An Integrative Pediatrician Answers 8 Questions About Your Child's Development
When my older son, H, was one year old, we were fortunate enough to be referred to Dr. Katiraei of Wholistic Kids and Families. At the time, we were living in Los Angeles and I was fed up with our regular western pediatrician who had been largely dismissive of my concerns about H's development.
So, when a friend of a friend told me about "a western-trained pediatrician who had opened up a wholistic practice", I immediately made an appointment.
Within minutes of sitting down to talk with Dr. K, I felt a wave of relief wash over me. His gentle demeanor, calm presence and quiet confidence told me we were in the right place.
He spent an hour listening intently to my concerns- asking questions and taking notes the entire time. After he examined H, he laid out a plan of action to get to the bottom of what was causing him to suffer.
Through a combination of labs, developmental history and physical exams, Dr. K was able to determine that H had a metabolic issue that was contributing to his sensory processing issues, something no western doctor would have ever tested for.
Long story short, with the help of Dr. K, we've been able to address the physical imbalances that are at the root of H's developmental issues. As a result of Dr. K's recommended supplementation, we've seen a tremendous improvment in H's behavior and mood.
Recently, H went through a rough patch. He'd been doing really well so we'd tapered off the supplements. But, getting a nasty case of Influenza B over the holidays sent his nervous system into a downward spiral.
Cue the intense explosions.
I'm talking next-level, aggressive, out of control meltdowns.
I knew he wasn't doing it on purpose and that there was something physical underlying his explosive behavior so I called Dr. K. He recommended running some labs as well as an Organic Acids Test and, while we waited for the results, to start him on an herbal adrenal tincture.
Two days of taking the adrenal tincture and H was noticably calmer. He's been taking the tincture for two weeks now and has not had a single meltdown.
Dr. K is an incredibly gifted, wise and dedicated physician who has helped hundreds of children and families. In addition to his impressive and extensive medical background, he is the most genuinely caring practitioner I've ever met. He was generous enough to sit down with me for an interview, so without further ado, here it is....
1. Tell us a little about your background and how you became an integrative pediatrician.
When I was in my residency, it became apparent that there was a lot more to the picture than I was being taught in school and in my training. Conventional pediatrics is not bad; pediatricians know a lot of amazing things and are able to help a lot of children. The tools and skills I learned during my western training have been invaluable. **But, it boils down to the fact that no one group or model of medicine has all the answers. This is what became apparent during my training. **
A pivotal moment for me during my residency was when I was working on a case with a child who had severe colitis. The attending doctors first used medications, then steroids and then, when those failed, they made the decision to remove this child’s colon. At that moment, and in many cases to follow, I thought, you’re kidding me, this can't be the only option! There has to be something better.
Over the last decade, I’ve gone to the functional medicine world, I’ve studied Medical Herbalism and Endobiogeny as well as many other modalities of healing. Over time, it has become apparent that no one person or group has all the information. But, when you can piece together snippets from multiple groups, you can get a much more coherent picture in terms of a child’s development and the things that are causing a child to have developmental issues.
There are so many different reasons children suffer, you have to be able to see all of them to be able to determine which things are the cause of the suffering. If someone has a hammer they’re going to use a hammer to fix everything- if the practitioner only has a certain lens, they are going to see everything through that lens.
For example, between 10 and 20 percent kids I’ve worked with have had undiagnosed tongue ties which cause a cranial nerve imbalance within their mouths that leads to patterns of sensory issues which eventually result in anxiety. It’s little things like this, that if the practitioner doesn’t know how to look for it’s going to get overlooked and the child is going to continue to struggle.
2. So many families I work with have the same story- they are concerned about their child’s development. They have noticed some “peculiar” behaviors and feel like something is “off” with their child’s development, yet when they bring their concerns up with their pediatrician, they are dismissed and told, “let’s just keep an eye on it,” or “all kids develop at a different pace, this is nothing to worry about.”
In your opinion, what are the strengths and weaknesses of western medicine and western-trained doctors when it comes to addressing a child’s developmental challenges?
In defense of pediatricians, they’re taught to look for catastrophic issues that are extremely harmful to a child. Our pediatric training system is still using a model from 20-30 years ago, when we didn't have the same degree of dysfunction or sensory issues that we see in children now.
There are new problems and a higher degree of dysfunctions that are showing up in ways we didn’t see before. Pediatricians are trained to look for the problems we have always known about, but now, the environment has changed, children have changed, issues have changed, and there hasn’t been an upgrade in the training and awareness that pediatricians need to have in order to understand these issues.
