See why practitioners are choosing Designs for Health, the trusted practitioner brand for innovative products and education. Learn More

susan hunter

Navigating Children’s Mental Health Disorders

Over the past few years, we have seen a significant increase in mental health conditions in the adult population and particularly in children.

Joining us today is Susan Hunter, a clinical naturopath. Who will be discussing how clinicians can navigate the management of children’s mental disorders.

About Susan:
Susan is a naturopath passionate about educating and empowering others to feel their best. Susan is a double-degree qualified clinician that enjoys treating functional gut problems, mental health conditions and hormonal disorders.

Susan is a published academic writer and lecturer to integrative doctors and allied health professionals. She has helped thousands of people by bringing care, structure and commitment to her work with them to help them achieve transformative results. Her mission is simple. Help people be happier and healthier by using individualised, evidence-based medicine.

Susan is also the founder and director of Radius Health, a Wellness Medicine clinic located in inner Melbourne. It is a patient-centred practice where our focus is to ensure every client is seen, heard and helped. At Radius Health, we are passionate about educating
and empowering you to make informed decisions about
your health and wellbeing.

Connect with Susan:
Website
:www.susanhunter.com.au/
Email: 
Susan@susanhunter.com.au

Transcript

Introduction

Andrew: This is “Wellness by Designs,” and I’m your host, Andrew Whitfield-Cook. Joining us today is Susan Hunter, a clinical naturopath. And today, we’ll be discussing navigating children’s mental disorders. Welcome to “Wellness by Designs,” Susan, how are you doing?

Susan: I’m really well. Thank you. Thanks for having me.

Andrew: It’s our pleasure. It’s a bit of in our honour, actually. Now, of course, tell us a little bit about your history because you come from a deep science background, right?

Susan: Yeah. So, look, I’ve originally studied to become a psychologist. That didn’t work out so well when I got to the statistics part of the degree. But yeah, I definitely did my undergrad in psychology and also studied and majored in health sociology. So I really had an interest in human psych and human wellbeing. And it was something that needed to kind of run its course, and I needed some time away after that degree to work out what I really wanted to do, and then resumed study a few years later after travelling, and did my Bachelor of Health Science in Naturopathy.

Andrew: Tell us a little bit about that journey. Because, I mean, it’s really interesting to me. You and I were discussing this a little while ago. You come from this hardcore science, investigational study. And then you went over to Southeast Asia, is that right? Or Tibet?

Susan: Yeah. So, it was the other way around. What had happened, well, I guess, you know, yes, I’ve done that arts degree with the psych and the science. But I went off and travelled through Southeast Asia and landed there for a while, and sort of explored more of the esoteric elements around wellbeing and really took an open mind. And I think when you’re in your 20s, you tend to be more open to all sorts of things. So I spent a bit of time, sort of, exploring different kinds of paradigms, like, you know, ayurvedic medicine, looking into, you know, things like the Yi Jing, and Buddhism. And, you know, it was all around balancing my chakra. Just loved the idea of kinesiology. And even became a vegetarian for a while. And I remember coming back to Melbourne and my grandfather just saying, “No child of ours is gonna be a vegetarian.” We ate meat. And also was wondering, “How can I bring all of this beautiful information and ways of living back and incorporate that into a career of sorts?” And so, I went off to, I think it was the Australian College of Natural Medicine at the time in Melbourne and did their history and philosophy of natural medicine subject, but also did an anatomy and physiology subject to kind of balance things out by doing a bit of the biomedical stuff, but also learning about the history of natural medicine. And I felt like, yeah, I loved both elements, and signed up and just did the degree pretty much full time for four years.

Andrew: But that was pretty open of you to want to come back and share, you know, what is such a rich, ancient culture, and try and incorporate that into the science that you’ve learned. So, I mean, it’s a pretty interesting meeting of the ways. I’ve got to say, you know, you say, “In our 20s, most of us are open.” Well, I wasn’t. I was really judgmental and quite rigid and searching for me and all that sort of thing. So I’m quite impressed by this openness that you have towards, you know, embracing other aspects, other viewpoints.

