The old adage is true that children are not little adults. Traditional Chinese medicine (TCM) has long known that the physiology of children is unique, as are the diseases that plague them. As TCM practitioners we, therefore, approach and treat childhood ailments differently than adult illnesses.
The principles we use to promote and restore health in children are geared toward strengthening zang fu organs, managing exuberant yang qi, and harmonizing the five elements. The field of environmental pediatrics (EP) also acknowledges the challenges of being young, and highlights the increased vulnerability of children to external influences.
EP excels in defining the role of toxicity in childhood development and disease progression throughout the human life span, as well as the enhancement of child wellness through contact with nature.
In blending the fields of TCM and EP, we can better understand the inner and outer ecology of childhood disease. More specifically, the integration of these two fields allows us as practitioners to have focused and clear conversations with parents about their child's health.
We can educate parents on:
- What toxic items, products and places they should have their children avoid to prevent future illness.
- Which outdoor environments they should be striving to have their children experience to promote healing.
- Which environmental factors they just simply don't have to worry about regarding their children's health.
- And, how to help their children heal, both from the inside out, and the outside in — with only minimal intervention.
Subclinical Toxicity in Pediatrics
Perhaps one of the greatest contributions of environmental pediatrics is the concept that children may present with sub-clinical toxicity. This guiding principle describes a "dose-dependent continuum of toxic effects" that can affect multiple organ systems and may not be evident without special testing or keen observation.1
The extent of sub-clinical toxicity is difficult to determine, but it is clear that chronic, low-level and cumulative exposure in children is widespread.1
The impact of repeated, low-level exposure to environmental toxins goes beyond just the individual or family and can last a lifetime. For example, subclinical lead toxicity in children results in significant decreases in intelligence (IQ scores), shortened attention spans, and memory problems.1
After long-term investigation, these same children later in life have higher rates of reading difficulties, school failure, and even incarceration.1 Since chronic, low-level exposure to lead and other toxins are widespread, subclinical toxicity has implications for the health of entire societies.1
According to Integrative Pediatrician Dr. Elisa Song, MD, if left unchecked, repeat toxic exposures in children can result in toxic overload, and lead to:
- chronic and recalcitrant intestinal dysbiosis
- impaired detoxification ability
- chronic inflammatory conditions
- immune-activated hypercoagulability
- immune system dysregulation
- propensity to latent infections2
Clinically, this can present in numerous ways. Some signs of toxicity in children include:
- digestive dysfunction
- food sensitivities, allergies, and intolerances
- behavioral issues and attention disorders
- developmental delays and learning impairments
- chronic low immunity or hypersensitivity
- frequent headaches, migraines, or chronic pain
- recurrent and/or latent infections
- childhood obesity
- precocious puberty and adolescent acne
- recalcitrant inflammatory conditions
- stubborn conditions with sudden, unexplained onset
TCM Pediatrics & Toxicity
In TCM pediatrics, subclinical toxicity in children can present as hidden evils, which erupt in myriad ways. For some children, they may have a propensity toward toxic-heat inflammatory conditions, such as chronic ear infections, sinusitis, and tonsillitis.
Other children may present with Spleen and Lung qi deficiency with damp/phlegm accumulation, such as in asthma, eczema, and allergies. And still other children may be impacted deeply, with Liver yin and Kidney qi and essence deficiency associated with developmental delays, speech disorders, or learning impairments.
In many cases, children may also display signs of increased stress and a propensity toward shen disturbances, which can be seen in cases of ADHD, Autism Spectrum Disorder (ASD), and Pediatric Autoimmune Neuropsychiatric Disorders associated with Streptococcal Infections (PANDAS).
Whatever the cause, we must become acutely aware of the role of the environment in shaping what we see in clinical pediatrics. We are often a first line of defense; have far more time with patients than pediatricians; and can use the four pillars of examination to detect illnesses before they arise.
Role of the Environmental Intake
In addition to examining facial complexion, tongue characteristics, pulse quality, and asking pertinent questions, TCM practitioners can easily add an environmental intake to their history taking to screen pediatric patients for signs of toxicity.
Dr. Jerome Paulson, MD and Lauren Gordon, MPH state, "The history is the single most important instrument for obtaining information on the role of environmental factors in causing disease in children."3 The history allows medical providers to view children holistically, in the context of their family, extended family, and community.
An environmental history asks questions such as:
- Where does your child spend most of his/her time?
- What chemical, physical, and biological hazards may be in or near your child's home or school?
- Are there are any industrial or agricultural "hotspots" near your child's home?
- Are there indoor sources of contamination where your child lives or plays?
- Is there a temporal relationship between your child's onset of symptoms and environmental factors?
In conjunction with physical exam findings and TCM diagnostics, a detailed environmental history can paint a more complete portrait of how a child's internal ecology is impacted by their external landscape.
At the Front Line
The World Health Organization (WHO) estimates that 36 percent of all diseases among children of ages 0 to 14 years are attributable to harmful environmental exposures.4 Subclinical toxicity can be easily overlooked with routine testing. As TCM practitioners, we can use our powers of observation and inquiry to detect physiological imbalances that may otherwise go undetected.
The Huang Di Nei Jing Ling Shu (chapter 55 – Inconsistent and Consistent) states, "The superior practitioner treats what is not yet ill and does not treat what is already ill."5
In other words, a superior practitioner treats an illness which has not yet developed.6 By merging the core concepts of environmental pediatrics with TCM, we can become astute pediatric clinicians and prevent modern childhood illnesses before they happen.
Of course, some children are already quite ill when they first come to us. For these patients, we can employ gentle detoxification regimens, enhance vital organ functioning, and help parents identify and reduce their children's continued exposure to environmental toxins. Although treatment strategies in holistic pediatrics vary by presentation, there are some general recommendations we can make to parents to enhance their child's detoxification mechanisms.
References
- Landrigan P, Etzel R. Textbook of Children's Environmental Health. Oxford University Press, 2014.
- Song MD E. "Pediatric Functional Medicine." Lecture presented at the East West Pediatric Medicine Training, Morgan Hill, CA, 2015.
- Paulson J, Gordon L. "The Environmental History and Examination: The Key to Diagnosis of Environmental Diseases."In: Landrigan P, Etzel R. (eds.) Textbook of Children's Environmental Health. Oxford University Press, 2014; pp. 475-481.
- Prüss-Üstün A, et al. "Preventing disease through healthy environments — towards an estimate of the environmental burden of disease." World Health Organization, 2006.
- Unschuld P.U. "Nan-Ching The Classic of Difficult Issues." Taipei: Southern Materials Center, Inc., 1986.
- Oosting K. "The Three Levels of TCM Doctors: Quality Guidelines in Classical TCM." TCM Classics Research Institute, The Netherlands, 2014.
