Screening for Childhood and Teen Depression

Posted by on Aug 2, 2018

June was National Safety Month and it brings to mind an important form of safety that is different from wearing seat belts, applying sunscreen or not talking to strangers. Challenges with mental health, such as those caused by depression, are a significant factor to consider when ensuring a child’s safety. This article briefly lists the risk factors, presenting signs, screening tools and management of pediatric and adolescent depression. It does not replace a conversation or evaluation with a healthcare provider. Please consult with you doctor as soon as possible if you believe your child or teenager may be struggling with depression and/or anxiety.   Risk Factors Risks for childhood and teen depression include family history of depression, bipolar disorder, suicidality, substance use, or other psychiatric illness.   Other risk factors include: – history of trauma, personal or family abuse – adverse events, stressors, neglect or major transitions in the family – struggles with gender or emerging sexual identity – having witnessed a natural disaster – hormonal or metabolic imbalances   Presenting Signs Depression appears in a variety of ways and many of the symptoms overlap with other health conditions. I highly recommend speaking with a doctor first before diagnosing depression yourself- a trained eye can identify if there are other causes for your child’s symptoms other than, or in addition to, depression.   Depressed or irritable mood Loss of interest or pleasure in almost all activities Weight change, failure to achieve expected weight gain Sleep disturbance- sleeping too much or too little Fatigue, low energy Feelings of worthlessness, excessive guilt Decreased concentration, inability to make decisions Suicidal ideation or thoughts of death   Screening Often, a brief conversation during an office visit can serve as an appropriate screening. If your child is a teenager, the doctor may ask to spend some time alone with them to create a safe, confidential space for discussion.   One tool used in screening for depression is the Patient Health Questionnaire-2 item screen (also known as the PHQ-2). Each question receives points for the following answers: “not at all” (0 points); “several days” (1 point); “more than half the days” (2 points); and “nearly every day” (3 points).   Over the past two weeks, how often have you been bothered by any of the following problems: Little interest or pleasure in doing things? Feeling down, depressed, or hopeless?   Patients who score 3 or more on the PHQ-2 should undergo additional assessment for depressive disorder with a mental health specialist.   Next Steps Conventional treatment for depression typically starts with a referral to psychotherapy, either performed by a counselor, cognitive behavior therapist or in group therapy. More advanced cases of depression may require pharmaceutical...

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Environmental Allergies: A Naturopathic Approach

Posted by on Jun 1, 2018

Imagine running through a field of tall grass and wildflowers, arms spread wide, sunshine on your face and the breeze blowing in your hair. That may sound like an afternoon well spent! For many of us however… the scene I described just sounds like an allergy nightmare! What can one do to start enjoying the outdoors again? Hay fever is very common among the general population. Most of us know the symptoms- stuffy or runny nose, itchy red eyes, brain fog, sneezing, headache and even sinus pressure. An underlying immune signal stimulates these processes. It involves an antibody named immunoglobin E (or IgE for short).   IgE travels through our body by circulating in our blood, and when it encounters an immune cell called a mast cell- it causes the mast cell to release histamine. It is this histamine release that triggers fluid buildup in our nose, makes our eyes itch and can even make our skin itch.   Conventional treatments work by suppressing histamine release- most of the allergy meds available over-the-counter at the pharmacy are called anti-histamines. They’re available as pills, liquid (usually for children) or nose sprays.   In naturopathic medicine, we offer similar quick-fixes but the foundational treatment is to find the root cause of your allergy symptoms and work from there. We often prescribe rapid-acting treatments specific to your symptoms, then make specific recommendations for long-term prevention of future allergies (and so much more!).   Naturopathic Approaches to Seasonal Allergies   If you find yourself immersed in a full-blown allergic state, our quickest-acting natural medicines use ingredients like freeze-dried nettle leaf, quercetin, vitamin C, bromelain and a unique strain of probiotic called lactobacillus L-92. These begin acting right away and are usually required at higher doses than average during an acute allergic flare.   Other natural approaches focused toward preventing future flares include supplementing with omega-3 fatty acids, probiotic blends and various lifestyle modifications.  More intensive strategies will be needed for some individuals that address some specifics of the immune system, and in particular the gastrointestinal tract and the lining of the small intestines where much of the status of our immune system is determined.   Lifestyle recommendations for preventing allergies may include: changing out of outdoor shoes and clothing upon entering your home keeping pets and outdoor gear off the bed keeping the bed covered during the day (with a thick blanket) and uncovering it for sleep running an air filter in the bedroom frequent washing, dusting and cleaning of the home to prevent dust buildup   Testing is also an option to identify which pollens or environmental exposures you may be allergic to. This usually involves a blood draw to analyze your...