Susan: Yeah, I think I still try and do that now. And I think it helps us just be better human beings by evolving and being open to everything that’s new. And it just means you add to the knowledge base that you have, as you explore and read and experience more. So as a clinician now, I’d like to think that I do, you know, bring a sense of, you know, being holistic in the way that I approach my clients. And often I will refer to, you know, various mind-body therapists to assist them. But also, really, work very much in an evidence-based and reliance on the nutritional biochemistry to help people get back to balance.

Andrew: Right. Okay. So look, let’s get into the subject matter, kids. Now, just how big an issue are we talking about here, especially in this new COVID era that we now live in?

Susan: Yeah, it’s a great question. I think we knew, before COVID, that we had a big problem when it came to pediatric mental health.

The Australian Child and Adolescents Survey of Mental Health and Wellbeing, this is back in 2014, had found one in seven or 13.9% of children, aged 4 to 17, had a mental disorder. And ADHD was the most common, followed by anxiety disorders, and then major depressive disorder. So we know that half of all mental disorders begin before the age of 14, and 1 in 10 people aged 12 to 17 in Australia we’re self-harming. And the really alarming thing is, suicide is the biggest killer of young people. So we knew we already had an issue.

And then, excuse me, as we know, the data is coming in pretty thick and fast about COVID and everything that comes with it. We know just this last month, you know, calls to Kids HelpLine have risen by 30% in Victoria, in the first six months of 2021, compared to the first six months of 2020, where we already were in pandemic. And then they’ve also increased by 14%, in New South Wales, with their latest lockdown. So, you know, we also know that Beyond Blue is stretched. They’re seeing a 29% increase in families reaching out for mental health support.

As each lockdown gets announced, we are seeing a really big decline in kids’ mental health around anxiety, depression, stress tolerance, and behaviour. And there’s been this really cool joint project that’s been done by the Queensland Center for Perinatal Infant Mental Health, along with Griffith University, the University of Queensland, the University of Southern Queensland, and the University of Melbourne. And what they’re finding is, as an example, that there was a 28% further decline in kids’ mental health between the first and the second lockdown in Victoria. So we’re up to lock-down 6 now, and I just really struggle to think about where kids are at. I know I’m seeing the cracks are definitely starting to show in my children who have been very resilient throughout this.

Andrew: You know, the worrying part of that statistic or those statistics that you spoke about, 30% increase, is that they’re the reported ones. What about the unreported ones? But what interests me, though, is that you say most of those kids, one in seven, 4 to 17 years with ADHD, that’s something that may or may not be maybe exacerbated by COVID lockdowns, but may not be initiated by it. But the second and third one, is anxiety and major depressive disorder. And this is something that befuddles me. As a kid, my growing up was, you know, and we weren’t rich, we were quite lower class sort of thing, you know, and we didn’t have a care in the world. So what is it that is causing, and I know this is a really big, onion-layer question, but what do you think is one of the major causes of kids’ mental capabilities today? Are we losing resilience?

Susan: Yeah, I love the word resilience as a term to sort of describe whether kids are, you know, mentally buoyant or not. We live in a very different time. Like, I just know, there’s no way I can ever draw comparisons and talk about how I walked five miles to school, back and forth, there and back, and all that sort of stuff. It just doesn’t compare. We live in a completely different time. So, yes, you know, we’ve got the internet and we’ve got, you know, issues around device time. We’ve got a world where we have ultra-processed foods. You know, basically, the majority of the supermarket shelves are packed with them. But, you know, when I’m looking from, as a clinician, looking at a child that’s presenting to me with, you know, very serious agoraphobia or self-harm or, you know, serious self-esteem issues, there’s a whole lot of modifiable risk that could be at play. And we know that can be epigenetics, that can be the toxin load they carry because we live in a, you know, the chemical world now. It can be digestive imbalances. So we’re looking at things like malabsorption and dysbiosis. We’re also looking at the, you know, the way that the psychiatry community look at this, which is that neurotransmitter deficiency, or sometimes excess. But it can also be things like histamine intolerance, or glutamate intolerance, or hormonal imbalances, or pyrrole disorder, you know, nutritional deficiencies, or excesses, or even just dysglycemia. So they all need to be explored. And you end up working out what flavour of mental disorder a child has. Sometimes it’s just one of those things. Sometimes it’s a combination of all of those things, and they need to be investigated thoroughly in order to know how to help them.

