Anne Baum (00:00):
When should you be concerned if your kid is always sick? What are the most common autoimmune diseases in children? Is playing in the dirt good for kids? All that and more on this episode of Because They’re Kids.
(00:15):
Welcome back to Because They’re Kids, the podcast that’s built just for kids and their parents. For those who may not know, I’m your host Anne Baum, president of Lehigh Valley Reilly Children’s Hospital and mom of two. I’m excited to be back for another episode. Kids come in all shapes and sizes, but from teen to toddler they all have one thing in common, they get sick. As a parent myself, I know how hard it is when your child gets sick, both on them and you.
(00:47):
That’s why today, we’re discussing what you can do to help keep your kid healthy. Here to help us talk about all things immunity are my guests, Dr. Tibi Villalobos, a pediatric infectious disease specialist at Lehigh Valley Reilly Children’s Hospital, and Dr. Dominique Bailey, a pediatrician with LVPG Pediatrics–Easton.
(01:09):
Tibi, Dominique, welcome to the show.
Dr. Dominique Bailey (01:11):
Thank you so much for having us, what a pleasure.
Dr. Tibisay Villalobos (01:14):
Thank you, Anne, for having us. We’re delighted to be here with you today.
Anne Baum (01:17):
That’s great. Really looking forward to our discussion. Let’s get into this. Why do kids get sick so often?
Dr. Tibisay Villalobos (01:26):
Well, the kids get sick because in the first few years of life, they are being exposed to things that they have never seen before. Their immune system is being developed and challenged every day, whether with their siblings, or if they go to school or they go to play dates. This time of the year, when we have so many viruses circulating in the community, those children are going to be exposed very commonly. If they attend a day care setting or other congregated places, that’s going to be a constant exposure during the fall and winter seasons.
Anne Baum (01:59):
It’s not always a bad thing, then?
Dr. Tibisay Villalobos (02:01):
It’s not a bad thing to get sick in the first few years, as long as those illnesses are mild and you recover completely from them. In between, your child is thriving well.
Anne Baum (02:12):
That’s great. What can we do to keep our kids healthy while they’re building their immune system, but also we don’t want them to get too sick?
Dr. Dominique Bailey (02:21):
Well, a lot of it is common sense. For instance, a child should eat a very varied diet and a very healthy diet. It’s very important they get lots of fruits and vegetables, all different colors. They eat lean meat, they eat good fats. They get plenty of rest. An average child, school-age child, still needs between 10 to 12 hours of sleep, and a teenager needs eight to 10. We know many of those teenagers don’t get anywhere near that at all.
(02:49):
In addition to that, they need to remain active because that will help them get lots of play outside and get exposed to some environmental microbes that are actually going to build their immune system healthily.
(03:01):
And reduce as much stress as you can in their life. Don’t over-schedule them, making sure that there’s plenty of family time, plenty of downtime. But attending school, and having fun, and doing some activities.
Anne Baum (03:13):
That’s great advice, appreciate that. What are some things that weaken a child’s immune system? Obviously, they’re getting exposed to the germs, this is good, building the immune system. We try to keep them healthy. But what are some things that get in the way?
Dr. Tibisay Villalobos (03:28):
One of the things that has gotten in the way, in the past two years, is that normally by the time the children get to kindergarten, they have enough exposure, they have enough virus experience. Now with the pandemic, we had two winter seasons when we have a number of children that, because of the pandemic, were never exposed to those traditional viruses that normally circulate during the winter, so by the time they are 4 or 5 years old, they don’t get that sick anymore.
(03:59):
Now we’re having children that, from age zero to 2 or 3, never have anything because we were covered, we were isolated. They wore masks to go to school. Now the last year and this year, those children are constantly exposed by their siblings, by going places, and they don’t have that immunity that they should have had, compared to last year. That is aggravating the situation, and I understand why so many parents are now worried, “Oh, my child is getting sick so often, compared to my older child and compared to other children,” and it’s because of that. Now we have a delayed immunity because of the lack of exposure due to the pandemic.
Anne Baum (04:39):
Ironically, the actions that we took to protect us against the COVID virus did not leave kids access to other viruses, and now they’re building up that immunity.
Dr. Tibisay Villalobos (04:52):
Correct. It protects against the COVID, but it also protects against kids having the flu, or having RSV [respiratory syncytial virus], or having strep throat during the fall and the winter, and being immune for the next season and the following season after having them.
