‘A person’s a person, no matter how small’ Dr. Seuss
As parents what we want more than anything is to have happy and healthy children, not only physically but also psychologically. And, to that end, appreciating the vital role of nutrition, physical activity, and also nurturing of their emotional and cognitive development through education and opportunities. Yet the importance of a child’s health extends beyond these concerns. Children represent the next generation of adults and their combined health and vitality will impact the very nature of our society.
There has been a huge increase in children experiencing difficulties with social, emotional and cognitive development, where one in eight children in England are suffering with at least one mental health disorder. Further statistics from 2017 show rates of mental health issues in children increase with age, as 5.5% of 2-4 year olds experienced mental health issues, compared to nearly 17% of 17-19 year olds.[i]
Children can develop the same mental health conditions as adults, they just express them in different ways. These can include anxiety, attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), mood disorders such as depression, and eating disorders (anorexia nervosa, bulimia nervosa). With children’s mental health week upon us, we want to help you understand what could potentially be contributing to these issues and what you can do to support your children.
WHAT TO LOOK OUT FOR
Often, as children lack the vocabulary or developmental ability to explain what’s on their mind, it can be difficult to differentiate signs of a problem from normal childhood behaviour. Some signs that your child may have a mental health issues include:
Mood changes e.g. persistent feelings of sadness or extreme mood swings.
Intense feelings e.g. overwhelming fear for no reason, often with physical symptoms such as fast heart rate.
Behaviour changes e.g. hyperactivity.
Difficulty concentrating and with imagination and pretend play.
Physical symptoms e.g. headaches, stomach aches.
Physical harm or suicidal thoughts.
Substance abuse e.g. drugs or alcohol to cope with their feelings.
Changes in eating habits e.g. taking food to their room/avoiding eating together.
A fixation around social media and their body image.
FACTORS THAT CAN AFFECT MENTAL HEALTH
Research has shown that certain pre-natal circumstances can influence the foetus towards mental health issues. For example, folic acid, may reduce mental health problems in children,[ii] whilstvitamin D deficiency in the mother has been linked with a reduction in brain development in the newborn,[iii] as well as an increased risk of autism-related traits later on.[iv]
In 2010, Landrigan believed that environmental exposures during pregnancy or in early infant life were a key feature and highlighted the fact that children are exposed to thousands of synthetic chemicals, of which fewer than 20% have been tested for neurodevelopmental toxicity.[v] Environmental factors such as pollution, diet, pesticides, infections, sensory overload and possibly even electromagnetic radiation are now under consideration. These could potentially increase the “body burden” of chemicals.
Good mental health often begins in infancy and research shows a child with a strong connection to the person who cares for them has a lower risk of developing mental health problems.[vi] Additionally, animal research showed that when put in the care of loving mothers, the mice grow up to be better mothers themselves, and this effect is so strong it can even stretch over two generations![vii]
THE DIGESTIVE SYSTEM
With an increasing number of babies being born by caesarian section,[viii] and then going on to use antibiotics throughout their childhood,[ix] there may be a link with the increase in gut disorders in children.[x] We are now aware of a gut-brain connection, where research has shown that changes in the gut microbiome can affect the brain’s physiological, behavioural and cognitive function.[xi] Both C-section births and antibiotic use are often unavoidable, but by supporting our children with a good, gut-supporting diet, as well as suitable probiotics, we can often reduce the risks associated with them.
Children with ASD have a higher rate of gastrointestinal symptoms than children with healthy development.[xii] This could be due to low levels of digestive enzymes and subsequent poor digestion and absorption,[xiii] resulting in low levels of trace minerals, such as zinc and copper, which are important for the central nervous system.[xiv]
Food reactions, are common in children with mental health issues, with one survey finding over 40% of autistic children having food sensitivities.[xv] The most frequently identified intolerances are wheat and milk products,[xvi] which are often associated with intestinal permeability.[xvii].
Elevated blood glucose (from high carbohydrate, high sugar diet) can affect cognitive function, with its cost common manifestations being reduced brain function, attention deficit, and compromised learning and memory.[xviii] So we could infer reducing sugar and refined carbohydrates in the diet could help improve cognitive function.
Inflammation plays an important role in the nervous system when it comes to mental health issues. A promising pilot study provides initial support of a relationship between childhood adversity, oxidative stress and mental health symptom development.[xix] Oxidative stress is an imbalance between free radicals and antioxidants in the body. Therefore, reducing the toxic load and increasing antioxidants can help to reduce oxidative stress and in turn inflammation. Common toxins that can affect the central nervous system include pesticides in food,[xx] air pollution,[xxi] and heavy metals, such as mercury.[xxii]
Neurotransmitters are chemical messengers used by the nervous system to transmit messages, and when sometimes they are disrupted this can lead to problems such as depression and anxiety. There are a number of neurotransmitters that exist in the brain, however, the most recognised and researched include serotonin, dopamine and GABA (gamma-Aminobutyric acid). For example, ADHD is associated with dopamine interruptions,[xxiii] and often presents with aggression and sleep disturbances.
