June 20, 2016
Colic is a condition in infants who cry incessantly and are difficult to soothe or calm down. Colicky infants often seem to be in pain and this can lead parents to worry and become frustrated. A recent review of the research on colic summarizes what we know so far.
June 09, 2016
New guidelines have been published for celiac disease and introducing gluten to an infant’s diet. They include key points on breastfeeding and a go-slow approach.
May 23, 2016
The FDA just finalized its new Nutrition Facts Label, which will now include the amount of added sugar found in packaged foods. While this is great news, parents still need to be vigilant when it comes to sources of hidden sugar in foods. This blog highlights key points to remember.
January 04, 2016
Chronic constipation is so common in childhood, it’s the reason 1 in 4 patients see pediatric gastroenterologists in Seattle, like me. This blog is meant to summarize the answers I give to the most common questions parents ask, regarding this common problem.
December 21, 2015
It’s not unusual for a child to be nervous about a visit to the doctor. That’s why the staff at Swedish Pediatrics hosts 'Teddy Bear Clinics' at local community events.
August 24, 2015
In a previous blog post
, I mentioned that the U.S. Food and Drug Administration (FDA) is making changes to nutrition facts labels (originally introduced 20 years ago to help consumers make informed and healthy food choices).
On July 27, 2015, the FDA added a supplement
to the initially proposed changes (originally published March 2015). It proposes that food manufacturers not only list the grams of added sugar, but also declare the percent daily value (%DV) for added sugars, which is a major step forward in aligning with international standards for sugar intake
, and a totally novel concept in terms of food labelling in the U.S.
July 08, 2015
It’s common knowledge that over the last few decades there has been a significant increase in the number of children with obesity in the U.S. One of the complications of obesity is a condition termed metabolic syndrome, which consists of the combination of high cholesterol, blood sugar, blood pressure, and waist circumference. Having metabolic syndrome has long been a well-known risk factor for heart disease, but less known is the relationship between obesity, metabolic syndrome and liver disease.
As a pediatric specialist who treats children with liver diseases, I am often asked to see children with a condition called “fatty liver disease.” In fatty liver disease, fat accumulates within the liver as a direct result of obesity and metabolic syndrome. The curious thing about this type of liver disease, however, is that it is identical to the liver disease seen in alcoholics.
June 29, 2015
As tears well-up in her eyes, I notice her husband's arms reaching over to comfort my patient’s mother. I continue to describe the disease that has been ravaging at their son's intestines, probably for the last several months. Although his parents had suspected something was seriously wrong when their son’s abdominal pain and diarrhea (which had initially seemed like the “stomach flu”) got progressively worse, nothing could’ve them prepared them for what I had just confirmed during his colonoscopy: Crohn’s disease.
June 24, 2015
Driving home recently, I heard a story on the radio about a state commissioner wanting to reduce restrictions on “junk food” offered in public schools. Surprisingly, this story jarred a long-forgotten memory from my childhood…
June 17, 2015
IBD (Inflammatory Bowel Disease) and IBS (Irritable Bowel Syndrome) are two completely different conditions that share very similar acronyms. Often I find people confused about them, even presuming they may have one, when in fact, they actually have the other.
March 09, 2015
Have you heard of the term “leaky gut”? It’s used to describe a (scientifically unproven) theory, which proposes that the lining of the gastrointestinal (GI) tract could be abnormally permeable to dietary and other environmental substances, which then “leak” into the blood stream to trigger inflammation. Sometimes, the “leaky gut” theory is put forth as the cause of a variety of poorly understood diseases, ranging from autism to autoimmune disorders such as multiple sclerosis.
As a gastroenterologist, trained with the knowledge of how the internal mechanics of the gut lining are designed to make it an effective barrier, I have always found it hard to accept this hypothesis. I wanted to share the findings of a recent publication showing that in a group of children known to have food allergies and gut inflammation, their GI tract was no more “leaky”, compared to the intestinal tracts of healthy children.