Anne Baum (05:06):
Right. How do we know when it’s just immunity-building versus that child that’s always sick? When, as a parent, do you need to take it to the next level?
Dr. Dominique Bailey (05:20):
They would have other symptoms. They may have a loss of appetite, fatigue, weight loss, and they wouldn’t recover well in between. They would be looking always sick, a mother would be worried, a father would be worried about it. Then we may have to make some steps to see if there’s anything else going on.
Anne Baum (05:38):
Do we start with our primary care physician, with your pediatrician, and then they help you find the way?
Dr. Dominique Bailey (05:45):
Absolutely. It’s generally best to come to your primary care because they know you best, they know the family. Then when we need to make referrals, make the appropriate referrals.
Dr. Tibisay Villalobos (05:53):
There are always some red flags that the parents may need to look at and when they need to be concerned if it’s not just that virus after virus, but when things are going a little bit out of hand and you may be worried that something else is going on.
(06:08):
For example, a kid that doesn’t go to day care may have one or two ear infections during the fall and winter season, after they have those viral infections. A kid that goes to day care may have twice as much, but they recover in between and they continue to grow, good appetite, activity. One of the red flags is when the kid gets sick often, but the illness lasts longer and it takes a longer time to recover. Or they are initially severe, like you get admitted for an ear infection and you end up in the hospital, if that’s something that is expected from the child. When you have a pneumonia that’s in response to the antibiotics at home and end up in the hospital more than once.
(06:51):
Those things are the length of infection, the time to recover and the frequency. And how the child is in between. If they recover and go on growing well and eating well and keeping up, it’s unlikely. But those things that your child doesn’t look healthy in between, that give you an idea of maybe we need a referral, we need to look into and talk to the pediatrician.
Anne Baum (07:12):
Right. Those are a little bit of that gut parent-intuition, and those red flags really are important when you’re trying to figure out if it’s just normal behavior or something more.
Dr. Tibisay Villalobos (07:26):
Yes.
Anne Baum (07:28):
OK. When it comes to autoimmune diseases, is this something that you’re born with or something you can develop?
Dr. Tibisay Villalobos (07:36):
I think it’s a little bit of both. Luckily, autoimmune diseases are rare in children. Some of them are related to genetic disorders that are unknown, so they are more frequent in certain families. But they may be acquired also later in life, by the trigger that made them to develop those autoimmune diseases.
Anne Baum (07:57):
What, when you say a trigger, what might be a trigger of something like that?
Dr. Tibisay Villalobos (08:01):
Even viral infections can trigger an autoimmune disorder if you have the makeup or the genetic condition that predisposes you to that. For example, type 1 diabetes. If you have a family member, or your parents or grandparents or uncles have type 1 diabetes, there is an increased chance that your children may have type 1 diabetes, but you don’t know when that may happen. You keep observing and inspecting, and get the advice from your pediatrician on how to look for [it]. But sometimes, a virus can trigger that immune system to stop working, and then it starts attacking itself, which is the base of the autoimmune disease. Instead of helping you to fight disease, then for some reason it turns against your body or some organs and it starts attacking them.
Anne Baum (08:49):
Right. Thank you for explaining that. When we say autoimmune disease, can you give us a little bit more, for our audience, what that actually means?
We hear the word, but what does that mean?
Dr. Tibisay Villalobos (08:59):
The immune system is supposed to protect us. We make antibodies to protect you from disease that normally occur early in childhood, and some of them will last a lifetime so we don’t get them again. When we see them again, we have a memory that [says], “Oh, I know that disease and we’re not going to get it again. We’re going to fight it.”
(09:18):
For some reason that we don’t know, there is a switch. After having an infection, or for a reason we don’t know, that same immune system doesn’t recognize your own cells or your own organs, and it starts attacking them. And depending on which organ is affected, you will have different symptoms. But it’s like something happened and the immune system started fighting you back.
Anne Baum (09:42):
Right. It’s basically going after itself.
Dr. Tibisay Villalobos (09:45):
Correct.
Anne Baum (09:46):
Yeah. How do you know if your child has an autoimmune disease? Obviously, you’re working with your primary care physician. What are some signs to be watching for?
Dr. Tibisay Villalobos (09:57):
One of them if [it’s a] fever for unknown reasons, so fevers that are not due to an infection or a virus, and they don’t have a pattern. They’re noticing an unusual pattern, they come and go without anything specific. Rashes that happen for, again, no particular reason. That’s why it’s important to be with your pediatrician that knows you since you are little, to know how to advise about what is normal fever and rash, or something that continues, repeats itself for weeks or entire months without having a reason.