Andrew: Right. But you spoke about modifiable factors. And yet a lot of the… I mean, talking about the aspects that you mentioned, we’re unravelling… It’s not just an onion. I mean, this is more than chicken, egg. This is a beast in itself, isn’t it? It’s huge. Like, this is massive.

Susan: Yeah. Yeah, it definitely can be. And I just know, from my own personal experience of helping one of my children navigate anxiety and, you know, suicidal ideation at the age of eight, that there were lots of contributing factors because it took lots of contributing solutions to get my son well. So, yeah, you can’t just really be thinking, “Oh, you know, this person’s anxious, let’s just work on GABA and put in some B6 and some magnesium and glutamine and hope that we’re gonna help the body kind of, you know, get back to balance.” It just doesn’t work that way. Rarely does it work that way. Maybe years ago, but I just find, you know, the more I’ve practiced over the last 15 years, the more complicated the clinical picture tends to be. And there are lots of layers of an onion that you’re often, kind of, peeling back to get to really understanding what is driving this kind of presentation.

Andrew: Right. And, of course, one of those layers has got to do with the family unit. And then you’ve got the psychosocial, the peer group. So there’s…it’s such an important aspect of a child’s life, which one of those is missing at the moment, in COVID lockdown, both in the Victoria and New South Wales.

So, let’s first talk about the family unit. Like, how do you delve into that? I mean, that must be sometimes very prickly.

Susan: I think in COVID, it’s really difficult, because, you know, sometimes people don’t feel safe in their own home, and they don’t feel like home is truly home, just based on the dynamic of how things are set up, the relationships they have with their parents. And in that instance, it’s really difficult. And what I know is psychological services in Victoria are so stretched that psychologists are asking people to tap into psychology services interstate because we can telehealth now. And I think that’s a really good thing for all naturopaths, and nutritionists to be doing, is to be ensuring that that piece of the puzzle is always in place and that people are able to reach out and get psychological support.

So, that goes beyond, you know, the scope of what we can help with, but definitely needs to be addressed. So, I’m all about the shared care model and ensuring your GP is on board to give you that mental health care plan. Then you’ve got the psychologist who’s also, you know, communicating with you as a clinician, so you both know what you’re working on. And that way, we can help people get the best result. I love the work of Dan Siegel with “The Whole-Brain Child.” So often I’m, you know, getting parents, if they can’t really tap into psychological services right now, to be trying to use very conscious parenting strategies, and helping their children understand their own feelings. And when they feel like, you know, they’ve kind of like, I talk about this concept of the brain kind of flipping its lid and then feeling out of control. And then always talking about the lifestyle factors that you can introduce like meditations. And I know, whenever my son’s saying, “Mom, I need a meditation to fall asleep,” that he’s a little bit kind of fragile. So they’re really good clues that might need a little bit of extra TLC at this time.

Andrew: Okay. So talking about that starting off a process of helping somebody to reduce their anxiety, some people go for CBT, meditation, whatever, we’re talking about a vagal response here. And part of that vagal response has got to do with digestion. So, this is part of this unravelling of the beast. Where do you start along this way? Do you have to get a quick win with, you know, let’s get some meditation in or some…forgive me, there’s eye movement exercises that you can do, all sorts of things? How do you get that quick win for the child so that the child trusts you and gives the parent some reprieve from their anxiety caring for their child?

Susan: Yeah, it’s a great question. I think, you know, in the initial stages, where you’re really trying to build rapport and educate parents around how, you know, the investigation element of what’s going on is important, this is gonna take time, you still wanna give some symptom relief. And I find, you know, quite often, we can come in with amino acids like L-theanine or taurine. You know, sometimes we want to look at tryptophan. Just depends on, you know, what that clinical picture looks like. But just starting to work around balancing the biochemistry of neurotransmitters can help kids feel better. And when I think, we can’t forget magnesium either. And often, you know, magnesium glycinate can be a really good way. Or using glycine with magnesium citrate or magnesium threonate really do help kids just get better sleep onset or feel, you know, less anxious, as you know, or as frequently or, you know, reducing the intensity of that anxiety for them so they’re sort of, you know, a little bit more back in their bodies. And sometimes, like, a modality that I love referring for where you don’t have to ingest or take anything, because sometimes you’ve got kids with sensory issues, so compliance is something to navigate. Sometimes just referring to a really great cranial osteopath can just help them, you know, get that nervous system unwinding a little bit and just, you know, help them feel like there is the possibility of overcoming this and feeling better.