A parent might notice some “strange” behaviors or have some concerns about their child that they voice to their pediatrician, but the the description doesn't add up to what the pediatrician has been trained to recognize so they default to saying something like, “let’s keep an eye on it.”
There needs to be a lot more education happening at both the professional and societal levels in order for us to get caught up on what’s going on with children today. Some, but not all, occupational therapists are trained and aware enough to identify sensory processing issues and a handful of neuropsychologists are as well.
But, outside these bubbles very few people have the ability to identify what’s causing these issues in children. That’s where the challenges these families are facing are rooted.
3. You specialize in working with children who have developmental challenges. Can you tell us a little about the patterns you’ve seen as far as the root causes of their dysfunction?
There are different clusters… one of primary clusters I see, especially with children who have sensory issues, is metabolic disturbances.
Most people think of metabolism in terms of weight gain, but the other side of it is energy production. When we eat food, we give our body nourishment and we break the food down for energy. The body has electricity running through it and what we don’t often appreciate is that not all people can produce electricity efficiently from the food they eat.
Roughtly 40 percent of kids I see have energy production that’s 30 percent less efficient than average person.
These are the kids who don't crawl on time, and are often late to walk. In older kids, they may play quietly and tend to not want to engage their bodies in any kind of activity. These are the kids that if you take them on a hike, they want to be carried shortly after you begin. When they go out on a soccer field, they run for five minutes and then want to stop. They are easily fatigued. Their energy production problems prevent them from engaging in life.
The cause of these metabolic issues is likely a combination of genetics, environmental toxins and god knows what else. The bodies of children are being stressed and assaulted in a remarkable way, in a way that is entirely new.
I think the reason we’re seeing more of this now as opposed to in children twenty, thirty years ago is that back then, there was much less time spent in front of screens, children had more outdoor time, a cleaner environment and cleaner food, so their nervous systems were not as burdened. They may have had some issues, but those issues did not reach the same peak as they do in children today.
Environmental toxins are a big issue that can affect the mitochondria which affects energy production. One of the biggest toxins out there is mold. In fact, if there’s one thing to be paranoid about, it’s mold. Most families don’t know it’s there.
Not only can it be in your house, it can be in your washing machine, especially front loaders, it can be in AC units, or you can have a water leak that you didn't know about. Metabolic issues in children caused by mold usually manifest in aggressive behavior and/or motor tics. I suspect that a large percentage of kids who are diagnosed with PANDAS actually have an undetected mold issue.
Very simply stated, children MUST move and use their bodies to become integrated into the body. Rolling, crawling, running, jumping amongst other movements are all needed to help organize our brain’s ability to efficiently process information.
When you look at children who are highly active, the ones who can’t stop moving, these kids are constantly engaging in vestibular and proprioceptive activities, they naturally engage in activity that allows them to be organized in their sensory processing. Occupational therapists are masterful in using movement to reorganize and rewire the brain, to allow the nervous system to reorganize so a child can efficiently process sensory input.
My own daughter had very low tone. I witnessed her go into a place where she was so insecure in her own body that she was afraid of movement. But when I
supplemented her, suddenly she started running fast, hopping, jumping off the couch etc.
Sensory processing and metabolism are related. There’s a lot of literature that goes further into this. When I supplemented my daughter for her metabolic issues, her sensory issues calmed down.
This calming down was not just because she was using her body more. It turns out that there are cells in the brain called PVN cells, that are the braking system when it comes to sensory input. They have multiple tentacles that connect to other brain cells at same time and they control how much sensory input travels through the brain. They are also one of the most energy hungry cells in the brain.
When there are issues with energy production, this braking system of the brain falters which allows more sensory signals to pass through uncontrolled. So, for kids with metabolic issues, there’s a double hit- they're fatigued so they don’t use their bodies, which causes poor sensory integration, which causes disorganization in the brain AND at fundamental cell level, the braking system of the brain is also not working properly.
Imagine the job of a crosswalk guard. What if the crosswalk guard was so tired that one out of three times, he just couldn’t hold the sign up to stop traffic. This seems to be what’s happening to these children at basic cell to cell signaling level. But, when you supplement these kids and boost their energy, within two to three weeks, they're happier, less reactive and less bothered.
Think about a time when you felt really crumby, exhausted and fatigued. Like how you feel when you have the flu, but without the fever... very low energy. Now imagine if that’s how you experienced life every day. This is what happens for a lot of sensory kids.