(10:28):
Joint pain. Kids are not supposed, even if they’re active, they’re not supposed to have joint pain or joint swelling, muscle aches, fatigue. Kids are active; even if they get tired after play, after sports, they’re supposed to bounce back. Loss of appetite. Fatigue that continues for a long time. Those are also, again, red flags that something may be going on. And again always look at the family history, if there is any family history of any autoimmune diseases that may be pertinent. GI [gastrointestinal] symptoms, not growing well, belly pain for no reason. Those are things that, over time, make you think, “OK, this is not my normal child, I need some advice.” That’s when the pediatrician starts to go about guiding you in the right direction.
Anne Baum (11:11):
That’s excellent. Now, I know you mentioned that most kids don’t have autoimmune diseases. But what autoimmune diseases do show up in children?
Dr. Tibisay Villalobos (11:22):
Depending on the age or the timing, on the symptoms, I can give you the example about type 1 diabetes. Also, Crohn’s disease is a disease of the GI system where there’s inflammation of your colon or your intestine because the body produced antibodies that caused that inflammation. There is also juvenile arthritis that may present sometimes just with fever. Fever and rashes, and not necessarily joint pain. There is also multiple sclerosis that happens in adolescents and young adults too. Depending on the symptoms, you can have an idea [of] the organ that is being involved in that.
Anne Baum (12:03):
Thank you so much for that. All right, let’s switch topics and think about our immune system. What can you do to boost your child’s immunity?
Dr. Dominique Bailey (12:14):
Just as we talked about in the beginning of the segment, it’s really important they eat a very varied diet, they get plenty of rest. They have good activity, they have downtime, reduce their stress.
(12:24):
But as far as the diet’s concerned, you want to make sure that they’re eating whole grains, lots of good, lean proteins. Good fats, such as plant-based lipids. And lots of varied fruits and vegetables.
(12:37):
As far as supplements are concerned, we don’t generally recommend them. We’d much rather that they get all their vitamins, their vitamin D, A, and their zinc from whole foods. There’s various, depending on what you’re looking to increase. ... For instance, vitamin D is ubiquitous in many, many foods, but generally your dairy. Zinc, you’re going to find in your lean proteins. Vitamin K in your leafy greens. All those things are so important.
(13:07):
Occasionally, we get kids that are not great eaters. I had a picky eater myself and they’re very frustrating. But what I generally recommend to a parent is, once a week, try something new on their plate.
Anne Baum (13:16):
Great.
Dr. Dominique Bailey (13:17):
But try a very small amount of it. If they eat it, then I ask the parents to reward them. I say give them extra 15 minutes of time, just with one parent or both parents, as opposed to rewarding them with food. If they don’t, just ignore it. But just keep on trying. Often times, just that positive reinforcement they get with the little extra attention from one parent or both parents can make a world of difference, as far as the picky eating is concerned.
(13:45):
You can also hide vegetables in some of the foods. For instance, pancake batter, you can put some pureed butternut squash in it. Some spaghetti sauces, if you can get them to eat that, you can shred some vegetables into that. Then, make it fun. Make the plate look fun for the kids. Decorate a carrot or something like that. …. The kids love to dip. I recommend giving them vegetables that they can dip and other foods that they can dip in.
(14:13):
All that is going to create a wonderful immune system in a child.
Anne Baum (14:18):
That’s great. I love the stealth vegetable idea, baking it into something. I’ve heard a lot about eat the rainbow, getting a lot of color on the plate. You would agree with that?
Dr. Dominique Bailey (14:29):
Absolutely.
Anne Baum (14:30):
That’s wonderful. When you’re thinking of eating and creative eating, you said decorate vegetables, hide them in there, when you have that really stubborn, picky eater. At what point is it a problem, and do you need to reach out for help?
Dr. Dominique Bailey (14:49):
Well, I think if you have a child that only eats five things and they’re all white, which I often see – pizza crust, insides of Oreos, things like that – then we probably should do a battery of blood work to see if there’s any nutritional deficiencies, looking at vitamin levels, and looking at their blood count and everything. Certainly, if that restrictive behavior’s gone on for a period of time, I would say at least three to six months, then I really think we should look into food therapy for the child, and a nutritionist.