Andrew: Right. You know, one thing that interests me about the different forms of magnesium is nobody ever taught me about ligands, and the various ligands and how they work in college. That was all up to commercial interests to teach us that. One thing that interests me is that it’s only recently that we’ve seen this form of magnesium in Australia, let’s say over the last two years, and that’s magnesium glycerophosphate. When I first saw it, I was reminded of my time consulting in pharmacy, where there was this really, really old, it was almost like a galenical product. And it was glycerophosphates, and it was isotonic for children. And it really interests me that it was cemented in my mind, though, when Mike Ash and Garth Nicolson did their work on the gut. And I was thinking, “Ah, we think it’s going to the brain, but this is actually helping the gut, which helps the brain.” So it’s just really interesting how these forms work and how… Yeah.

Susan: Yeah, it’s all interesting. I just know in my son because it’s, obviously, it’s like for Henry, there’s definitely like a gut-brain axis connection. And yeah, you were talking about vagal innovation being a part of this. Whenever he feels anxious, it’ll go to his tummy, and whenever it goes to his tummy, he just wants an Epsom salt bath. And that’s so interesting that you say that. That’s just anecdotal, obviously. But yeah, and he’s not the first client. Like I’ve got a few little boys who are a bit the same and so, they might kind of get into a habit of needing a bath a few times a week. But when you throw those Epsom salts in, like, you are getting another little magnesium heat that must be helping them feel better because they crave it.

Andrew: So is it these quick wins that enabled you to get the, not just the child’s trust, but the parent’s trust in repeat business, if you want it to be pragmatic or mercenary, but repeat trust so that you are now engaged with the therapy of the child, the ongoing therapy of the child with the…it’s not permission, it’s more than that. It’s the acceptance of the parent. You know, the working with is the word I wanted to use.

Susan: Yeah. If you’ve had families come to you that have never really experienced work with a naturopath, there often is this kind of expectation around there being a magic bullet, right? So, you know, we see that with pharmaceuticals. And our process is very different. You know, my process, particularly at the outset, is all about exploration through very thorough investigations. So if we can get a blood draw with a child, that’s a bonus, but quite often it’s urine, hair, stool that we’re using with functional labs to explore various elements of health, to work out what those contributing factors to their mental health picture are. And I just need parents to feel like, while we’re exploring that, we are seeing some improvement in their picture. And it does take the load off, so parents don’t feel worn down. Because it can be very difficult to feel like a present and calm parent when this has been wearing you down. It affects the family environment in a big way, in a negative way quite often. And we just want to get that quick win, not just to get them to come back, but to make their day-to-day experience a lot easier.

Andrew: I know this is a bit of a deflection on to the parent as well, but do you find that when you’re treating the child, that you have to treat the parent as well because they’re at the end of their tether and potentially, you know, their stresses are mirrored by the child to some degree? There’s a second part of this question as well, and that’s to do with siblings. Do you involve siblings in this, so that there’s no antagonism between the siblings or they’re getting all the attention because they’re sick? I can remember thinking this of my brother.

Susan: Yeah, that’s really big. Look, I write… I’ve written in the past a lot around this concept of radical self-care because women tend to really show off their own well-being and put their kids first. There’s that whole element of, you know, the burnt chop syndrome, where you end up being the one that’s eating the chop that no one else wants to eat because you overcooked it. But really, for me, I find women only really or mothers, and they’re predominantly the people I see that are reaching out to help their children, they struggle to put themselves at the front of the line and to understand that they’ve got to be well in order for their kids to be well.

So I do have those conversations with them. But quite often, they’re not ready, and they will often, you know, sort of put their child as the priority. And it can feel really overwhelming often to try and work on two people’s health at the same time. So quite often, sort of get their kid on track, and then I’ll sort of shift my focus and talk to, “Will, hey, you’re pretty stressed and, you know, you’re obviously not, you know, eating lunch, and you’re not really looking after yourself. You’re not getting out and exercising.” So there is some of that, that we’ll start, you know, talking about to help them look after themselves. And then when it comes to siblings, I do like to understand the dynamic, to understand the stresses that are being experienced across the family unit. But yeah, you do end up treating whole families over time.