January 16, 2015
Toddlerhood is a time when children are going through a lot of changes. Children enter pre-school, toilet-training begins, diets change, and sometimes stooling patterns become different as well. The latter issue often leads to parental worry. One of the most common changes that parents of toddlers bring up during visits with me is that their toddler’s stools seem very loose or watery (“diarrhea”). More often than not, the diagnosis ends up being “toddler’s diarrhea”, a harmless type of diarrhea that generally starts after a child is weaned. (Other names for this condition include “functional diarrhea of childhood” or “chronic non-specific diarrhea of childhood”.)
Toddler’s diarrhea occurs due to a relative immaturity of the intestinal tract of young children. Relatively speaking, sugars and some fluid get poorly absorbed. The stools often contain undigested food particles (carrots a...
January 09, 2015
A recent consensus statement written by international pediatric nutrition experts has recommended that infants and young children avoid rice-based drinks. This is due to the fact that some types of rice contain large concentrations of inorganic arsenic, a first-level carcinogen. There is no safe level of intake, because any exposure is risky. The longer the exposure to inorganic arsenic, the more toxic its effects.
The newly published report reminds us that rice and derived products such as starch, flour and syrup are used to fortify different foods, including drinks, purees, and snacks. These are foods often fed to infants and young children. Since most of the inorganic arsenic in rice is concentrated in the outer bran layers, the report also highlights that potentially, the most harmful type of exposure is that which comes from products manufactured from brown rice...
January 07, 2015
On Monday the New York Times published an article about the FDA’s plan to research the safety of a very commonly prescribed medication, polyethylene glycol 3350 or PEG 3350 (most commonly known under the brand name, MiraLAX®). As a pediatric gastroenterologist who often recommends this medication, I wanted to share my personal thoughts after reading the article.
First of all, although the news was certainly a surprise to me, it was a pleasant one. I was ...
December 17, 2014
I’m fortunate enough to have lived most of my life with hardly a worry in the world when it came to personal health issues. However, this year changed my outlook. Firmly into the fourth decade of my life, it became necessary to schedule some basic preventative health care screens for the first time. This then led me down to what seemed like a never-ending path of scheduling and completing test after test, followed by even more appointments. As the year progressed, I also became involved in a serious health care issue affecting a very close family member which led to learning how to navigate the maze of international health care!
As 2014 finally rolls to an end, I reflect on some valuable lessons learned, having experienced medicine from the perspective of a consumer rather than a provider.
December 08, 2014
As a pediatric gastroenterologist, I’m often asked whether there is any way to prevent a child from developing celiac disease. Based on what I knew regarding how food allergies develop, I used to counsel families that there might be a “window of opportunity”, between four and six months, when it’s possible to introduce grains and other gluten-containing foods that could potentially “teach” the immune system to tolerate gluten and thus lower the risk of developing celiac disease.
However, my “window theory” recently got thrown out the window when the results of two important scientific studies were published in the New England Journal of Medicine.
September 12, 2014
Recently, there has been a lot of discussion in the media about a severe type of respiratory illness affecting many children, mainly in the Midwest. The respiratory illness, caused by an infection with Enterovirus D68, is scary to parents, because it’s hard to differentiate whether their child is ill from this particular virus or just has one of the many other viruses that cause cold- and flu-like symptoms around this time of year.
Sometimes media reports leave families with more questions than answers, which is why Dr. Dianne Glover, one of Swedish’s pediatric infectious disease specialists, wanted to share this information with you:
- Enterovirus D68 (EV-D68) is an unusual form of an otherwise common group of viruses referred to as Enteroviruses. These are hardy viruses that usually spread by the respiratory route, but can also spread b...
July 09, 2014
Bellyaches, stomachaches, or belly pain in school-age children are a common occurrence. At least half of the children that get referred to pediatric gastroenterologists like me come for treatment of their chronic, recurrent abdominal pain. Parents often feel frustrated because despite multiple visits to physicians, even emergency rooms, they are left with more questions than answers all whilst their child continues to suffer.
