Dr. Jacob Teitelbaum's Column
...expert advice on CFS, Fibromyalgia and other Health Topics.
You can benefit from Dr. Teitelbaum's wisdom and experience by visiting us at The Environmental Illness Resource regularly to read articles from his latest newsletter!
Monday, July 28th, 2008:
Treating CFS and Fibromyalgia in Children
by Jacob Teitelbaum MD
Used with permission "From Fatigued to Fantastic" (Penguin/Avery Oct 2007).
Chronic fatigue syndrome and fibromyalgia afflicts children as well as adults. Fortunately, children also respond well to treatment. As an internist I was initially hesitant to treat children, but I began doing so after lecturing in England around 15 years ago. After the talk, a mother came up to me and said that I needed to treat her seven-year-old daughter. I told her I couldn't, because I wasn't a pediatrician. She very sweetly smiled and told me that she was not going to let me leave the country until I treated her daughter! She was so loving and caring that I could not tell her no, and I told her that if she found a pediatrician that would work with me, I would treat her daughter. The girl is now healthy and doing well, having finished college. Since then, I have treated many children in conjunction with their pediatricians.
Although the "SHINE Protocol" is very effective in children as well as adults, there are some differences in the treatment approach. Most important would be to treat the autonomic dysfunction, yeast and other infections, adrenal support, milk allergies, and thyroid resistance. This article will discuss how to help children recover from these illnesses.
Getting Kids And Young Adults Well—Information for Patients Under Age Sixteen
If you're under age sixteen, you most likely have neurally mediated hypotension (NMH)—sort of like low blood pressure—and an allergy to milk proteins. Some doctors do a type of test called the tilt table test to diagnose NMH, but I treat NMH without doing the test first. It's not a bad idea to have it done, but it is expensive and uncomfortable.
To treat NMH, your doctor can prescribe the medications fluoxetine (Prozac), midodrine (Proamatine), fludrocortisone (Florinef, which is modestly effective), and/or methylphenidate (Ritalin) or dextroamphetamine (Dexedrine). Of all of these, Dexedrine or Ritalin are most helpful in those under 20 years of age. In addition, the following things can be helpful:
- Avoid sugar. Stevia is a healthy sweetener you can use instead.
- Take the Energy Revitalization System vitamin powder or similar multivitamin supplement.
- Dramatically increase your intake of salt and water. Aim for 8 to 15 grams of salt and 1 gallon of water each day.
- If you have stomach or bowel symptoms, cut out all milk products and any foods containing casein or caseinate (milk protein) as ingredients.
- If you have taken a lot of antibiotics and/or steroid medications (cortisone, prednisone, or others) ask your doctor to consider treating you with the antifungals Anti-Yeast (an herbal mix; take 1-2 caps twice a day) for five months, and fluconazole (Diflucan) for 6-12 weeks to get rid of possible yeast overgrowth. (See chapter 5 in my book "From Fatigued to Fantastic!" for more information on treating yeast and other infections.) Taking Probiotics like Acidophilus Pearls two twice a day for five months also helps restore balance in your body.
- If you run frequent fevers (temperatures over 98.8°F), you likely have a hidden infection. I would consider a trial of an antibiotic like doxycycline (if you're over eight years old) for six months. If you're not better, then refer to the rest of the program outlined in my book. Doing the free questionnaire on my website will also help tailor a treatment protocol specifically for you.Fortunately, these simple suggestions help most kids get better!
Which treatments should be avoided or modified in children?
Once the child is ~ 100 pounds or more and over 13 years old, treatments dosing for the SHINE Protocol is largely the same as for adults. The key exceptions:
1. Do not use testosterone or DHEA till they stop growing (no increase in height documented at least 1 year) as testosterone signals the growing edges of the bones to stop growing (permanently), it can stunt their growth.
2. I am quicker to use florinef .1 mg (good in kids—not very effective in adults) along with dexedrine in those under 21 years old as they have more autonomic dysfunction causing their symptoms, and these are very helpful for this. I am slower to use SSRIs unless other treatments are ineffective.
3. If they have abdominal cramps, treat yeast, of course, but also look for milk allergies (do a 10 day elimination diet to diagnose).
4. No cipro in kids under 18 and no tetracyclines in kids till the adult teeth are in (9 years old).
5. Heparin is a last resort. Consider antiviral therapies with ProBoost, IV Vit C and Valcyte (if labs positive—see pages 140-141 of the new edition of From Fatigued to Fantastic!). Though Professor Montoya's placebo controlled study showed modest benefit (significant for the brain fog component), experience suggests that the small subset that test positive often do very well with it when combined with the entire "SHINE protocol" we use.
6. Kids are more likely to need 30 mg of dexedrine (the maximum dose I usually use) where in adults, 5-12.5 mg is usually enough. Kids need more salt and water loading for adrenal and autonomic support as well.
7. Children are more likely to need ultralow dose cortisol (adrenal support) and high dose T3 for thyroid support.
For children under 100 pounds or under 13 years old, medication doses should optimally be adjusted by a pediatrician.
Used with permission from Dr Jacob Teitelbaum's free newsletters-available at www.Vitality101.com
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