Andrew: I just wanna temper something I said. I said about my brother and my jealousy sort of thing. And all he had was his tonsils out. And I was jealous that he got to eat jelly.

Susan: And ice cream.

Andrew: I mean, it was so, so selfish of me and so, so trivial. But anyway, sorry, Dave. So, let’s get further into treatment. You mentioned a few things. The magnesium. You said theanine. What about other neurotransmitter precursors? Do you ever use those? And how do you actually get the child to take these?

Susan: Yeah. So we do a lot of our own compounding in the clinic of amino acids. So, I love really working on identifying the biochemical pathways I think needs support. So, often it will be that combination of either identifying if a child is a high or a low-dopamine child. And if we can do genetic profiling, that’s really, really helpful to understand how those neurotransmitters are probably behaving, but also asking the right questions to identify where they sit on the spectrum of deficiencies or excesses with neurotransmitters. So, yeah, the GABAergic pathway, like we’re using herbs as well. So sometimes you just wanna be doing a little bit of Valerian or working with kava, where you see it kind of fits the picture. But yeah, you know, tyrosine as a cofactor for dopamine production, exploring what thyroid function looks like because that can have a huge impact on mood.

But it just depends on the flavour of whether we think this is predominantly, you know, neurotransmitters out of balance, but sometimes you’ve got to kind of track back and go, “Well, why?” You know, they might have methylation issues, and that’s impacting their ability to produce, release, and break down their neurotransmitters, and you’ve got to work on that. But then I know, from clinical experience, just focusing on methylation and knowing that sometimes in order to be able to positively impact and balance methylation, you’ve got to be working on underlying gut problems, or underlying heavy metal toxicity in order for, you know, your methyl donors to do their work and to really assist the child in feeling more balanced mentally and emotionally.

So, it’s a bit like a ball of wool sometimes. You feel like you’re sort of untangling and kind of pulling it out and going, “Oh, okay, this is what is going on.” And it can be very multifactorial. But I think in the initial stages, working to balance neurotransmitter production and addressing nutritional deficiencies, you tend to see an improvement, while you do the underlying corrective work in the background to eventually have them, you know, right on top of things and back in balance.

Andrew: How much do you focus on nutrient deficiencies? And how much do you focus on food as like a, you know, treatment?

Susan: Yeah, good question. Yeah. I think the majority of the time, and a lot of other practitioners probably find this as well, what I tend to see is, you know, really pronounced zinc deficiency in patients. So, with that, just being zinc deficient in and of itself, you’re gonna see a child with a narrow palate, you’re going to see, you know, really picky eating kind of, you know, presentation as well. And so, I find that by just working on topping up their zinc levels over two or three months, we start to see this kind of openness to bringing in new foods. So I’m all about keeping presenting the foods that they’ve rejected, keep putting it on the plate, don’t make a big deal out of it, and eventually, they will eat the broccoli. Might take six months. Sometimes, took one of my kids 12 months, but now they’re, you know, great at eating broccoli. So, I think zinc tends to be one of those key minerals that kids, you know, time and time again present with deficiency for that. So I’m routinely testing plasma zinc and total vitamin B12.

Susan: Iron studies and looking at their folate levels to get a sense of where they’re sitting with those, and then when it comes to diet, working within the parameters of what works in that family. So, some kids are just not gonna drink a green smoothie to get, you know, active folate from those uncool leafy greens, but other kids might.

So, I have to maybe sometimes create a blueberry smoothie and put some spinach or some silverbeet into that in order to let the purple of the blueberry kind of hide it and get it in there, so we can be a bit sneaky. But sometimes we are solely relying on supplements in order to kind of open up the picture so those kids can be more receptive to eating more whole foods in their diet.

Andrew: This is very interesting because that’s kinda like comparing and contrasting the work of Julia Rutledge in Massey University in New Zealand. So, this is Professor Julia Rutledge versus Professor Felice Jacka. So, Julia Rutledge used a multivitamin to help with mood in ADHD kids, I think it was, and Felice Jacka talks about the mood…and forgive me, she’s got a centre. I’ve forgotten the name for it.

