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Mother Nurture

© Rick Hanson, Ph.D. and Jan Hanson, L.Ac. 2001, 2002, 2003

Optimizing a Child's Health

In our last column, we discussed how to teach several fundamental psychological skills to children, including letting go of upsetting experiences and taking in positive ones. These skills will help anyone, but they're especially useful for spirited or cautious/rigid children. In this column, we'll explore how to optimize a child's health - certainly worth doing in its own right, but also a real aid to any child with a challenging temperament. We'll also discuss getting support.

The Mind/Body Connection

Sometimes a temperamental issue that seems purely psychological will turn out to have, in part, a physical cause. For example, when he was about five years old, our son became grumpy and blue, a change from his normally sunny disposition (although he continued to appear perfectly healthy). At night, when Rick put our son to bed, he often heard forrest say that his throat was "tight." Some kids in Forrest's school had gotten strep throat recently, so Jan and Rick suggested that Forrest have a throat culture done at his upcoming, annual pediatric appointment. The doctor (a wonderful, caring pediatrician) did not see any symptoms, but he was happy to order the test anyway, and indeed Forrest had strep throat. Within days after treatment began, he was back to being his old, cheerful self.

Careful Assessment

This story also points out the importance of getting good assessment. With the development of modern medicine, many fabulous tests are available that will give you detailed information about your child's health: why not use them? They will give you the facts that will reduce your uncertainty about what's going on, and enable you and your child's health care providers to make better decisions. The sooner you have that information, the sooner everyone can benefit from it. Other than the prick of a needle for a blood draw, assessment can't hurt a child - unlike the wrong treatment, or no treatment at all (if there is in fact a problem, or an opportunity to improve his or her health). The worst case result is that assessment rules out a problem, but that means you've got one less thing to worry about: not a bad result, after all!

Whenever a child has a challenging temperament, we think it's a good idea to look into nutritional deficits, allergies and food sensitivities, and gastrointestinal (GI) problems. Why? Spirited children seem especially vulnerable to allergies (perhaps because they are one more form of dysregulation), and any child is more able to control himself and learn from his experience - and the efforts of his parents! - when he's not distracted internally by an overly reactive immune system. Stress - which is generally experienced more frequently by spirited and cautious children than by easygoing ones - disturbs the gastrointestinal system, and the results can include tummy aches, constipation, and less ability to absorb nutrients. We've consistently seen sensible efforts to bring an optimal balance to a child's physiology lead to mild to moderate improvements in her mood and temperament - and once in awhile, a dramatic benefit.

As a starting point, tell your pediatrician about your child's temperamental or psychological issues, and see if the doctor thinks there might be some physical basis for them. You could also consult with a licensed professional who has specialized experience with nutritional deficits, allergies, or gastrointestinal problems in children.

Sensible Care

If assessment reveals any condition that is wearing on your child - and perhaps exacerbating temperamental issues - you'll want to care for it in sensible ways. Here are some options for using nutrition, or the skillful management of allergies or GI disturbance, to help your child's temperament.

Nutrition - Besides leading to weight gain and tooth decay, sugar can really crank up spirited kids - so we definitely recommend limiting it to 20 grams a day. One of the easiest ways to accomplish this is to cut down on sweet drinks; for example, there are about 45 grams of sugar in a can of coke.

A different sort of problem occurs when there's too little of a nutrient. In particular:

Research on children with attention deficit/hyperactivity disorder (ADHD) - an extreme version of spiritedness - has found that those who ate a high protein breakfast were much calmer and more focused at school.

Essential fatty acids have been useful in the treatment of ADHD for some children, as well as for dyslexia and dyspraxia (poor motor skills or balance), and we've seen rigidly cautious children become more flexible after giving them essential fatty acids.

Deficits in all of the B-vitamins have been shown to lower mood; one of the most important of these is B-6, which the body must have in order to make serotonin. Now here's the tricky part: B-6 may be low because a child is not eating enough (in foods or supplements), or because his body cannot convert the B-6 he does get into its active form, which has a mouth-bending name, pyridoxal-5-phosphate (P-5-P). You can get P-5-P in a health food store, and research has shown it to be quite effective in lifting a person's mood, particularly when his or her serotonin levels are known to be low. (P-5-P should be taken in the morning before eating breakfast or any supplements with minerals, since P-5-P and minerals block the absorption of each other.)

Minerals in general are important for mood and self-control, but they are low in many children. Magnesium is especially calming, and it has been shown to be helpful for children with ADHD. The Recommended Daily Allowance (RDA) of magnesium for adults is 320 mg; a reasonable aim would be to give a child the fraction of that dose that is proportionate to his body weight. Since it is hard to get that much magnesium from the diet most kids eat, we suggest using a supplement of magnesium citrate, aspertate, or glysinate. Besides helping the immune system, zinc has been shown to be low in children with ADHD, so supplementation may be worth trying with a particularly spirited child. The adult RDA is12 mg, and you can adjust that amount in proportion to your child's weight.