A typical scenario is a child whose pain seems worst in the mornings after awakening and towards the evening, especially after dinner or before bedtime. Often the child doesn’t want to eat breakfast and if forced, tells his parents he feels nauseated. When asked where the pain is, the child most often points to the area around his belly button.
More often than not, depending on a few other factors, the diagnosis ends up being ...
June 23, 2014
Do you wonder if your child might have “lactose intolerance”? Have you ever thought of removing dairy from your child’s diet? If the answer to either of these questions is yes, here are a few things to remember when it comes to lactose intolerance in kids:
- Lactose is broken down by lactase.
While lactose is the carbohydrate (sugar) found in milk, lactase is the enzyme that digests the sugar. This enzyme is found in the lining of the small intestine, breaks down lactose into simpler molecules that are easier to absorb. When there isn’t enough lactase, the sugar isn’t properly absorbed, which leads to the symptoms of “intolerance”, which include gas, bloating, pain and diarrhea.
- True lactose intolerance is rare in young children.
Although children as young as infants can “transiently” have l...
June 18, 2014
Despite test results that show no evidence of their children having neither any detectable allergies to wheat nor any signs of celiac disease, many parents choose to have their children follow a gluten-free diet. This is because of convincing stories of how gluten (a protein found in wheat and other grains) seems to cause their kids to have belly aches, nausea, bloating and a variety of other symptoms.
For years, this was hard to explain without a scientific explanation. Gastroenterologists like me had a hard time supporting families who wanted to follow gluten free diets, without a good “medical reason”. Then, in 2011, researchers from Australia conducted a double-blind, randomized, placebo-controlled, rechallenge trial in nearly 3 dozen patients (none of whom had celiac disease or wheat allergy), all of whom described worsening symptoms when unkno...
June 09, 2014
“Every time my child eats, his belly hurts. I think he must have a food allergy. Can you help us?”
Countless times have I heard this from parents of children worried about foods being the cause of their child’s gastrointestinal (GI) complaints. Some families wonder whether their child should start a “gluten-free” or other type of dietary change. More often than not, families have already tried a few diets before meeting with me.
Parents considering these types of elimination diets need to be aware of a few key points:
The difference between “food allergy” and “food sensitivity”:
May 20, 2014
Time is running out if you want your opinion to be heard when it comes to the FDA’s proposed changes to the iconic food label that we’ve all come to rely on when buying packaged foods.
This is a big deal. For those of you who haven’t heard, highlighted below are the key proposed changes:
Require information about the amount of "added sugars". A review of this was discussed in Dr. Thekke Karumathil’s blog a few months ago.
Remove the “calories from fat” label
Update serving size requirements
Present "dual-column" labels to differentiate "per-serving" and "per-package"
March 31, 2014
It is with great happiness that I update an earlier blog posted several months ago with the news that patients with food allergies now have a law that helps them afford their treatment. On Friday March 28th, Governor Jay Inslee signed a law that makes Washington the most recent state in the country to set a mandate for medical coverage of elemental formulas in the treatment of Eosinophilic GI disorders (EGIDs). EGIDs are a severe form of gastrointestinal inflammation that results from food allergy.
February 26, 2014
On August 5th, 2013, the U.S. Food and Drug Administration (FDA) at long last published a formal rule regulating the use of the term "gluten free" on foods and beverages. Even though this came with a big sigh of relief to the millions of people with celiac disease living in the US, consumers should be aware that the law gives manufacturers one year to be in full compliance (and goes into effect August 5, 2014).
As we head into the final months before the law’s final compliance date, I thought I’d highlight a few other key points about this brand new law:
1. No symbols needed.
The law does not require or recommend manufacturers use any particular symbol or food label, but if a label should include any of the following phrases, compliance must be ensured:
- "Free of gluten"
January 10, 2014
A 4 week-old infant and his mother came to my office last week. The mother had started seeing small flecks of blood and stringy mucous in the infant’s diapers a week prior. The baby was fine in every other way, breast feeding normally, and looked quite healthy when I examined him.
