David Berger, MD Board Certified Pediatrician

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David Berger, MDBoard Certified Pediatrician
3341 W. Bearss Avenue Tampa, FL 33618 (813)
960-3415 www.wholisticpeds.com
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Topics of Discussion

• What is Wholistic Pediatrics?
• Pre-Pregnancy and Pregnancy Planning
• Safe(r) vaccination strategies
• What is a parent to do when a child is sick?

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What is it?

• a word I made up (like truthiness or
  Katrinagate)
• A modification of the word holistic
• I use it to mean medicine looking at not just the
  whole person, but the whole family and the whole
  environment
• Its what happens when you mix a Pediatrician and
  a Social Worker.

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Pre-Pregnancy Planning

• Dont allow any mercury containing products to
  enter the body for 6 months prior to conception.
• Have all amalgam fillings removed 6 months prior
  to conception. Go to www.iaomt.org for a
  qualified dentist. Consider chelation after
  removal.
• Consider heavy metal testing and chelation prior
  to conception.
• Consider genomics or methylation pathway testing
  on the perspective mother.

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Pre-Pregnancy and Pregnancy Nutrition
(GENERAL CONSIDERATIONS)

• Eat Organic as much as possible
• Avoid processed foods and additive/colorings
• Increase protein intake eat protein whenever
  carbs are consumed. This can reduce the
  likelihood of gestational diabetes
• A good daily multivitamin (there are many, I
  prescribe FemOne from Metabolic Maintenance it
  is 1 capsule daily)
• Fish Oil High Potency, enteric coated products
  are better tolerated, especially for pregnancy
  women. Can freeze if still an aftertaste. Aim for
  about 1-2 gm combined EPA/DHA daily. I use
  Xymogen OmegaPure 600EC (360EPA, 240DHA)
• Calcium 1000mg daily

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Pre-Pregnancy and Pregnancy Supplements

• I have performed metabolic tests on many
  mothers of children with ASD, and a large
  percentage have abnormal glutathione pathways.
  Supporting this pathway could be of tremendous
  benefit
• MB-12/folinic acid at a minimum, used as a nasal
  spray prepared by one of the many fine
  compounding pharmacists. 1250mcg MB-12 and 300mcg
  folinic acid per dose, to use 1 spray twice a
  day.
• MB-12 consider SQ injections, with a minimum
  dose of 2500mcg every 3 days.
• Folinic acid or Folapro 800mcg a day. Back down
  to 400mcg daily if having negative reactions.
• glutathione preferably used daily as an inhaled
  nebulizer or TD emu oil cream (200mg 1-2 times a
  day) or as oral lipoceutical (Essential GSH, at ½
  tsp daily).
• N acetylcysteine I only use this with
  documented low plasma cysteine levels. 100mg
  twice a day. Can exacerbate yeast infections.

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Things to ease Labor and Delivery

• During last trimester
• Perineal Massage www.childbirth.org/articles/massa
  ge.html
• Hypnobirthing www.hypnobirthing.com
• To Induce Labor
• Plenty of walking
• Borage or Evening Primrose Capsules as a vaginal
  suppository to soften the cervix
• The Big O. Sexual Intercourse can induce or
  speed up labor, especially if orgasm can be
  obtained.
• During actual Labor
• Water Birth www.waterbirth.org

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Benjamins Birthday
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Once the Baby is Born

• Breastfeed, Breastfeed, Breastfeed
• If previous child with sensitivity to
  casein/gluten, consider having mom avoid it.
• Hepatitis B If moms status is negative,
  defer.
• Vitamin K Probably benign, oral is an option,
  check out my article on Medical Topics on
  ww.wholisticpeds.com
• Eye ointment Probably benign, used as preventive
  for gonorrhea transmitted from the birth canal.
  If using defer for 1-2 hours as it can blur
  babys vision and affect bonding.
• GET HOME AS SOON AS POSSIBLE!
• Hospitals are for sick people. Your home is the
  best place for you and your healthy baby.

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Post Partum Depression

• Omega fatty acids
• Increase Omgea-3s to 3-4 gms daily (highly
  recommend Fish over Flax)
• Omega 6 fatty acids to balance the Omega-3s. I
  prefer Borage Oil, providing about 500mg of GLA
  daily
• Dehydrated Placenta
• The rapid loss of the placental hormones are a
  contributing factor
• A womens placenta has exactly what she needs to
  replace these hormones

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Safe(r) Vaccinations?

• Not discussing individual vaccines or vaccine
  schedules today.
• The AAP says it is fine to vaccinate during times
  of illness if not severe
• I disagree, I would prefer the body to be as
  healthy as possible for vaccination.
• I wait at least 2 weeks upon recovering from an
  illness before routine immunizations are given.