Susan: The Food & Mood Centre. Yeah. Deakin.

Andrew: Thank you. Yeah.

Andrew: She concentrates on diet. Now, that’s a really interesting contrast there. But I guess there comes a point where to get that quick win you have to intercede with something while you’re working on changing a diet. So, is that how you work, you use supplements in the initial stage while you’re retraining?

Susan: Absolutely.

Andrew: Gotcha.

Susan: Yeah. I think because we kind of work in the natural health space, and are so acutely aware around diet quality, and what good quality looks like to us, it’s a bit of a no-brainer, but I think we’ve just got to kind of meet our clients where they are and just be that step ahead, or just above.

So, when we’re providing recommendations around what they should be focusing on eating, you can’t expect someone who’s been eating Cocoa Puffs every morning for the last five years to stretch into, you know, creating this beautiful high protein, healthy fat, you know, egg, avocado sort of frittata thing for breakfast, like, it’s just too big a stretch.

So for me, it might be, “Well, let’s explore a smoothie, and let’s have a look at how we can maybe add a little bit of really clean protein powder into that. And what flavours does that child like?” So, I think it’s really important to meet people where they’re at and make it accessible, and then build from there.

Andrew: Yeah. A salient piece of…or a lesson that I learned was to try and get away from bread. And I’m not totally successful with it. Okay. But to try and get away from bread. My morning breakfast was instead of having, you know, scrambled eggs on toast, I’d make an omelette with mashes with tomatoes with spinach.

That made me so damn full. I couldn’t even eat. I couldn’t even look at it. It was just pushed to the side. It was a really interesting mind flip, though, that I’d still cook the toast for a while until I just realized I don’t need the toast. I just need the food…

Susan: That’s funny.

Andrew: …and not the eggs.

Susan: Yeah. But it’s amazing, like, once you have…and this is the thing, right? Like, getting people to experience something new, and then the benefit of that, like, I know when I flipped from eating porridge for breakfast and feeling, like, really hungry an hour later to having, you know, eggs with lots of veggies beside it and not needing a single thing till lunch, that, for me, was, like, a game-changer around regulating my blood sugars, my energy. My mood was so much better by doing a high protein, healthy-fat brekkie.

Andrew: Oh, God, I’m just salivating now about the mashes I cook. And the trick, for me, as a bloke was to make it all in one fry pan. No other pots and pans. It was the washing up that was the limiting factor. I thought it was funny. So, you mentioned methylation issues before.

And I’ve heard that if you give some people MTHF that it can actually flip and make them more anxious. How do you navigate this? Because that would take away that quick win. How do you sort of intercede with something like the active folates when we’ve got this issue that you might get a negative side effect from it?

Susan: Yeah. That’s a really good question. I think having a genetic profile in front of you gives you a bit more information around whether someone’s going to be a, you know, tetra methyltetrahydrofolate candidate, and that I have seen people really respond quite poorly to some of the methyl donor formulas that are out there. So, it’s really rare that I bring in methyl folate as a supplement, particularly in children, I don’t find I need it.

And I know that in that instance, you can do a food-as-medicine approach. You know, get them trying to do uncooked leafy greens, whether that’s salad or smoothie if they tolerate it, or even, you know, having oranges, like, looking at other high folate foods.

And starting with that, and starting with some…like, methylcobalamin or hydroxocobalamin as another way to support the methylation pathway tends to work really quite safely as a starting point. And then just ensuring that, you know, you get a sense of what needs support in the folate cycle and the methylation cycle.

And then being a bit more targeted around nutrient cofactors support, but I tend to steer away from methyl-folate. I just find people can aggravate, and the last thing I want is clients aggravating because they’re…no one wants to experience that. I’ve done that to myself in the past, and it doesn’t feel very good.

Andrew: Okay. So, of course, part of this treatment strategy is forming treatment goals. And indeed, in some cases, when you’ve got resistant patients, particularly, those who are, you know, brought up on the white diet, you know, the white bread, the white this, the white…all ultra-processed food is to make contracts. How do you navigate treatment goals and contracts so that you end up getting the best results and pulling them along the way, willingly?

