Lori Walsh, MD, FAAP, ABOIM, Medical Director, Advocate Good Shepherd Hospital Center for Health and Integrative Medicine, and Medical Director, Pediatric Integrative Medicine, at Advocate Children’s Hospital is an expert in pediatric integrative care with a particular interest in the role of nutrition in children’s health. In this column, she shares her perspectives in taking an integrative approach with children, from the time they are in the womb through their youth. Dr. Walsh considers the cultural and socioeconomic factors of a person’s life and involves the family for optimal care. She is actively involved in the Healthy Active Living Clinic, which takes a team approach to treating children with an elevated body mass index.
To Contact Dr. Lori Walsh
Lori Walsh, MD, FAAP, ABOIM
Medical Director, Advocate Good Shepherd Hospital Center for Health and Integrative Medicine Barrington Illinois.
Medical Director, Pediatric Integrative Medicine, Advocate Children’s Hospital, Change to Park Ridge, Illinois.
Healthy Active Living (HAL), Chicagoland Children’s Health Alliance, Wilmette, Illinois.
Website: https://www.loriwalshmd.com
Q: How did you first become interested in integrative medicine?
Lori Walsh, MD, FAAP, ABOIM: My early awareness of integrative medicine began in college. I attended a college that I now consider was in a “blue zone” area with easy access to healthy foods, a strong outdoor culture, and the availability of many other healing modalities. I majored in molecular biology but found myself taking herbal medicine classes in the community and learning about other complementary therapies. At that time, medical school training did not include much about the integrative approach. When I trained in pediatrics, it felt like I was on the path of prevention and health building. During my general pediatric work, however, I came to the realization that I did not know enough about how to help the children I was seeing, particularly those who had chronic symptoms. There were many changes in medicine during that time that no longer allowed for the continuity of care and necessary time needed with patients. So, I sold my practice, which freed me up to do a Faculty Scholars in Integrative Medicine at Northwestern led by Dr. Melinda Ring, and this sparked my interest to also complete the Andrew Weil Fellowship in Integrative Medicine in 2021.
Q: What are some of the challenges or conditions in children’s health today that call for an integrative approach, and how does the integrative approach differ in children compared with adults?
Dr. Walsh: Pediatric conditions such as anxiety, attention deficit disorder, functional dyspepsia, sleep problems, inflammatory conditions, chronic health conditions, an elevated body mass index (BMI), asthma, and others would receive help from the anchor of an integrative approach, even if medication is required. Unfortunately, pediatricians do not have the time or the training (yet) to have in-depth discussions with their patients about nutritional changes or mind-body techniques, etc. They also may not be seeing the content that could educate them about integrative topics, as there is little written about this in the standard pediatric journals. When I talk to patients and pediatricians, I say that an integrative approach can benefit everyone, and it is just good medicine.
Training in pediatrics as my primary expertise has provided me with the lens of knowing where a child is in their developmental stage to best understand their perspective and what their strengths and weaknesses may be. For instance, a three-year-old can be very concrete in their thinking and have magical thinking. So, talking with them about why it is important to go to bed at a certain time may include talking about how many of the animals in the world are sleeping at that time too. They may also respond to the idea of a magical wand that helps to rest their body so it can fall asleep. There are a variety of ways that we communicate with children that are clearly different than the way we speak with adults. The other difference, of course, is that the parents, and many times the whole family, need to be a part of the process of supporting the child or teen. Including the family turns out to be a good rule for adults as well.
Q: Little is taught about nutrition in medical training, and yet we are learning that healthy nutritional patterns are one of the main foundations for good health. Why is nutrition and culinary medicine so important, particularly when helping prevent illness and treat disease in children?
Dr. Walsh: We have all the data we need to act on the findings that supporting pregnant women and their children in the first 1000 days (a woman’s pregnancy through her child’s second birthday) is essential for the woman’s and the child’s life (https://thousanddays.org/). Nutritional and emotional support has a major effect on how the child’s body and immune system develop and influence their predisposition to disease in later life. There is even evidence that the health effects of poor nutrition in the mother are passed down through the generations. As a result of this data, nutrition must be one of the first factors to consider in a child’s life.