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Vaccine Titers

• The number of vaccines recommended for each
  disease is a best estimate for what it takes to
  protect the population
• Many people do not need the full series to be
  protected.
• Some people will never gain immunity, even if
  extra vaccines are given.
• 
  Booster shots?
• 97 of children are protected for a given vaccine
  PRIOR to getting the 4-6 year old vaccines
  (Pertussis is the exception, I find few are
  protected).
• IgG (not IgM) is the test that needs to be
  ordered. Each disease has its own test. Most
  labs can run these tests(I mostly use Quest,
  insurance usually covers it). The lab should
  report reference values that indicate immunity.
• Titers for viral illness (MMR, Polio
  neutralizing antibodies types 1-3 from Quest or
  Specialty), if protected at 4-6 years old,
  usually indicate protection for life. I dont
  repeat these in the future.
• Titers for bacterial illnesses (i.e. tetanus and
  pertussis), even if protected at 4-6 years old,
  usually go down over time and should be repeated
  every 1-2 years.

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Vaccine Exemptions

• Laws vary from state to state.
• There is a rather limited number of reasons that
  a Medical Exemption can be written. There is no
  one disease state that will allow for exemption
  from all vaccines. The CDC has a list of what
  reasons a particular vaccine can be exempted at
  www.cdc.gov/nip/recs/contraindications_vacc.htmGu
  ide
• Doctors can write a medical exemption for any
  disease that shows protective antibodies.
• Autism is not an accepted diagnosis for a
  medical exemption.
• Some states permit for philosophical
  exemptions.
• Most states permit for religious exemptions but
  the law varies from state to state. General
  information, and specifics to Florida law, can be
  found at www.know-vaccines.org

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Safe(r) Vaccinations?

• Supplements to give with vaccines
• Vitamin A Twice a day, the day before, of and
  after any vaccine.
• Vitamin C, Echinacea (or Larix), and Zinc from 3
  days before until 3 days after any vaccine.
• Doses vary by age, and are the same as listed in
  the On the first signs of Illness article on
  the Medical Topics page of www.wholisticpeds.com

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On The First Signs of Illness

• The immediate starting of high dose Vitamin A,
  Echinacea/Larix, Vitamin C and Zinc usually will
  considerably shorten the length of illness.
• Try getting in at least 2 doses the first day.
• Dont wait until the 2nd symptom appears.
• Refer to the On the first signs of illness link
  on the Medical Topics page at www.wholisticpeds.co
  m for age appropriate dosing, including for
  adults .

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What Warrants Immediate Attention?

• Any sign of respiratory distress, such as rapid
  breathing, labored breathing, difficulty catching
  ones breath, or nasal flaring.
• Any associated urinary symptoms such as pain with
  urination, blood, increased urine frequency, or
  flank pain associated with fever need to rule
  out urinary tract infection.
• Any associated mental status changes, confusion,
  or lethargy warrants immediate evaluation. Giving
  a single dose of a fever reducer such as
  ibuprofen (preferably) or acetaminophen (ie
  Tylenol) to see if this improves the symptoms
  would be acceptable, but if not rapidly
  improving, immediate medical attention is needed.
• Temperature over 100.5F in children under 2
  months of age.

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Fever

• A natural response of the body to an infection.
• If a fever is allowed to stay, children on
  average will recover from the illness 1 day
  faster.
• Temperature over 100.5F in children under 8
  weeks old require immediate intervention and
  septic work-up.
• Fevers under at least 107F are not dangerous.
• Febrile seizures occur not from how high a fever
  is, but from a rapid change in body temperature.
• Fevers over 104.7F with no other symptoms
  increase the likelihood of a bacterial infection
  further evaluation is warranted.
• Fevers that last more than 5 days in a row should
  be further evaluated.

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Fever

• When to treat
• If a child is miserable.
• If a child can not sleep.
• If a child will not drink.
• What to treat with
• Tepid bath
• Acetaminophen 15mg/kg every 4-6 hours (I prefer
  Feverall suppositories)
• Ibuprofen 10mg/kg every 6-8 hours (I prefer
  dye-free Advil/Motrin)
• Acetaminophen and Ibuprofen can be given
  staggered in 3 hour intervals
• never use an alcohol rub or ice bath. This can
  lower the temperature too quickly.

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Ear Infections

• The AAP now endorses Watchful waiting instead
  of antibiotics in non-ill appearing children over
  6 months of age.
• 80 ear infections will resolve on their own
• Ear pain happens due to the fluid pressing
  against the ear drum, not the infection itself.
  Sterile fluid can cause just as much pain as
  infected fluid
• If not treating, and there is a possibility that
  a different doctor may see the child on
  re-evaluation, dont settle for its infected.
  You need to know in a few days if things are
  better or not. Find out if
• Is it pink, red, or neither? (the more red, the
  more likely there is infection
• Is the ear drum thick or thin? (thicken indicates
  infection)
• Is the ear bulging or flat? (Bulging indicate
  increased fluid-pressure)
• Does the eardrum move on pneumatoscope or
  tympanometry?
• Is there fluid? Is the ear drum filled with fluid
  or is there a fluid level seen
• If there is fluid, is it clear or does it look
  like pus
• Are the landmarks seen
• Re-evaluate in 2-3 days if not doing better