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PEDIATRICS: Approach to constipation in children

Posted by on Apr 11, 2018

Constipation is a common complaint among pediatricians’ offices. Most children experience brief periods of constipation over time that usually resolve on their own. Symptoms that warrant medical attention include recurrent, prolonged constipation, bleeding, pain, excessive straining or fear of passing stool. Many children who have previously experienced painful bowel movements instinctively begin to withhold their stool, causing a vicious cycle of even harder-to-pass stool that may lead to impaction. This article discusses common causes of constipation, prevention strategies and treatment. This article is not intended to diagnose, treat or replace the advice of a medical provider. Please share your concerns with your child’s doctor if he or she struggles with constipation. Routine well-child visits are important for ruling out metabolic, neurologic and endocrine causes for these symptoms.  Common Causes Initiating solid foods or introducing cow’s milk to the diet may lead to constipation as it is easier to offset the correct ratio of fiber and water required to make soft, easy-to-pass stool. Cow’s milk slows intestinal movement and can satiate the child’s appetite, making it less likely they will drink water or eat fiber-rich foods. Dysbiosis of our microflora can cause a multitude of symptoms, many of them gastrointestinal. Stool testing can help identify if the child is missing important probiotic bacteria in their gut- facilitating a more customized treatment plan. A different approach is to test for food allergies- another condition that can cause a wide variety of symptoms. Food allergy testing can be completed using a simple finger stick- no blood draw is needed. Starting school can be a significant transition for children; they must learn to navigate new schedules, locations and classmates. A change in routine may interrupt a child’s natural bowel movement pattern- leading to withholding or a reluctance to use the restroom at school. Stress is another common cause of disordered bowel habits. During times of stress, it is harder for a child to sense (and act) when their body is ready to have a bowel movement. Toilet training, travel and the arrival of a new sibling are all very common times when children may experience brief interruptions in their body’s natural routines.   Preventing Constipation Below are some general tips for avoiding constipation. Ultimately, evaluation and treatment by a medical professional is always recommended for a more personalized approach. Routine: if a child is toilet trained, encourage they spend time on the toilet after every meal. If the child has struggles using an adult-sized toilet, start with a portable children’s toilet or use a stool to raise their feet so their knees are flexed. If the child is at school for a portion of the day, encourage time on the toilet before and...

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Insomnia Part 2- Botanical and Nutraceutical Strategies