Anne Baum (15:18):
Food therapy, tell us more. What does that mean?
Dr. Dominique Bailey (15:23):
Well, that’ll be a therapist; it’s usually an occupational therapist that will introduce different textures to a child. Sometimes, they’ll just have them sniff it to start, and then maybe they can get it close to their mouth. It’s a very slow process, but over the course of months, usually we have some good results with it.
Anne Baum (15:44):
Well, that’s great. I know some kids are really sensitive to texture, just like they might be sensitive to sound. Is texture sometimes one of the reasons an individual is a picky eater?
Dr. Dominique Bailey (15:56):
Yes, absolutely. You even see that in adults, where an adult may not like a pudding because they maybe had a muscle memory as a child like that and they’ll just seem to avoid it. Kids are the same way.
Anne Baum (16:08):
You talked about making a fun plate and the elements that would go on there. What does a good meal look like on that plate?
Dr. Dominique Bailey (16:18):
About 50% of the plate should have fruits and vegetables on it. I don’t get too wound up if the kids don’t eat vegetables. The only thing they’re lacking is the vitamin K from their leafy green vegetables. If they’re fruit-centric and they love berries and grapes and orange segments, that’s what I tell the parents to do. Then, about a quarter of the plate should be their protein and about a quarter, a good carbohydrate. If we can get some whole grains in them, that’d be great. Quinoa, and good wild rice, brown rice, all different things. Or even a mixture, mixing some white rice into it with some brown rice. A little bit at a time.
Anne Baum (16:57):
That’s great. Are there some proteins that are better than others at boosting the immune system? Or is it lean protein across the board?
Dr. Dominique Bailey (17:05):
I would say stick with the healthier meats, which are going to be your lean proteins. I think kids should also have hamburgers and pork chops if they want, and things like that.
Anne Baum (17:14):
What are some guidelines to use in selecting vitamins and prebiotics or probiotics? I know there are a lot of advertisements out there for things. It’s difficult to choose.
Dr. Dominique Bailey (17:25):
It can be very overwhelming for a parent because they’re going to get information from many different sources. Friends, neighbors and obviously the internet and Facebook. I always recommend you stick with a national name-brand formula. I’d look for a good multivitamin, whether it’s liquid or chewable depending on the age group, with some added minerals. Sometimes it’s hard to get that zinc in the kids, and so I’d like to add the added minerals with that.
(17:51):
Otherwise, with the prebiotics and the probiotics, it’s really best to try to get those from a food source. The probiotics coming from cultured foods, like sauerkraut, yogurt, kefir, things like that. Then, the prebiotics from fiber-containing foods, some bananas, plantains, things like that. But otherwise, there are very good supplements for probiotics and prebiotics. There is some evidence that they definitely help to boost the immune system. Of course, having the appropriate vitamin levels is going to do that too.
Anne Baum (18:22):
That’s great. I’m sure your pediatrician can help with that recommendation as well.
Dr. Dominique Bailey (18:27):
Absolutely.
Anne Baum (18:28):
Let’s think a little bit about outdoor play and how that gets into boosting the immune system. We’ve heard about kids playing in the dirt, and that that’s a good thing, a bad thing. Tell us more about that.
Dr. Dominique Bailey (18:44):
I’ll approach it first, and then I’ll let Tibi take over. But years ago, we were an agrarian society so we’ve spent most of our time outdoors and there were a lot less diseases. We had a boosted immune system, I’d say, 100 years ago. Now we spend most of our time indoors, so we’re exposed to a lot of indoor allergens and we have lack of activity too. I think it’s multifactorial.
(19:10):
I think kids playing outside is terrific. Even in the winter, as long as they’re dressed appropriately.
Anne Baum (19:17):
That’s great.
Dr. Tibisay Villalobos (19:18):
Yes, that’s absolutely true. I used to live in the South, where the winters are short and the summers are humid and long, so kids used to play longer in the outside. Then the rural kids, of course they spend more time [outside], compared to the urban kids.
(19:34):
Right about, probably 10, 15 years ago, there was a very good study that came out of the Medical College of Georgia that showed that kids of urban areas and living indoors have less exposure to natural antigens that are in the environment, and therefore they have more asthma, skin allergies and environmental allergies. That exposure to also normal, natural components of the environment may protect you against developing allergies later on in life. It boosts your immune system to play outdoors.
Anne Baum (20:09):
Those little exposures really add up in boosting the immune system?
