Here's a recent publication (written with a student) on when to worry about your child's fever, and what to do to help them get better ... better!
As my daughter and I were walking the other day, she - somewhat randomly - inquired about how people become blind. I told her there were many ways, but there were a few that were most commonly responsible in Canada. She asked me if there was any way of preventing blindness, and I told her that yes, most cases of blindness in Canada are preventable (think diabetes, macular degeneration) or treatable (visit http://www.cnib.ca for more info). I told her that the best way of keeping her eyes as healthy as possible was to eat her fruits and vegetables and move her body lots. She gave a huge sigh and we both laughed, because that's what she always hears from me. Eat your fruits and veggies. Move your body. Get enough sleep.
She's kind of tired of hearing it, but I hope that with the regular prompts - and even more powerfully, modelling by the adults in her life - it will seep into her consciousness and her habits. Because it's not just her naturopath mom who thinks this is important. This article in the journal Cureus is an excellent overview of the importance of establishing these lifestyle behaviours in childhood. If we want our population to be healthy, if we want the adults of tomorrow to be capable of being productive members of society, then these are the foundational habits that are critical to foster in our young people today.
The recipe for a healthier kid, and the adult they will become? Independent of all other factors (with acknowledgement of the challenges inherent in achieving some of these habits influenced by the social determinants of health):
1. Lots of fruits and veggies (and other good nutritional practices that go along with this).
2. Lots of movement (also tied to awareness around time engaged in sedentary activities like media use).
3. Lots of sleep (acknowledging its impact on stress reduction, growth, and immune system function).
How is your kid doing? How are you doing?
We tend to think of weak bones as being a problem of old age. However, building strong bones is a job for youth. Bone mass is laid down in childhood - we reach our peak bone mass by about the age of 20 - so helping our kids optimize bone health is critical to prevent osteoporosis years later. The stronger our bones become when we're young, the better off we'll be when we're older. Most families know this, and (like the Canada Food Guide advises) diligently ensure their children consume their milk and dairy products.
However, the British medical journal recently released a study showing that boosting calcium intake did nothing to prevent fractures. How can this be? Haven't we always been told that milk "does a body good"??
Bone health relies on far more than just calcium. Although it's an important component of healthy bones, there are a range of other nutrients - including vitamin D - that affect the metabolism of bones, kind of like the mortar that holds a strong wall together. Fruit and vegetable consumption alone is an independent predictor of stronger bones. Weight-bearing physical activity puts muscular force onto bones that challenges them to become stronger. It's important to keep the activity to moderate levels during development - the stress of intense training can negatively impact bone development. Minimizing stress reduces cortisol, a hormone that weakens bones, among its other toxic effects.
Calcium is still an essential mineral, for bone health and other important bodily functions. However, while dairy is a great source of calcium, despite the best efforts of the Dairy Board to convince us otherwise, dairy need not be its own food group. The Mediterranean dietary guidelines minimize dairy as its own food group, as does the Harvard School of Public Health - note the conspicuous inclusion of healthy oils in both images as well - important for metabolic and immune system function.
Nuts and seeds are a great source of calcium; eaten whole, or in their "butter" form, they're a delicious way to boost intake. Try almond butter on your toast, or add tahini (sesame seed butter) to your dips, soups and sauces. Green leafy vegetables contain calcium, and provide additional benefits of fiber and vitamin K, both helpful to bone health. Tofu (made from organic, non-GMO soy) is an excellent source of calcium; the phytoestrogenic effect of the soy may also benefit bone health after menopause. Stir-fried kale and tofu with a tahini sauce gives a powerful hit of not only calcium, but many other nutrients necessary for bone health.
Although I'm not generally an advocate of canned foods, I do like canned wild salmon or other cold-water fish with bones as a source of both calcium and omega-3 fatty acids - use it to make delicious salmon burgers, or mix into a green salad. Strong bones require minimal inflammation, and the healthy fats from wild fish are a helpful way to reduce it in the body.
If you or your child do well with dairy (signs that you don't might include eczema, sinus congestion, frequent ear infections, digestive difficulties, or behaviour struggles - come see me to discuss if a trial elimination might be a good idea), it can definitely be included in a balanced diet. Goat and sheep products are often better tolerated than cow, and have a pleasant flavour. There are many delicious varieties of cheese from around the world to try. Our family loves fermented dairy in the form of yogurt as an excellent way to support healthy gut bacteria - it's super easy to make at home, and you'll get more bacteria bang for your buck! See below for instructions how!