Allergies, food sensitivities, and food intolerances - Allergies, etc. are becoming so widespread that they are probably the most common chronic illnesses in modern, industrialized societies, affecting 15% to 30% of the population. If you minimize or eliminate a child's exposure to the substances to which she reacts, in our experience there is often an improvement in temperamental problems. Sometimes this is fairly easy - don't acquire a cat if she's allergic to its hair, or get an air filter/ozone machine in her bedroom if she is affected by molds or pollen - but often it's a major pain. For example, if a child is allergic to gluten (in wheat, oats, rye, and barley), tasty, alternative foods are available in the cookbooks listed in the box, but it's still hard to keep a child away from bread, pizza, or cookies (we've dealt with this first-hand, since our son is allergic to gluten). Work with a good allergist, read up on allergies, and take the long view: an occasional splurge (birthday cake!) is alright for most kids, but it's the daily exposure to allergens that adds up over time.

Additionally, it seems like a wise, general principle to allow as few artificial or toxic chemicals to enter any child's body as possible. Some kids - particularly ones who are anxious or spirited - seem especially sensitive to their environment, such as to new carpets or a fresh coat of paint. Certain food additives may seem to have a marked effect on your child's temperament, like food dyes, artificial sweeteners, or monosodium glutamate. You can try eliminating a suspected culprit from his diet for a few weeks, and see if that makes a difference.


Helping a Child with Allergies, Food Sensitivities, or a Food Intolerance

American Academy of Allergy, Asthma, and Immunology -

Asthma and Allergy Foundation of America -

Also see the list of cookbooks on p. XXX [Chapter 5].

Gastrointestinal disturbance - Tommy's tummy can ache for a variety of reasons, including stress, allergies and food sensitivities, and an imbalance of the microorganisms in his GI tract. In our previous two columns, we discussed ways to deal with stress, and the material above is a good introduction to allergies and food sensitivities. As to an imbalance of microflora in the gut - sometimes termed dysbiosis - that's a big topic that deserves specialized attention, but here is a summary of a standard approach that's a kind of road map:

Starve the pathogens by eating much less sugar and white flour

Kill them with prescription drugs or herbal products

Compete with them by adding beneficial microorganisms (e.g., lactobacillus or other "probiotics")

Repair the damage to the GI tract, typically by taking supplements such as deglycyrrhizinated licorice or L-glutamine

Get Support

Since kids with demanding temperaments are bound to take more work, their parents need to make a special effort to share the load fairly, and to get support. In general, it may make sense to increase the amount of care your child receives from others, and it always makes sense for you to increase your own self-nurturance! In particular, you and your partner should have periodic summit-meetings about your plan for your child; a challenging temperament is not going to go away or be entirely "fixed" by any intervention, no matter how skillful. Perhaps read a book together - such as the excellent, Raising Your Spirited Child- and use it to come to a common view, or go together to see a parent educator, therapist, or a behavioral pediatrician.

Counseling or a social skills group could be an effective way to teach a child, even a young one, important skills - as well as offer ongoing guidance to his or her parents. This is also an effective way to identify and deal with psychological factors that may be affecting a child and intensifying her temperament, such as stress on the family or tensions in the parents' relationship. These resources are highly confidential, and young children usually like going to a therapist, since they get to play for an hour with a nice grown-up who gives them her undivided attention; before a first visit, you can describe the therapist as a kind of coach or teacher. Your pediatrician or preschool director can probably give you referrals to local therapists or social skills groups, or you can call the referral line in the local county association of different kinds of therapists that is listed in the yellow pages of the phone book. Many therapists will work on a sliding scale basis, and most counties also have non-profit agencies that offer professional services at a very low fee - such as A.P.P.L.E. FamilyWorks! Additionally, the office of education - or the school districts, in many counties - will assess, at no charge, preschool and school-aged children with perceptual, motor, or other psychological difficulties, and often provide helpful interventions as well; contact these organizations to see what services they might offer your family.

Sometimes, what looks like an ordinary matter of temperament is, in fact, a deeper psychological issue. For example, some children who are particularly rigid have a developmental disorder on the autistic spectrum, and some highly spirited kids actually have ADHD; for example, at least five percent of the first-grade boys in a typical school will have ADHD. In such cases, you definitely need professional help - and you can find it using the referral sources described in the paragraph above.

* * *

Perhaps more than anything, try to take the long view when you're working with a challenging temperament. Most of these issues get smaller and smaller with the passage of time. Once again, Mother Nature is on your side! Qualities that are troubling in a preschooler - like risk-taking confidence or unbelievable persistence - are highly desireable in many work settings. Try not to get too invested, too aggravated, or too controlling. Your child has his or her own destiny to work out, and the poignant and wonderful truth is that you have very limited influence over its unfolding. It's more important to preserve your relationship with your child than it is to ensure nearly any particular outcome. Try to relax and keep your sense of humor. Play the long game to win: do everything you can to prevent any irrevocable disasters, but as long as your child stays on the game board and makes it to adulthood intact, he or she is almost certainly going to be just fine.

(Rick Hanson is a clinical psychologist, Jan Hanson is an acupuncturist/nutritionist, and they are raising a daughter and son, ages 12 and 14. With Ricki Pollycove, M.D., they are the authors of Mother Nurture: A Mother's Guide to Health in Body, Mind, and Intimate Relationships, published by Penguin. You can see their website at or email them with questions or comments at; unfortunately, a personal reply may not always be possible.)