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AAPI’S NUTRITION GUIDE TO OPTIMAL HEALTH: USING PRINCIPLES OF FUNCTIONAL MEDICINE AND NUTRITIONAL GENOMICS For a variety of reasons, infants and children are more prone to dehydration than adults. Symptoms of mild dehydration include tiredness, muscle weakness, lightheadedness, and headache. In children with autism, these symptoms can be easily missed. Children with autism often have expressive language delays or are non-verbal and unable to express their thirst. Some children with autism do not even recognize the sensation of thirst and therefore never ask for water. These children are especially susceptible to dehydration. Subtle though the symptoms may be, dehydration will have a major impact on how the child feels both physically and mentally, his ability to function normally, and his ability to excrete toxins out of his body. The chart below lists the total amount of water a child should consume daily (26). The amount of total water a child needs will vary according to their level of physical activity, medical problems, and weather environment in which you live. A Registered Dietitian can calculate more exactly the total amount of water a child requires based on their individual needs. ADEQUATE INTAKE OF WATER Age Group Total Water Children Liters/day Cups/day 1 – 3 years 1.3 5 4 – 8 years 1.7 7 Males 9 – 13 years 2.4 10 14 – 18 years 3.3 14 > 19 years 3.7 15 Females 9 – 13 years 2.1 9 14 – 18 years 2.3 10 >19 2.7 11 Source: Food and Nutrition Board, Institute of Medicine, National Academies Eliminating toxins from drinking water – It is important to consider the source of the water for a child because safe, uncontaminated drinking water is vital to his health (53, 54). In the autism community, neurotoxins are a major concern and many parents try to eliminate heavy metals from their children’s environment as much 124 as possible. Common sources of water pollutants include: � Biological agents (bacteria, viruses, parasites) � Inorganic chemicals (arsenic, lead, mercury, chromium, nitrates) � Organic chemicals (pesticides, benzene, polychlorinated biphenyls, trichloroethylene) � Disinfectant chemicals (chlorine, chlorine dioxide, chloramines, haloacetic acid, trihalomethanes) � Radionuclides (radon) These pollutants can affect major body organs such as the kidneys and liver; promote certain forms of cancer, leukemia, and anemia; and may affect the neurological and gastrointestinal systems (55, 56). Consider the use of a home water purification system, such as a reverse osmosis water filter, to reduce various contaminants in drinking water. 3) TREAT GASTROINTESTINAL PROBLEMS Gastrointestinal problems involving the esophagus, stomach, small intestine, and colon are very common among children with autism (57, 58, 59, 60, 61). It appears that GI problems are more prevalent in children with autism than other children. In a study published in the Journal of the Developmental and Behavioral Pediatrics in 2006, 70 percent of children with autism were found to have a lifetime history of gastrointestinal symptoms, such as abnormal stools, constipation, frequent vomiting, and abdominal pain (62). A research article released September 2011 by Williams, Hornig, Buie, et al. indicated that GI activity of children with autism differs from other children primarily in two ways; intestinal cells show abnormalities in how they break down and transport carbohydrates, and their intestines have abnormal amount of certain bacteria (63). A consensus report published January 2010 in Pediatrics stated that problem behavior in children with autism spectrum disorders may be the primary or sole symptoms of gastrointestinal disorders (64). 2012
AAPI’S NUTRITION GUIDE TO OPTIMAL HEALTH: USING PRINCIPLES OF FUNCTIONAL MEDICINE AND NUTRITIONAL GENOMICS Elimination Problems – One of the most common GI symptoms children with autism have is chronic constipation. Research confirms that constipation is more common in children with autism than other children (65). Abdominal X-rays of children with and without autism who are experiencing stomach pain has shown that autistic children have a significantly higher rate of excess stool in the colon. Children with chronic constipation often associate bowel movements with pain and deliberately hold in their stool to avoid a bowel movement. Due to holding in their stool, over time the child will no longer recognize or respond to the urge to have a bowel movement which exacerbates the constipation. If the child is experiencing chronic constipation, he will feel uncomfortable and may even be feeling severe pain. These children may express their pain as behavioral and feeding problems. Chronic constipation can also result in physical issues such as megacolon and encopresis. On the other end of the spectrum, some children with autism also tend to have problems with chronic diarrhea, loose stools, non-formed stools, or a combination of all three at different times. Many parents describe their child as never having had a normally-formed stool. Chronic diarrhea is diarrhea that is present for more than three weeks and is not associated with an illness. Many medical professionals refer to it as chronic nonspecific diarrhea (CNSD). If a child with CNSD continues to gain weight and grow taller at a normal rate, many medical professionals do not consider it a significant health problem or suggest any specific medical treatment to resolve the bowel issue. Parents, however, are usually very concerned about their child’s abnormal loose stools and rightly so. If the child with autism is having difficulty controlling his bowel function, it will impact him in many ways. For instance, having chronic diarrhea, loose stools, and/or non-formed stools will affect his ability to potty train, forcing parents and other caregivers to continue changing diapers beyond the typical age. The child’s bowel issues may make him feel uncomfortable which will affect his sensory system and can lead to behavioral problems. He may also encounter nutritional deficiencies because chronic diarrhea 125 causes malabsorption of vitamins, minerals, and other nutrients. This impedes his body’s ability to repair the lining of the GI tract, which only serves to exacerbate his malabsorption of nutrients. This vicious cycle of chronic diarrhea, malabsorption, and nutrient deficiencies can compromise the child’s overall health, brain function, and behavior. The Gut - Behavior Connection - Undiagnosed gut problems can cause serious behavioral problems in children with autism, particularly those who are unable to verbally express the pain they are feeling. If a child is nonverbal, he may communicate how he feels through his behavior. Unfortunately, too often these symptoms are dismissed as ‚typical‛ autistic behaviors as opposed to attempts to communicate what the child can not put into words. Identifying and correcting the child’s gastrointestinal disorder will lead to significant improvement in his behavior. A child with gut problems may suffer from one or more the follow symptoms: � Gastrointestinal symptoms - reflux, vomiting, abdominal pain, bloating, flatulence, loose stool, diarrhea, constipation, infrequent stool, straining to pass stool � Vocal behaviors - clearing of throat, screaming, sobbing, whining, moaning � Motor behaviors - facial grimacing, gritting teeth, grazing, mouthing on clothes, pacing, self-injury, jumping up and down, aggression, puts pressure on abdomen � Change in overall state - sleep disturbances, irritability, oppositional behavior � Mealtime behaviors - food refusal, limited variety of foods, mealtime tantrums, discontinue eating foods he used to eat Dietary Treatment of gastrointestinal symptoms Referral to a Registered Dietitian is important to educate parents on basic nutritional management of GI problems. Often basic nutritional interventions will heal the child’s gut and resolve their GI symptoms. Step 1: Dietary Modifications 2012
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