Category: Pediatrics

Premature Pubarche: What Is It And Why Should We Care?


Has your child developed early pubic or underarm hair?  Premature pubarche (PP) is when girls under 8 and boys under 9 have premature development of pubic and/or axillary hair. It tends to happen more in girls.  It is different from “precocious puberty” because it does not include breast buds or testicular development and there usually isn’t increased linear growth (height). One thing to note, PP is a diagnosis of exclusion – meaning we have to rule out other possibilities first, and once that is done, PP is considered a normal variation of development.

What could it mean for the patient long term? PP has been associated with a higher risk of a variety of conditions including obesity, insulin resistance, PCOS, metabolic syndrome, cardiovascular issues; and mental health issues (even during childhood).  

If one has PP then we can start helping that child to avoid these potential health issues with diet and lifestyle changes, reducing chemical exposures, appropriate supplementation, monitoring and providing education for the child and the family.

Taking care of kids is a passion of mine.  If you have concerns about your child’s development, please reach out for an appointment. 

Pediatric Constipation and Encopresis

Constipation is a fairly common issue in children that often resolves itself with a few lifestyle changes.  But left untreated, it can become a chronic problem and even lead to encopresis (involuntary passing of stool, often due to impaction).  Naturopathic health care really shines in helping these children have healthy bowel movements. 

The difference between constipation and encopresis:

When a child is constipated, he or she has fewer bowel movements than normal (<3 times per week) or delay or difficulty in passing stool. Bowel movements can then become hard, dry, and difficult to pass. Your child may avoid going to the bathroom because it hurts. Stool becomes backed up (impacted) in the rectum and the large intestine (colon). When the stool can’t move forward, the rectum and intestine can become enlarged. Over time, liquid stool can start to leak around the hard, dry, impacted stool. This soils your child’s clothing and is called encoporesis

Ruling Out Underlying Health Conditions 

  • Primary care visit (we can do this at BNHC) to rule out other pathologies – this may include referrals for testing like an abdominal x-ray and/or barium enema, and bloodwork.
  • Stool test to rule out bacterial imbalances, parasites, poor digestive function.  Here’s an example of one we run at BNHC: https://www.diagnosticsolutionslab.com/tests/gi-map)

Actions to consider:

  • Food intolerance testing can be very helpful in finding a potential cause of the constipation.  It may take several weeks of avoiding the offending food/s before change takes place.  In general, avoid a high fat, low fiber, high sugar, junk-food diet
  • Read Are Foods Causing Your Symptoms: Understanding Testing Options
  • Fluid intake is essential.  Track the amount your child has and have water available around the house. Avoid soft drinks and fruit juices. If they don’t like plain water, consider herbal teas or snacks of juicier fruits like watermelon or even sucking on ice cubes.
  • Fiber – think legumes, vegetables, and whole grains.  If your child has a dry constitution then think moist fibrous foods vs dry fiber (apple sauce, whole fruit, oatmeal vs bread).
  • Exercise helps the body create motion in the bowels to push stool forward and out.
  • Abdominal massage – gently and slowly rub castor (or another oil) in a clockwise fashion.  Heat can sometimes be useful
  • Try relaxation training or mindfulness techniques.  Constipation and subsequent encopresis may be from stress in the family or with friends or at school.  Mindfulness helps decrease stress and gives the child a tool for life.
  • Encourage a sense of humor among the family to help ease any tension that may have built up around pooping.
  • It’s really important to do child-led potty training to decrease the risk of constipation/encopresis in the future.
  • Biofeedback can be used to help get on a stooling schedule and to help re-learn the body’s signals.
  • Chiropractic care can help rule out or correct structural contributors.

There are a number of supplements that might be helpful:

  • Kid-friendly digestive aids instead of laxatives
  • Probiotics can help to diversify the normal flora and compete with overgrowth bacteria which will aid the mucous layer lining the gut and promote better digestion.
  • Homeopathy can be useful, especially if there is a strong emotional component. 
  • Demulcents and gentle GI herbs can restore rhythm and function.  
  • Calcium and especially magnesium can help.  Some find help by adding fish oil.  

There are so many options to consider as you see in the list above.  Consider scheduling an appointment at Boise Natural Health Clinic and we can guide you through the process and help your child have bowel movements successfully again.

No More Bedwetting

Nocturnal Enuresis (bedwetting) is a common and embarrassing problem.  There can be various factors that may play a role such as bladder size, a hormone imbalance, chronic constipation, a or a structural problem. Read More about Bed-wetting from Mayoclinic.org.  But sometimes all it takes is a lab test.  I have been helping kids and young adults identify food sensitivities that cause bedwetting since I learned about the link over 20 years ago at a nutritional medical conference. 