Culinary medicine is a practical approach to teaching easy, plant-forward meals that are nutritious and within the socioeconomic and cultural context of the family. It allows for a translation of what we know is good for the brain, immune system, and body into an everyday meal plan that a patient can use. This is much more effective than a clinician simply saying to a patient, “Eat more fruits and vegetables.”
Given that there is little nutrition training in medical school and residency, most pediatricians are not aware of straightforward ways to make meals more nutritious or even the idea that babies are best fed vegetables first, as they are open to new foods at this age. Most of the education of feeding babies I received during my residency was conveyed from one resident to another. When I went to look for the origins of why rice cereal was the first food, I could not find any clear data.
Q: What are a couple of examples of how focusing on dietary habits can help or reverse some common medical conditions in children?
Dr. Walsh: The most obvious medical conditions in children that can be managed through a change in dietary habits (as well as sleep, movement, and stress) are the conditions that manifest through an elevated BMI—fatty liver, hypertension, type 2 diabetes, musculoskeletal pain, sleep apnea, anxiety/depression, and hyperlipidemia. These conditions can be the result of one or several of the following: ultra-processed foods, low fiber intake, overconsumption of food, sugar-sweetened beverages, lack of physical movement, poor sleep quality, unmanaged stress, and heredity, among others.
Q: You mentioned how you promote health within the cultural and socioeconomic context of the patient. What are some of the things that clinicians should keep in mind in this regard?
Dr. Walsh: We all know how a story we tell can sound to another person—filled with family dynamics, opportunities not taken, even misalignment with what we value. We also all have generational, cultural, and socioeconomic circumstances that make up our narrative. I remember this when I am listening to a patient’s story and work to make the visit very safe for a story to be told (and perhaps retold by the end of the visit). The integrative medicine intake form also has questions that help paint a picture. I use this information to ask clarifying questions, the most valuable one being, “What is important to you?” I also look for opportunities to make recommendations that are “radically simple.” First, they cost no money, such as establishing a routine sleep/wake cycle or getting early morning sunlight and/or finding a few minutes for themselves in the morning. Second, I look for what is available to them in terms of movement, such as safe areas to walk in a park, forest preserve, or gym. In terms of nutrition, I provide access to food pantries, recipes that are nutrient dense and inexpensive, and provide knowledge of what is in the grocery stores where they shop. These are all examples of how clinicians can keep cultural and socioeconomic factors in mind when caring for patients.
Q: Please tell us about the Healthy Active Living Clinic and how you are improving children’s health in that setting.
Dr. Walsh: The Healthy Active Living Clinic, Chicagoland Children’s Health Alliance, Wilmette, Illinois, is a multidisciplinary clinic comprised of myself, a behavioral psychologist, and a registered dietician who see children from age three through 23 with an elevated BMI, and we also see their parent(s) over the course of several visits, spaced one month apart. The first, third, and fifth visits are in person, and the second, fourth, and sixth are virtual, with either the registered dietician or the behavioral psychologist. At in-person visits, I am at the visit with the families, and the rest of the team is virtual, allowing us to all collaborate on the questions we need to ask and to create goals. The team approach helps us learn from one another and to shift at a visit if, for instance, there is a significant mental health issue within the child or family that our behavioral psychologist will need to help sort through before we can continue with other goals. We have learned to set small goals and link them to something they are already doing, have the whole family commit to the same changes, and focus on health building, including sleep, movement, stress management, nutrition, and not just focusing on their weight.
We have a pediatric preventative cardiologist who joined us to collaborate on caring for children who have elevated lipids and hypertension that may need some investigation of their cardiovascular health. Our messages are the same though—build health—medication, if necessary.
Q: What is your final advice to integrative clinicians when working with children and thinking about the importance and impact of a healthy diet?
Dr. Walsh: Nutrition is a key part of the health of a child. In an ideal world, obtaining a detailed dietary history as part of well visits and chronic care visits and a modified dietary history at acute care visits can be a way for families to understand the place of nutrition in the health of their child. It gives them the opportunity to make small changes. An example of this would be at a sick visit of a child with a mild upper respiratory infection and malaise, we would teach the family how to make a simple homemade soup broth and suggest some food-based solutions in addition to the use of medication. Step-by-step, clinicians can work with children and their families to build their health through good nutritional habits along with many other integrative modalities.▪
