and responsibility I have in answering each family differently and give you my top general “going green” pointers.

1. Green your food and water.

OK, I cheated already.  This is really a two-for-one.  But what is more important than what we put in our bodies?  I always say, start with what you have control over.  And food definitely is at the top of the list.  Where to begin?  If you and your kids are dairy drinkers/consumers, go organic.  You’ll avoid antibiotics, hormones and pesticides.  Not bad, huh?  Next step – avoid the conventional dirty dozen fruits and vegetables, popularized by the Environmental Working Group, and buy organic.  Ideally, we’d only buy organic, locally-grown produce – good for you and for the earth – but the reality is most people can’t afford to do this and many of us don’t have access to these foods on a regular basis.  As for water, it’s hard to read about water quality these days and not be concerned about levels of heavy metals like lead and arsenic as well as pharmaceuticals present in drinking water.  You could buy bottled water, but that’s expensive and you have to worry about plastic exposure – again, good for neither you nor the environment.  Consider investing in a filtration system for your home.  In the long run, it will save you money and provide you with what I believe is, in general, the healthiest water supply possible. 

2. Green your cleaning.

Other than food and water, what else can we control? Air quality is next on my list. Not so much outdoors, which is an issue we’re going to have to solve as a society, but definitely in your home. There are so many healthier versions of cleaning agents you can either make yourself or buy that it’s a shame to keep using toxic products to clean your house. Simple, inexpensive options like lemon juice and baking soda work well for many needs. I teach everyone I possibly can how to make a neat DIY hand sanitizer. While we’re at it, cleaning applies not only to your home but to our bodies as well (and I can sneak in a tip 2B here). Shampoo, soap, moisturizers, baby lotions, diaper creams, toothpastes, sunscreens, and so on — there are an increasing number of chemical free, safer options available now. Check out the Green Guide for greener personal care solutions for your family.

3. Green your mind and body.

Wait a minute, you say.  You just mentioned our bodies.  What is this mind-body stuff?  I’m referring to integrative concept of mind-body health – literally, the connection between a healthy body and a healthy state-of-mind.  Pick something – ANYTHING – that helps you and your kids develop a mindful or contemplative practice.  Exercise, dance, do yoga, meditate, pray – whatever it is that helps you better center yourself.  Better yet – bring more greenery, literally, into your life.  Bring a new plant into your house.  Plant a garden.   Grow your own organic fruits and vegetables and you’ve got tips #1 and #3 covered.  So get outside and help cure the nature-deficit-disorder plaguing so many families today.    

Do we live in a toxic world?  Sure.  Is it easy to be paralyzed by indecision about how to start cleaning up your entire life?  Absolutely.  It’s like walking into that messy room and not knowing where to begin.  But you have to pick something.  Don’t use the excuse that “it’s just too hard, so I’ll start tomorrow.”  This is too important.  Pick one thing and take that first baby step.  Pretty soon you’ll be walking, and then running, to a cleaner, greener life.

—KIWI columnist Dr. Lawrence Rosen

I’m excited to introduce you to KIWI’s new pediatrician columnist (check out his first column in our April/May issue, out next week), Dr. Larry Rosen. He’s also going to blog for us, so keep an eye out every month for The Whole Child blog from Dr. Rosen. I think you’ll all love where he’s coming from. But don’t just take my word for it–learn more about him right here, right now! 

–Sarah, KIWI editorial director

Hi.  I am Dr. Larry Rosen, Kiwi’s new health contributing editor.  I am pretty excited about this opportunity to bring my passion for holistic children’s health care to this forum – it’s a perfect fit.  I am a Kiwi parent – one interested in the optimal health of our children through an increasingly popular blend of natural and conventional care called integrative medicine.  It’s the way I live my life and the way I run my primary care pediatric practice, The Whole Child Center.  But what is this “whole child” philosophy and what does it have to do with integrative medicine and being environmentally responsible?

I have been called a “green” pediatrician.  I take this as a great compliment and a serious responsibility.  Look, “green” is hot.  Everywhere you look, we’re encouraged to “go green.”  The term ‘green’ these days reflects doing what is best for our planet.  Green products are considered safe for the environment and healthier for people who use them. Are green doctors the same? I think so.

The central tenet of green medicine is mindfulness about the effect the environment has on health and wellness, and about the effect health care has on the environment.  I specifically designed my practice as an environmentally responsible healthcare facility and operation.  We built our space using ecologically sustainable materials, use nontoxic cleaners and are virtually paperless, using a state-of-the-art electronic medical record system.   I wanted the space I work in to reflect the type of care we deliver.  Furthermore, we discuss at every visit, starting with prenatal consultations and going all through adolescence into young adulthood, the important environmental factors in creating optimal health.  Organic foods and mattresses, nontoxic toys, growing and making your own food, how to avoid air and water pollution – these are just some of the issues we discuss in everyday conversations.  And these are the same issues that I know are important to you as Kiwi readers.

But to be a green doctor, I think, also means adopting holistic, “whole child” philosophies with a key focus on promoting and supporting wellness.  In health care parlance, this is known as integrative medicine.  Integrative medicine – and by association, integrative pediatrics – is in part about using complementary therapies, like acupuncture or yoga, along with conventional remedies when appropriate.  We do value natural solutions when safe and effective – but we also deeply believe in a philosophy of health care that is more than about acute disease treatment.  It’s about prevention and creating wellness and understanding the importance of mind-body-spirit connection in helping kids be as healthy as they can be.  True health is considered not just the absence of disease, but the presence of optimal functioning.  Additionally, we value individuality and understand that one size does not fit all. Each and every child responds uniquely to each and every therapy, each and every time.  And most importantly, we recognize the connection between doctor and patient (and in pediatrics, doctor and family) as crucial to health and healing.

“Integrative Medicine is the practice of medicine that reaffirms the importance of the relationship between practitioner and patient, focuses on the whole person, is informed by evidence, and makes use of all appropriate therapeutic approaches, healthcare professionals and disciplines to achieve optimal health and healing.”

-Developed and Adopted by the Consortium of Academic Health Centers for Integrative Medicine

Integrative medicine, therefore, is relationship-centered. The bond and communication between pediatrician, child and family is crucial both diagnostically and therapeutically. Furthermore, the interaction of each child with his or her environment (local, global, natural and artificial) is key.  The community aspect of integrative health care is so important.  We do not exist in isolation, and we have an obligation to work together for our kids.

I look forward to developing this partnership with you, as I have with my own patients and families over the years.  And together, we will advocate for our children and help them create a better, healthier world, for they are indeed our most precious natural resource.