Posted by on Feb 16, 2018

  A note about supplements and botanicals: herbs are powerful medicines that hardly ever have just one function. On the contrary, herbs and nutraceuticals have various actions that act synergistically. Please check with your clinician who is knowledgeable in these areas before initiating a new product as it carries the risk of interfering with other medications.   Herbs In the beautiful and vast world of botanical medicine, there are well-known, tried-and-true herbs for insomnia. The classic insomnia herbs, and some with published research include skullcap, valerian, lemon balm, kava, hops, passion flower and chamomile. Other great herbs that may help relax the body and brain for sleep include lavender, oatsraw, and even poppy. Ashwaghanda has been studied for its sleep-inducing effects over time and may help establish a healthy sleep cycle with regular use.   The herbs mentioned above come in a variety of forms- alcohol/water based tinctures, non-alcohol based tinctures, capsules, tablets, loose leaf teas or powdered root. They’re available as single-herb products or are combined with multiple herbs and/or nutrients for a stronger effect. At many naturopathic clinics, doctors can even create a customized combination of herbs that are specific to your unique needs; this is called an herbal formulation. Tea blends are also a great option, but could potentially interrupt sleep if it ultimately causes you to wake in the night to urinate!   Aromatherapy Soothing scents like lavender, chamomile or rose can switch our brains into nighttime mode. These oils vaporize well in an essential oil diffuser. You can also take a warm Epsom salt bath with a few drops of oil sprinkled in… with a candle burning nearby. Some soothing, relaxing music playing softly in the bathroom won’t hurt either! Are you getting sleepy yet?   DIY- To make a lavender hydrosol spray at home, add 10 drops of lavender oil into a spray bottle full of water. Spray this mixture in the air, on your skin or even in your bedroom for maximum aromatherapy effect.   Nutraceuticals While browsing the aisles at our local health foods store, there is no shortage of products to help us sleep. The art of the medicine lies in selecting the correct one for the type of insomnia you have. Examples of products on the market for insomnia include 5-HTP, L-tryptophan, melatonin, magnesium, l-theanine, GABA, phenibut…. and there are many more. Each of these products boasts a different mechanism for shifting our body into sleep mode. The most effective way to know which one works for you is to have a comprehensive intake with your doctor who will take a careful and informed health history. There are also situations where underlying causes need testing such as thyroid, glucose, cortisol, melatonin, and neurotransmitters....

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Insomnia: Naturopathic Evaluation and Treatment Part 1

Posted by on Jan 31, 2018

  Although it may be an obvious fact, it must be said; sleep is an integral part of our lives. A good night’s sleep allows the body and brain to rest.   While we sleep, our immune system goes on high alert and scans the body for infection. Our brain converts short term memories into long term storage, a process called consolidation. And lastly, our conscious brain temporarily takes the back seat while our subconscious runs loose. When sleep quality starts to diminish, consequences are felt immediately and their detrimental effects accumulate over time. Studies suggest that poor sleep (or less than 7 hours per night) increases one’s chances of heart disease, obesity, depression and even diabetes. Yikes!   “OK you’ve scared me enough Dr. Manning- what am I going to do to start sleeping better??”   While often a challenging chronic health issue, insomnia is one of the most responsive conditions to naturopathic treatment modalities. The solution for you could be an easy switch or it may require a comprehensive evaluation and plan- always check with your doctor before initiating any treatments listed in this article.   Below you will find an overview of naturopathic approaches to insomnia- split into three parts:   Insomnia Basics: finding the root cause and lifestyle interventions Botanical and nutraceutical treatments for insomnia Investigating insomnia: when treatments aren’t helping   Insomnia Basics: finding the root cause and lifestyle interventions Treatment for insomnia should never be “one size fits all.” As always in naturopathic medicine, identifying and addressing the root cause of why you can’t sleep is paramount to treatment success and long term cure.   So… Why can’t I sleep? Looking deeply and with depth at your problem can help you identify the reason why sleep is not a satisfying, refreshing experience. Your doctor may ask the following questions: Do you have trouble falling asleep? Do you have trouble staying asleep? Do you wake often throughout the night? How much time do you spend in bed? Sleeping? Doing other activities in bed like reading, watching TV, eating? What is your work/school/home schedule like? Some causes of insomnia are obvious while others may take a little digging (e.g .nutrition, pain, medications, anxiety) and maybe testing for a thyroid disorder, a blood sugar problem or cortisol dysregulation among others.   Food, News and Booze Do you eat large meals shortly before bedtime? Do you watch headline news at night? Do you engage in a liquor, beer or wine night cap most evenings? These all have the potential to significantly interfere with your body’s “winding down” process, either by causing a spike in your blood sugar or even worse- a spike in your body’s stress hormone, cortisol.   Experiment this week by replacing your...

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