One factor that can affect the regulation of dopamine in children is the increased use of technology, and specifically video games, as they can increase dopamine seeking behaviour and sometimes become addictive. Excessive gaming can also impair cognitive control, have a negative effect on sleep and schoolwork, and research has shown persistent online game use from childhood could exacerbate atypical brain function.[xxiv] On the other hand, traditional play with both peers and parents can enhance brain structure and function, and can also help to regulate the body’s stress response.[xxv] Further research has shown that conversation raises oxytocin (the bonding hormone), whereas texting can increase cortisol (the stress hormone).[xxvi] In today’s society, the use of technology is unavoidable and if used in moderation, can also be beneficial. For example, using well-designed educational apps, in the presence of an adult, can be used to reinforce what children are learning at school.[xxvii]
Serotonin is often referred to as the happy hormone, and so can have a direct impact on a child’s mood. Tryptophan is the amino acid needed to produce serotonin. Meals exclusively of carbohydrate increase the availability of tryptophan and hence increase serotonin production in the brain. In many individuals, poor mood stimulates the eating of palatable high carbohydrate/high fat foods that stimulate the release of endorphins. This will follow with a rapid blood glucose dip which has been linked to irritability.[xxviii]
Omega-3 research demonstrates that a deficiency of a specific fatty acid (DHA - docosahexaenoic acid) correlates with altered learning, and deficient neurotransmitters, which can affect memory and cognition.[xxix] Omega-3 deficiency may also contribute to ADHD, dyslexia(specific reading difficulties), dyspraxia, and ASD.[xxx],[xxxi]
SUPPORTING CHILDREN WITH MENTAL HEALTH ISSUES
To prevent the possibility of mental health issues, optimise maternal folate and vitamin D levels, and ensure adequate omega-3 in diet - either through food or supplementation.
Optimise digestion - L-glutamine to support the gut wall and reduce inflammation,[xxxii] and probiotics, especiallyLactobacillus rhamnosus, which may help with GABA[xxxiii], [xxxiv] production, supporting relaxation and stress reduction.[xxxv]
Omega-3 supplementation has been shown to reduce hyperactivity in ASD.[xxxvi],[xxxvii] Good food sources include eggs, mackerel, salmon, flax seeds, chia seeds and walnuts.
Having vitamin D levels checked every six months and supplementing accordingly, if possible with an emulsified form to help with absorption.
B vitamins and zinc - for nervous system support, combined with magnesium can improve social interaction and language skills. [xxxviii]
Eating small regular meals, reducing refined carbohydrates and sugar, and eating meals including high quality protein can help to regulate blood glucose levels.
Encouraging traditional play and reducing use of technology.
Talking therapies or counselling can help children work through their feelings and emotions. It may be useful to participate in family sessions or find local support groups. It can often be hard to find a practitioner you feel comfortable with, so it could be worth looking at a service that helps you find a suitable practitioner for children such as Therapease: https://www.therapease.co.uk/
Children’s mental health is a complex issue, however, we hope that this gives you some insight into some potential causes and empowers you to support your children through and seek the assistance of a health professional, such as the GP, when necessary. If you would like further information or some tailored advice, please do not hesitate to contact our Clinical Nutrition Team on 0121 433 8702 or firstname.lastname@example.org.
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[ii] Roza SJ et al. Maternal folic acid supplement use in early pregnancy and child behavioural problems: The Generation R Study. Br J Nutr. 2010; 103(3): 445-52
[iii] McGrath JJ et al. Vitamin D3-implications for brain development J Steroid Biochem Mol Biol. 2004; 89-90(1-5):557-60.
[iv] Vinkhuyzen AAE et al. Gestational vitamin D deficiency and autism-related traits: the Generation R study. Mol Psychiatry. 2018; 23(2): 240-246
[v] Landrigan PJ What causes autism? Exploring the environmental contribution. Curr Opin Pediatr 2010; 22(2):219-25
[vi] Winston R and Chicot R. The importance of early bonding on the long-term mental health and resilience of children. London J Prim Care (Abingdon) 2016; 8(1): 12-14
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[viii] Wise J. Alarming global rise in caesarean births, figures show. BMJ. 2018; 363
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[xi] Wang HX and Wang YP. Gut Microbiota-brain Axis. Chin Med J (Eng). 2016; 129(19): 2373-80
[xii] Valicenti-McDermott M et al. Frequency of gastrointestinal symptoms in children with autism spectrum disorders and association with family history of autoimmune disease. J Dev Behav Pediatr. 2006; 27(2 suppl): S128-36.