The brain is energy hungry, muscles are energy hungry and the adrenal glands
are energy hungry organs. When children have metabolic issues, they take a hit in their energy production and their brain suffers, their muscles suffer, their general mood suffers and their adrenals tire out.
No wonder they’re so grumpy! Adrenals are what we need to get us going in the morning. When cortisol isn't being produced, mornings are a nightmare. When we address energy production issues with kids and treat the adrenal glands, this pattern shifts. They wake up happy.
4. Can you give an example with a patient who was struggling with behavior, learning and/or attention issues and through testing, you discovered a physical or chemical imbalance, were able to treat it and saw a significant improvement in the child’s functioning?
Most of these kids have other things layered on top of the metabolic issue.
One example is with a 13-year-old young man who came to see me because he was depressed, anxious and struggling in school. He wanted to get off medications and feel better.
He had one of worst cases of metabolic issues I’ve seen; big time abnormalities. I supplemented him with a metabolic cocktail and within two months, his depression had lifted, he was engaging with friends, and coming out of his darkness.
What was interesting was that in the summer, he was doing great. Then he came to see me when school started and all of the sudden the anxiety back, and he was feeling horrible. He said, when i’m in school, everything drives me crazy- class bells ringing, kids talking noisily in the halls, assemblies, it’s too much. I realized he had an undiagnosed sensory processing issue. I referred him to an occupational therapist and now he’s free of all of it.
5. If you could give parents of children with developmental challenges one piece of advice, what would it be?
There are basic things families can try on their own if they choose to but I would still do it under the guidance of someone. Coq10 and Carnitine are two examples of supplements that are extremely safe to try and helpful for kids with metabolic issues.
Even if a family is in a more remote area that doesn’t have practitioners who are readily available, chances are there’s still someone who can work with them- a family practice doctor with a more wholistic approach, a chiropractor, osteopathic doctors or a naturopath. It’s a matter of thinking outside the box and finding an ally with whom they can partner.
They can say, “look, my kid is tired all the time, he skipped his milestones, I would like to try this supplement, can you watch over us as we try this?” They can even present this to their pediatricians.
6. Are there certain supplements you recommend every child take?
Parents have to understand their child’s specific needs. Parents can’t look at any one supplement as a magic pill.
If you have a child who tires easily, has a hard time getting up in morning and had delayed milestones, there’s likely a metabolic imbalance, in which case Neuroneeds is a wonderful supplement to try. .
One thing we need to do is to open up the doors of conversations to help parents see all different possibilities as to why children suffer; it’s never just one thing that’s the cause. And we need to help parents understand who to partner with.
7. Are there specific questions parents can ask or tests they can request from their regular pediatrician?
Doing a basic screening that tests for anemia, zinc and thyroid function is always helpful.
But, the vast majority of kids do not have imbalances that would show up in basic blood work. That’s where things get tricky. There are specialty labs and alternative ways of looking at those labs which can give more answers.
I would recommend that parents try to stand back and see the story of their child. Look at their historical timeline about how and when things went awry and then get very curious about what’s ailing them.
If your child was doing fine then around three to four years old, things fell apart, you’re probably dealing with some sort of insult like mold. In the case of a child who was always "off," you are likely dealing with metabolic and/or digestive issues.
8. You are in the process of creating an incredible resource for parents, can you tell us a little bit about it and where parents can access it?
Yes, the website is called Wholistic Minds and it’s a resource to help parents find a personalized roadmap for their child’s healing.
Right now, the site is at the beginning level. Once it’s fully functional, it will be a system that has an algorithm to help parents understand the key factors that are ailing their child and then guide them towards what kind of testing is necessary. Parents can join the mailing list right now to receive our newsletter and to be the first to gain access to the free forums and library when they are up and running.
Parents can also take a quiz that will give them a preliminary idea of what factors are contributing to their child’s struggles.
At the end of the day, the main reason I’ve created Wholistic Minds is to help parents gain clarity about what’s affecting their child. There are too many families and children out there who are suffering and I want to help put an end to that.
A huge thank you to Dr. K. for sharing all of this invaluable information. If you have specific questions, you're in luck! Dr. K and I will be doing a LIVE Facebook Q & A on Tuesday, March 3rd at 10am PST. This is your chance to get some answers to the questions your regular doctor is not trained to address.
Email me with your questions and please pass it on to anyone you know who might benefit. Hope to see you there!