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Ear Infections What to do if not giving
antibiotics?(or in addition to)

• Plenty of fluids.
• All supplements listed On the first signs of
  illness.
• Ear Oil (Mullein Flower, St. John's Wort,
  Garlic, Goldenseal,Lobelia). I prefer Gaia
  Childrens Ear Drops. This goes in the ear,
  warmed, 2 drops 3-4 times a day.
• Elder-Eyebright Herbal combination that helps
  open up the ear and sinus passages to promote
  draining of the fluid. Made by Gaias Children.
• If the child is having ear drainage or has
  tubes, do not put Ear Oil in the ear, but
  strongly consider using drops such as Floxin
  instead or oral antibiotics.
• Pain meds
• Oral or rectal as for fever
• Auralgan (antipyrine/benzocaine) in the ear,
  alternate with Ear Oil.

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Urinary Tract Infections

• I am much more inclined to start antibiotics if
  there is associated fever or flank pain, this
  could indicate a kidney infection which is much
  more serious.
• I try to get a urinalysis and culture with
  sensitivity before starting holistic therapies.
  If patient is not better in 3 days, antibiotics
  are warranted, but by then the sensitivity panel
  will be back
• Treatments
• Vitamin C NON-BUFFERED, to bowel tolerance, to
  acidify the urine
• Cranberry Extract/D-Mannose Inhibits adherence
  of bacteria to bladder wall. Solaray has a
  combined product. Give ½ cap 3 times a day for
  smaller children, 1 cap 3 times a day for older
  kids and adults
• Uva Ursi natural antibiotic that concentrate in
  the urine. I prefer standardized extracts. Small
  children should not exceed 200mg of arbutin
  daily, larger children max dose 400mg, and adults
  800mg daily, not for more than 2 weeks.

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Influenza

• Refer to Treating the Flu handout on Medical
  Topics Page at www.wholisticpeds.com for detailed
  discussion.
• Treatments
• On the first signs of Illness Protocol.
• Oscillococcinum a homeopathic remedy with
  demonstrated efficacy in placebo-controlled
  studies
• Elderberry an herb with some evidence of
  anti-influenza activity. Sambucol is the actual
  product that has been studied.

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Intestinal Illnesses

• Refer to Treating Intestinal Illnesses handout
  on Medical Topics Page at www.wholisticpeds.com
  for detailed discussion.
• Treatments
• Dehydration PREVENT IT. Breast milk and
  Pedialyte are optimal solutions. A home recipe is
  provided on the webpage.
• Probiotics replaces that which is shed during
  illness. Studies have shown that using probiotics
  during an intestinal illness can reduce the
  length of diarrhea by 50.
• Chamomile preferably as a tea such as
  Sleepytime. Decreases abdominal pain and nausea.
• Ginger Can be taken as extracts, capsules, or
  fresh shavings added to tea. Decreases abdominal
  pain and nausea.

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Cough

• We cough as a mechanism to keep our airway clear.
  I only suppress a cough if a child can not sleep,
  keep fluid or foods down, if they have chest
  muscle pain from the cough or if they are
  miserable.
• Cough Suppressants
• DM of choice
• Cough medicine with codeine if really needed
• Fritillary Loquat Extract a Chinese Herbal
• Decongestants cough can result from a post nasal
  drip. Drying up the discharge can decrease the
  cough
• Nasal decongestant drops Phenylephrine directly
  in the nose
• Oral decongestants phenylephrine or
  Pseudoephedrine, preferably dye-free.
• A natural inhalational treatment
• 1 quart of distilled water, 1 ½ tablespoons each
  of molasses and sea salt
• Bring to boil.
• Inhale the fumes. Either directly with towel over
  head or in a furniture tent. Direct adult
  supervision required.

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Strep Throat

• Not all sore throats are Strep
• Strep usually does not have accompanying nasal
  discharge/congestion or cough
• There should be enlarged, red tonsils usually
  with pus/exudate present
• Always test, dont treat presumptively
• Rapid tests are 95-97 accurate
• Cultures are definitive but take 2 days to come
  back. Wait on results to come back before
  starting treatment
• I always treat a positive strep test with
  antibiotics due to risk of rheumatic fever or
  glomerulonephritis in untreated cases.
• Penicillin IM (Bicillin LA) under 60lbs
  600,000U 60-90lbs 900,000U, over 90lbs
  1,200,000U
• Oral penicillin or amoxil, 1st gen
  cephalosporins, or Zithromax are alternatives
• Probiotics 2x the usual dose on the treating
  intestinal illnesses page
• If the child is always getting strep, culture
  throat when not sick. Patient may be a carrier,
  which requires different treatments to eradicate.

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Good General Resources

• The Holistic Pediatrician by Kathy Kemper, MD
• Swedish Medical Center Online Health Library
• http//www.swedish.org/body.cfm?id300oTopID13
• Kirkman Labs Online www.kirkmanlabs.com