The Food – Bedwetting Connection Evidence is Not New

A study done of 100 children in 1965 and published in the reputable Annals of Allergy showed the evidence but was long forgotten in conventional medicine.  The study was summarized by Dr. James Breneman in 1978: “Of the 100 patients subjected to the food exclusion program, 87 were completely controlled as long as they avoided their particular food allergens … The average number of days to control these 87 was 4.87 … the ingestion of a food to which the patient was sensitive would temporarily reproduce enuresis.” 2  Of the 100 children, 13 did not improve due to non-compliance or other explanations such as bladder infection, inflammation, and a physical obstacle restricting flow of the urine out of the bladder.

Food Sensitivities are Not Food Allergies

Despite the words often being used interchangeably, there is a difference.  

Food allergy symptoms are sudden (minutes to hours) and often dramatic such as with peanuts.  An Epi Pen is often needed, and the person must never eat the food.  Testing for food allergies will not rule out food sensitivities.

Food sensitivities are different.  The time from ingestion to symptoms developing can be hours or even days later.  This is why people do not associate their symptoms with ingesting the food.  Sensitivities to foods can cause a wide variety of other chronic symptoms besides bedwetting: headaches, gastrointestinal issues, musculoskeletal pain, mental and emotional changes, skin issues and more. 

Are Foods Causing Your Symptoms? 

Please refer to our article: Are Foods Causing Your Symptoms?  Understanding Testing Options.  

Sources:

  1. https://www.mayoclinic.org/diseases-conditions/bed-wetting/symptoms-causes/syc-20366685?utm_source=Google&utm_medium=abstract&utm_content=Nocturnal-enuresis&utm_campaign=Knowledge-panel
  2. Breneman JC.  Nocturnal Enuresis, A Treatment. Annals of Allergy. 1965;185-191. (summarized in Dr. Beneman’s book, Basics of Food Allergy, 1978, Chapter 8, pages 54-66., as cited on in an article by Jonathan V Wright, MD, at https://www.meridianvalleylab.com/stop-that-bedwetting/.)

Kids and Sleep

By Nicole Maxwell, NMD

Sleep problems affect 20-30% of children and in many cases it can be addressed with naturopathic care.

Symptoms of insomnia include:

  • Sleep problems – difficulty falling asleep or staying asleep or waking up too early in the morning.
  • Tension/worry about going to bed and being able to fall asleep.
  • Being sleepy during the day.
  • School or disciplinary problems.
  • Irritability/mood swings.
  • Depression.
  • Hyperactivity.
  • Decreased attention span.
  • Aggression.
  • Memory problems.
  • Making errors or having accidents.

One issue is if we expect the child to be sleeping more than they need to or if they are in their bed longer than needed.  Reduce the sleep window to match the sleep needs to alleviate this possible bedtime struggle.  

How much sleep does each age group ideally need?

  • Preschoolers (3-5yo): 10-13 hours, no less than 8 and no more than 14.
  • School-aged Children (6-13yo): 9-11 hours, no less than 7 and no more than 12.
  • Teenagers (14-17yo): 8-10, no less than 7, no more than 11.

Some possible causes of insomnia include:

Stress: kids can suffer from stress just like adults.  Any school issues?  Bullying?  How’s family life?  Sibling relationships?  Any changes like recently moving?  Letting your child share their feelings can work wonders.  Naturopathically, we can treat this with adaptive herbs that are gentle for their system.  Consider ashwagandha: it has calming and focusing effects for students and helps calm the mind for restful sleep.

Use of caffeine or other stimulants: besides the obvious ones, many clear sodas and energy drinks have caffeine.

Medication side effects: drugs that treat ADHD, antidepressants, and others may cause insomnia.  We can help manage those side effects through nutrient guidance.

Other medical disorders: Growing pains, thyroid issues, heartburn and muscle cramps may cause insomnia.  We offer physical exams and many lab options to help rule these issues out or in and treat accordingly.  Magnesium is great for muscle cramps and growing pains. Magnesium is also an easy item you can try safely at home.  Food sensitivities may be linked to nightmares and sleep issues.  We offer food sensitivity testing at our office.  Blood sugar dysregulation often causes middle of the night insomnia.  Try a bedtime snack like a couple slices of apple with a nut butter on top or a hard boiled egg.

Environmental factors: Perhaps the room is too hot or too cold, not dark enough, or it’s too noisy.  These can be addressed with the appropriate mattress, bedding and curtains.  Another environmental factor includes restricting electronic usage in the bedroom and turning off Wifi at night.

I am happy to help you and your child/children uncover the source of the sleep difficulty and guide you to a safe and effective plan.  I work with herbs, nutrients, homeopathy, and diet. Contact Boise Natural Health Clinic at (208) 338-0405.