Susan: I think you’ve got to kind of read the client around what is attainable. And I do talk a lot to, you know, the importance of, “Right now we’re working on this, and next we’re gonna work on this, and down the track, we’re working on this,” so that they have a path, a really clear path of, “Okay, so while we do this, it’s fixing this, but there’s also more that we wanna be addressing.”

And gives people some guidance. They don’t feel like they’re in the dark. Every supplement, if they’re given one, I always provide a rationale on that prescription of what that’s doing. So, in terms of contracts, I tend to just sort of work on one key thing and just keep asking about it, because no one ever really learned anything by being told once. Often, I’m having to constantly talk about how are we going with gluten-free at the moment?

Because we know, you know, that you are celiac gene-positive, how are we going with the swaps? Where are you… What’s hard? What do you need help with? And by helping people troubleshoot, they can continue to maintain their end of the contract.

So, often we’re really coaching clients in an ongoing fashion and kind of also being, you know, their cheer squad when they are kind of fulfilling the contract as well. So, just being a part of their journey and letting them know you’re invested in their outcomes tends to keep them on the hawk and happy to keep doing the work.

Andrew: You know, I think you just hit a really important point there about being their cheer squad. I think it was Kate Holme [SP], speaking with her that she…not first said it, but it’s indelibly in my brain. I have to ask just one last quick question, and that is safety issues. When do you tread really lightly? You were talking about MTHF with kids. What about things like iron? How high do you go? What forms do you like with iron and others?

Susan: Yeah. I think you’ve definitely got to go with, you know, a weight-based kind of dosage range. So, often I’m using, you know, about 25 milligrams of iron in an adult a day, either at the start or the end of the day, just in terms of, you know, really optimizing the bioavailability of that iron with the hepcidin sort of doorways opening for that iron to be absorbed well.

So, it’s really just based on the weight of the child that I’m able to do that calculation using Young’s Rule. I don’t really steer any… I don’t go higher with that. I find with zinc that you can be a bit more liberal, particularly, if you’re suspecting they’ve got some low stomach acid issues, and it’s a bit the same with iron, too, and B12.

Just making sure that you are supporting healthy HCL production because of that vagal nerve innervation involvement that can be there for some kids, you’ve got to really work on optimizing the absorption of those key nutrients that need HCL. But, yeah, I think I place where I tread very lightly and I hear myself sort of saying it is when I’m doing microbiome-balancing work.

So, when it comes to bacterial overgrowth, or when we’re looking at pathogenic parasite infections, being really careful around the herbs I choose to help assist with, you know, resolving those sorts of infections is really important. And definitely ensuring that you’re going into damage control around repopulating lost elements of the microbiome using pre and probiotics because that’s such a delicate sort of ecosystem, and often children are still just forming their microbiome.

So, particularly, in young ones, like, I just won’t even run a comprehensive stool analysis and treat any kind of overgrowth in a child under the age of two. And then as they get a bit older, and I feel like the microbiome is more resilient, I will, you know, probably look at being a little bit more liberal and more confident around bringing in, you know, a combination of different herbs and chemical constituents that I know are gonna be useful. But, yeah, that’s probably what another area where I just think be careful.

Andrew: That’s great. That’s great, and wise words. Susan, there’s so much more to this, obviously. I mean, mental health disorders and issues, as you say, it’s a burgeoning, unfortunate area… Let’s word that properly. It’s unfortunately a burgeoning area of care and concern. And you are an expert in the responsible care of these children, and indeed, their caregivers and family units.

So, I thank you so much for sharing what we can in, like, a 45-minute segment. This really requires a webinar, minimum, a conference, a two, three-day conference to give it any sort of credence. But I thank you so much for taking us through just a few tips and pearls today on “Wellness by Designs.” Thank you so much.

Susan: My pleasure. Thanks for having me.

Andrew: And thank you for joining us today. Of course, you can catch up on all the other podcasts and the show notes for this podcast, which I’m sure there’s going to be heaps on the “Wellness by Design”…forgive me, on the Designs for Health website. I’m Andrew Whitfield-Cook, and this is “Wellness by Designs.”