So get out with your kids to jump on a trampoline, swing around the playground, skip rope or have a dance party! Adults can go for a run or hit the gym for the same physical benefits, but it's not always as fun for some folks. The activity loads your bones to make them stronger, and helps to reduce the negative impacts of stress. Being outside while you do it gives that extra vitamin D that is so important. Eating a Mediterranean-style diet (lots of fruits and vegetables, whole grains, plant-based proteins, healthy oils) will create the best possible nutritional environment for bones. It's so important to create an opportunity for kids' bones to develop properly, and for those of us who are past that prime time, we can keep our bones as strong as possible using the same principles. Have fun!
We just got back from a week on the French River (an historic waterway and stunning bit of land and river about three hours north of Toronto). My kids have done a lot of camping with me, and we've paddled, but I've never challenged them to do an extended trip that required them to work in quite this way. They were game from the start, and I was super excited about our adventure!
However, everyone was a bit grouchy on the first day. There was general grumbling about paddling and living in tents for the next week; there was the predictable bickering between the kids; I was edgy and distracted after the drive and with mental reviewing of gear and food. We were on the river for less than an hour (in fairness, paddling into a stiff headwind) when I brought the hammer down. I launched into a tirade about how lucky we were to live in such a beautiful country. To have clean water to swim and paddle in (and drink, with a bit of help from a great filter). I lectured that our country (the colonial version) was built on canoe trips along this very river. These were skills that they had the responsibility to learn as Canadians. It was a privilege to be here and I had had just about enough complaining.
My lectures rarely have a great impact (who's do?). I'm sure they tuned me out. But they stopped grumbling. And it stayed that way! Over the next five days these two city kids learned to shit in the woods (properly), pitch their tent, use a compass, read a map, paddle a boat efficiently, and portage gear. They rediscovered one another, worked as a team, solved problems and spent time together - by choice! They swam, built fires, jumped off cliffs, ate in the rain, and were tougher than many adults I know. We saw otters and turtles, eagles and herons. We talked religion and politics, worked through various forms of angst, made up stories, and learned new songs. We got scraped and tanned and dirty and tired. Our circadian rhythms adjusted to the rising and setting of the sun. We snuggled and laughed. We filled our lungs and we filled our souls.
We're back in the city now. Time will tell how quickly we'll all revert back to itching for digital distractions. I'm already up waaay past when my body tells me I should be. The bickering has begun again. I think we're already looking forward to next summer ...
This summer while I was volunteering as the doctor for a summer overnight camp, I had a little girl present with a fever and nothing else. No sore throat, no cough, no tender tummy, no earache. She wasn’t having diarrhea and she wasn’t throwing up. Just a fever. What to do?
We live in a culture afraid of illness. We don’t seem to trust our bodies to get well. Any little twinge sends us running for the Tylenol or the Advil. We do it for ourselves, and we do it for our kids.
Here’s the thing – that fever, that lethargy, that blah feeling? That desire to curl up with a blanket and a cup of hot peppermint tea? It’s our body’s brilliant way of telling us to conserve energy and resources for defending against an intruder. Fevers serve a huge purpose when we’re ill – they create an inhospitable environment for viruses and bacteria; they shift our immune system into “on” mode; they increase our heart rate and output, helping circulate all the factors that are necessary to get us well. Suppressing the fever turns all of that off, which may make us feel better in the short term, but does us no favours in the long run – it may actually impair the immune system’s ability to fight the infection, possibly increasing the time we take to recover!
Fevers are helpful. In the context of an otherwise healthy body, they are not harmful. They are self-limiting. And the most important thing is to find the cause of the fever, not to indiscriminately (fearfully?) yank it down. In older kids (ie. over three) we can tolerate a reasonable temperature for a little while even if there are no other signs or symptoms, letting the body sort it out. If the fever helps the immune system do its job before symptoms manifest, then excellent! And there are lots of ways to make a child more comfortable in the meantime using herbs, water therapy and homeopathy – strategies that increase comfort while helping the fever, not opposing it.
So that little girl. I tucked her into bed, gave her lots to drink, and checked on her throughout the day. In a few hours, her temperature was normal, her energy was back up, and she was back at play. Hopefully with a stronger, wiser immune system that was permitted to do its job.