Stress and addiction in young minds

Chronically ills kids seem to be the new normal, said Elizabeth Mumper, MD, at the 2019 Institute for Functional Medicine Annual International Conference in San Antonio, Texas.

Pediatric medicine has shifted from acute to chronic care, with conditions like asthma, allergies, diabetes, autism, seizures, obesity, anxiety and depression, pain, opioid misuse, and alcohol abuse becoming more common. Instances of child abuse and gun violence are also on the rise.

In the past 20 years, opioid misuse has reached epidemic proportions across all demographics. Children and teenagers who experience pain, stress, or trauma may turn to opioids as an escape.

We need to address this, Mumper said, and create policies that prevent and allow children to remain with their families during treatment; give providers tools to recognize, treat, and support children and their parents affects by trauma to lessen the lifelong impact and promote healthy families, and ensure families have real and timely access to services through Medicaid and other prevention and treatment programs.

It’s all about balance, Mumper said, balancing neurotransmitters including dopamine, norepinephrine, and serotonin. If any are dysregulated, imbalances occur, but we can effectively help children regulate these neurotransmitters, she said.  

Practitioners treating pain must understand central sensitization as an underlying mechanism that promotes chronic pain, Mumper said. They must expand use of nutrients that reduce inflammation and incorporate integrative and functional care modalities that have centrally acting effects.

Trauma is another major cause of pain, stress, and addiction in children. The brain is not structurally complete at birth. Myelination, proliferation of synaptic connections, and development of glial and circulatory support systems all continue long after a child has entered the world. Nature gives children a chance to adapt to the specific needs presented by the environment into which they have been born. Opportunities for optimal development include:  

• Adequate nutrition
• Avoidance of toxins such as lead, mercury, and alcohol
• Nurturing, loving, and stimulating environment
• Caregivers present, attentive, and consistent

The more emotionally charged a learning situation is, the more likely it is to result in long-term modifications, Mumper said. Gene expression determines neuroendocrine structure and is strongly influenced by experience and environment.

Promoting resiliency in children is also important. Factors positively relating to fostering resilience include cognitive capacity, health attachment relationships, motivation and ability to learn and engage with supportive environments, and the ability to regulate emotions and behaviors.

"It's not about genes determining your destiny," Mumper said. "It's about turning the right ones on and off at the appropriate times." 

What can we do to encourage the patient to change? Mumper looks at the functional medicine matrix and plots out modifiable personal lifestyle factors:

• Sleep and relaxation: Detoxification and daytime behavior
• Exercise and movement: Antidepressant qualities
• Nutrition: Specific nutrients have impacts on certain behaviors, including magnesium and zinc
• Stress: Children are particularly amenable to mind-body interventions
• Relationships: Never underestimate the power of a supportive adult who believes in the child

Nutrition therapy in particular has been shown to decrease violent behavior, Mumper said. She also encourages practitioners to ensure patients are getting the recommended amount of sleep, plenty of exercise and play, and manage stress.

Modalities for use in pediatric patients, Mumper said, may include both self-regulation practices, such as  routines (for meals, sleep, exercise, activities), positive self-talk, journaling, humor, taking a break, and talking to someone the child trusts; and mind-body techniques, such as progressive relaxation and body scan, meditation, biofeedback, cognitive behavioral therapy, autogenics, self-hypnosis, guided imagery, and yoga and tai chi. 

"We can't get ourselves out of this horrible situation of chronic pain, stress, and addiction using the same kind of thinking that led us to be here," Mumper said. "We need to focus on factors that support human health and reframe how we treat work with patients." 

Editor’s note: This article is part of Integrative Practitioner’s live coverage of the 2019 Institute for Functional Medicine Annual International Conference. For a full list of coverage, click here.