[xiii] Horvath K et al Gastrointestinal abnormalities in children with autistic disorder. J Pediatr 1999; 135(5):559-563
[xiv] Damodaran M and Geetha A. Level of Trace Elements (Copper, Zinc, Magnesium and Selenium) and Toxic Elements (Lead and Mercury) in the Hair and Nail of Children with Autism. Biology Trace Elem Res 2011; 142: 148-158
[xvi] Lightdale JR et al. Effects of intravenous secretin on language and behavior of children with autism and gastrointestinal symptoms: a single-blinded, open-label pilot study. Pediatrics 2001;108:90.
[xvii] de Magistris L et al. Alterations in the intestinal barrier in patients with autism spectrum disorders and in their first-degree relatives. J Paediatr Gastroenterol Nutr. 2010; 51(4):418-24
[xviii] Razzak RA et al. High normal blood glucose levels may be associated with decreased spatial perception in young healthy adults. PLoS One. 2018; 13(6): e01999051
[xix] Horn SR et al. Childhood adversity, mental health and oxidative stress: A pilot study. PLoS One. 2019; 14(4): e0215085
[xx] Keifer MC and Firestone J. Neurotoxicity of pesticides. J Agromedicine. 2007; 12(1): 17-25
[xxi] Babadjouni RM et al. Clinical effects of air pollution on the central nervous system; a review. J Clin Neurosci. 2017; 43:16-24
[xxii] Bose-O’Reilly S et al. Mercury Exposure and Children’s Health. Curr Probl Pediatr Adolesc Health Care. 2010; 40(8): 186-215
[xxiii] Sharma A and Couture J. A review of the pathophysiology, etiology and treatment of attention-deficit hyperactivity disorder (ADHD). Ann Pharmacother. 2014; 48(2): 209-25
[xxiv] Sugaya N et al. Bio-psychosocial factors of children and adolescents with internet gaming disorder: a systematic review. Biopsychosoc Med. 2019; 13:3
[xxv] Yogman M et al. The Power of Play: A Pediatric Role in Enhancing Development in Young Children. Pediatrics. 2018; 142(3): e20182058
[xxvi] Seltzer LJ et al. Instant messages vs speech: hormones and why we still need to hear each other. Evol Hum Behav. 2012; 33(1):42-45
[xxvii] Bozzola E at al. Media devices in pre-school children: the recommendations of the Italian pediatric society. Ital J Pediatr. 2018; 44(1):69
[xxviii] Benton D. Carbohydrate ingestion, blood glucose and mood. Neurosci Biobehav Rev. 2002; 26(3): 293-308
[xxix] Sinclair AJ. Docosahexaenoic acid and the brain – what is its role? Asia Pac J Clin Nutr. 2019; 28(4): 675-688
[xxx] Antalis CJ et al. Omega-3 fatty acid status in attention-deficit/hyperactivity disorder. Prostaglandins Leukot Essent Fatty Acids. 2006; 75: 299–308.
[xxxi] McNamara RK and Carlson SE. Role of omega-3 fatty acids in brain development and function: potential implications for the pathogenesis and prevention of psychopathology. Prostaglandins Leukot Essent Fatty Acids. 2006;75:329–349
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[xxxiii] Barrett E et al. γ-Aminobutyric acid production by culturable bacteria from the human intestine. J Appl Microbiol. 2012; 113 (2): 411-417.
[xxxiv] Shan Y et al. Evaluation of improved γ-aminobutyric acid production in yoghurt using Lactobacillus plantarum NDC75017. J Dairy Sci. 2015; 98 (4): 2138-2149.
[xxxv] Bravo J.A et al. Ingestion of Lactobacillus strain regulates emotional behavior and central GABA receptor expression in a mouse via the vagus nerve. PNAS. 2011; 108 (38): 16050-16055.
[xxxvi]Amminger G et al. Omega-3 Fatty Acids Supplementation in Children with Autism: A Double-blind Randomized, Placebo-controlled Pilot Study. Biological Psychiatry. 2007; 61: 551-553
[xxxvii] Bent S et al. A Pilot Randomized Controlled Trial of Omega-3 Fatty Acids for Autism Spectrum Disorder, Journal of Autism 2010; 41:545-554
[xxxviii] Mousain-Bosc M et al. Improvement of neurobehavioral disorders in children supplemented with magnesium-vitamin B6 II. Pervasive developmental disorder-autism. Magnesium Research 2006; 19 (1): 53-62
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