Dr. Tibisay Villalobos (20:14):
Yes. I do infection diseases, so I know about germs, so then we become germophobes. We clean everything with Lysol and Clorox and sanitizer. Those natural barriers that the body needs to develop to fight the germs are not there, so when they finally encounter them, then they develop, not autoimmune, but an exacerbated reaction to those exposures.
(20:42):
As you gradually introduce the kids to the natural things, yes, play in the dirt. They play barefoot on the backyard, not that I wanted that to happen because of all the issues. But in the healthy way, I know how to protect them. A good dose of outdoor play is advisable to boost the immune system.
Anne Baum (21:05):
Where do we find that balance between keeping our house clean and sanitary, and getting exposed with those little bits of the germs?
Dr. Tibisay Villalobos (21:18):
That applies to everywhere – health care in developing countries, everywhere in the world – the best measure is washing your hands. Hand washing has showed to [prevent] all infectious diseases at all levels. In the health care level, in the staff that work in the medical field. Hand washing before and after play, after coming from outdoors, always keeping that common sense that you also need to shower after you are exposed to the outdoors. All those common-sense things help you to keep the balance about how much exposure.
(21:47):
It’s OK to play in the dirt, just don’t eat the dirt. That’s another issue we can talk about later.
Anne Baum (21:58):
That’s great. How would you like to leave our audience? What are your great pieces of advice about keeping kids healthy and understanding disease as it’s here, present in our community? Especially during the winter, when things really pop up.
Dr. Dominique Bailey (22:18):
Well, I think a lot of it is common sense like we’ve talked about, all the different measures to keep your child, and also being judicious in trying to avoid germs when you can. For instance, we know that big indoor public places are going to be a germ pool. I especially recommend parents with newborns not to take the child out for at least two to three months, at least [not] out into public places. They can go outside; fresh air is great for a baby. The hand washing. I’m just going to reiterate what Dr. Villalobos said, that that’s the No. 1 way to prevent infection in your child.
Anne Baum (22:52):
Right.
Dr. Tibisay Villalobos (22:54):
Also, let’s not forget about the vaccines. The vaccines are also an important way to boost the immune system. We have vaccines that are designed for the infant to protect them against pneumonia, ear infections, blood infections, brain meningitis, that brain infection. Let’s not forget that keeping our kids vaccinated prevents them from having some serious infectious disease. When our kids don’t get vaccinated, then the circulation of those bacteria and viruses increases. Be mindful of that.
(23:23):
I want to remind everybody, we are in the winter of 2024 … and we have an outbreak of pertussis, whooping cough, north of our Valley. We also have a few cases of measles in the Philadelphia area. When we forget about how good the vaccines may be to protect against those, then the diseases start reappearing again. The vaccines, yes they do protect and they boost your immune system. It’s just another tool to keep your kids healthy.
Anne Baum (23:53):
That’s great advice.
Dr. Tibisay Villalobos (23:54):
Additionally, I wanted to mention to the parents that we have many, many children hospitalized with influenza. We haven’t even peaked in our influenza season, that it looks more like a traditional season compared to others, but we have many more cases. The common thing is some of these children seem to be sicker and end up being hospitalized, that not one of them has been vaccinated for the flu this season. It is a reminder that the flu vaccine is not perfect, it’s not going to protect you against getting the flu 100%, but the kids that have gotten the flu vaccine for several seasons do have immunity and it keeps you from getting severe flu and ending up in the hospital. Just a reminder that it’s not too late still to get your flu vaccination this year.
Anne Baum (24:42):
Dominique and Tibi, thank you so much for joining us today. Any final thoughts before we wrap up Episode 2 of Because They’re Kids?
Dr. Dominique Bailey (24:52):
I think we went over tons of information and hopefully it will be very helpful to the local parents. It was such a pleasure to be here. Thank you for having us.
Anne Baum (25:00):
Thank you.
Dr. Tibisay Villalobos (25:01):
Again, thank you, Anne. Thank you, Nikki, for being here with us and letting us share your time, and hopefully we provided some useful advice for you and your family.
Anne Baum (25:10):
Well, there you have it. For more kid-focused health tips, advice and must-know news about Lehigh Valley Reilly Children’s Hospital, follow us on Facebook and Instagram at LVHNChildren. Remember, every parent needs a partner through parenthood, so make sure to subscribe to or follow Because They’re Kids wherever you get your podcasts, so you never miss an episode.