I diagnosed the infant as having cow’s milk protein-induced proctocolitis, the term referring to allergic inflammation of the lower gastrointestinal tract from exposure to cow’s milk.
This is a diagnosis I make often. Here's what you should know about infants with milk allergies:
- It’s more common than you think. 2-3% of infants in the U.S. are allergic to cow’s milk protein. It is even more common in infants with eczema or who have parents or siblings with allergies.
- It’s seen in breast fed babies. Over 50% of infants with this condition are breast milk-fed infants.
August 23, 2013
I remember one day during my pediatric gastroenterology fellowship, a mother and child were walking in front of my professor and me, as we made our daily rounds in the hospital. When the pacifier fell out of the toddler’s mouth and the mother picked it up and put it right back into the child's mouth, my professor remarked to me, "mark my words....that child will never get Crohn’s disease!" My professor was referring to the theory of the "Hygiene Hypothesis". This theory is thought to explain (at least in part) why so many more people in developed nations become afflicted with autoimmune diseases such as Inflammatory Bowel Disease (IBD - Crohn's disease and Ulcerative Colitis) as well as food allergies, compared to people in non-developed nations.
In non-developed countries, where children are...
August 16, 2013
Magnets, a common household object with which we are all familiar, can be surprisingly dangerous, especially to children. If this statement is startling to you, here’s what you need to know.
Beginning in the 1970s and 80s, scientists discovered a new type of magnet, the so-called “rare-earth magnet”. Made from some of the “rare earth” metals of the periodic table such as “Neodymium”, these new magnets are not only the strongest, most powerful magnets known to man (magnetic forces up to ten times that of other magnets), they are also permanent and relatively inexpensive to manufacture. These properties revolutionized the production of many household products, even toys. Basically, magnets we find in everyday items today are no longer made using old-fashioned magnets from a generation ago!
As a pediatric gastroenterologist, I am writing this blog to warn you of the dangers, should these powerful magnets be accidenta...
July 26, 2013
Eosinophilic Gastrointestinal Disorders (“EGIDs”) are a severe form of gastrointestinal inflammation that results from food allergy. Children and adults in the U.S. are increasingly being diagnosed with this condition that unfortunately requires strict elimination diets, and many times, a life-long inability to eat foods that most of us take for granted each day, including dairy, wheat, soy, and eggs.
For children requiring such restrictive diets, pediatric gastroenterologists like me work hard to find adequate alternate sources of nutrition. For my patients with EGIDs, I often prescribe special “elemental formulas” as a treatment to both heal the intestinal inflammation and prevent further harm. These formulas are completely allergen-free while meeting 100% of a child’s nutritional needs.
However, in the state of Washington, most ....
January 24, 2013
Is your child under the age of 6 and having problems with feeding or weight gain? Swedish’s GAINS program can help you and your pediatrician by doing a full assessment and providing specific recommendations. The Growth and Integrated Nutrition Service at Swedish (GAINS) is a multidisciplinary program, which includes doctors, nurses, dietitians, behavioral specialists, and feeding therapists.
There are many medical conditions that lead to growth and nutrition problems in children. We are experts at working with children with:
- Feeding difficulties
- Poor weight gain
- Failure to thrive
- Children with feeding tubes
- Breastfeeding Difficulties
Here are some frequently asked questions about the GAINS program:
January 07, 2013
As your baby grows, you’ve probably started wondering when and how to start feeding
your infant solid foods. Here are some general tips to consider:
Is there a safe age to start feeding solid foods to my infant?
Yes, most infants this is between four and six months of age.
Why is there a ‘safe’ age to start feeding solids?
There are a few reasons why this age is safest. The first reason is because prior
to four months of age, an infant is not developmentally ready to safely eat from
To be able to swallow solids safely, an infant needs good head control; to be
able to sit well with support; and to have lost the “extrusion reflex” (the reflex
which enables newborns to tightly latch and suck from a nipple, but makes them shove
a spoon out of their mouth).
The second reason an infant should be fed solids between four and six months
is something many families are not aware of: i...