KIDS FOR KIDS GI PROJECT
Extra, extra!
Read all about it!
Q&A with Dr. Athos Bousvaros
Associate Director of the Inflammatory Bowel Disease Program, Boston Children’s Hospital
Athos Bousvaros MD, MPH is a pediatric gastroenterologist who has worked at Boston Children’s Hospital for over 25 years. As Associate Director of the Inflammatory Bowel Disease program at Boston Children's Hospital, he spends much of his time treating complex cases of Crohn’s disease and ulcerative colitis referred from across the country. His research interests include identifying the cause of IBD by studying the intestinal microbiome, developing new therapies for IBD, and examining the immune response of IBD patients to immunizations. He has over 100 original and review publications in medical literature. We had the honor of speaking with Dr. Bousvaros, and are so grateful for his sharing his time and insights with the Kids for Kids GI Project community.
Kids for Kids GI Project:
As Associate Director of the Inflammatory Bowel Disease Program at Boston Children’s Hospital, your research interest includes developing new therapies for IBD. Are there any potential new therapies or treatments being investigated for which you are particularly excited about?
Dr. Bousvaros:
Honestly, nothing that I see as a "game changer," but I am excited about some of the oral treatments that are being developed for IBD, including the JAK kinase inhibitors (tofacitinib, upadacitinib) and the S1P receptor modulators (ozanimod).
Kids for Kids GI Project:
You have greatly contributed to patient education materials including co-authoring the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) book “Your Child with Inflammatory Bowel Disease,” helping develop medical comics including “Pete Learns All About Crohn’s and Colitis,” and “Amy Goes Gluten Free,” and collaborating on the NASPGHAN website GI Kids. When a family first receives a diagnosis, it seems these would all be excellent resources. Which would you recommend checking out first? Are there any other resources through Boston Children’s Hospital or any other sources that you’d recommend?
Dr. Bousvaros:
For IBD, check out the Crohn's and colitis Foundation and NASPGHAN websites, and if you want more information, the NASPGHAN book. For celiac, the Boston Children's website is great.
Kids for Kids GI Project:
The following article from Harvard Health Publishing discusses how stomachaches are very common in children and “nothing serious at all,” but that sometimes a stomach pain can be a sign of a more serious problem. The article has a helpful list of warning signs to look out for. Here at Kids for Kids GI project, we would encourage families to review this list and in consultation with a family doctor, seek help of a gastrointestinal doctor if needed. Are there any other clues or symptoms that you think parents might look out for to determine if their child might have a more serious GI condition that should be investigated?
Dr. Bousvaros:
I think any child with chronic abdominal pain should be evaluated by a physician, and even a gastroenterologist, if the pain is affecting their quality of life. Even if the pain is not caused by a disease like Crohn's or celiac, there are many things we can do to help treat typical belly pain (aka functional abdominal pain).
Kids for Kids GI Project:
If there is one piece of encouraging news you can share with children who have a chronic gastrointestinal condition of any kind, what would it be?
Dr. Bousvaros:
There are many great health care professionals who care for children that are willing to help. Also, more treatments are being developed daily!
​
-------------------------------------------------------------------------------------------------------------------------
Q & A with Dr. Roya Pilcher
Pediatric dental specialist, Smile Valley Pediatric Dentistry
​
Dr. Roya Pilcher has been a pediatric dental specialist since 2005. Her treatment philosophy is inspired by advice from her father, a physician. On the day she graduated from dental school, he told her, “Treat every patient like they are a member of our family.” Based on this idea, Dr. Roya developed the Sequential Approach to Familiarize and Engage (SAFE) technique for pediatric dentistry, which encourages your child to become an active participant in their treatment and promotes a positive attitude around their dental care. In addition to working with the growing patients and their families at her Washington, DC practice, Dr. Roya is also an active member of the American Academy of Pediatric Dentistry and the Greater Washington Academy of Women Dentists. She is past president of the D.C. Association of Pediatric Dentists and Dean’s Faculty at University of Maryland.
​
Kids for Kids GI Project:
Dr. Pilcher, you mentioned that kids who have certain GI conditions should take extra careful care of their teeth as they may be more likely to get cavities. Can you please explain why?
Dr. Pilcher:
GI conditions can have a detrimental effect on overall health, especially oral health. First, certain GI issues offset the balance between the protective and harmful bacteria in the oral cavity, thereby causing cavities. Additionally, certain medications individuals consume to manage and treat their GI issues can cause dry mouth, also known as xerostomia. Saliva is integral to decreasing the acidic environment of the mouth, keeping the teeth clean, and also allowing for remineralization of the dentition. With decreased saliva, an individual will be more prone to obtaining cavities. Alternate medications used to treat GI conditions are also known to cause gum issues. Furthermore, certain conditions like GERD or bulimia cause the mouth to be in constant contact with acid. The acid causes erosion of the teeth, thereby weakening them and making them more susceptible to cavities. Finally, individuals who are suffering from GI issues may have a restricted diet or may not be able to eat certain foods. A diet lacking in specific nutrients can cause an individual to be more prone to cavities.
Kids for Kids GI Project:
Can you please share any extra steps kids might do to take the best care of their teeth?
​
Dr. Pilcher:
It is essential to go for your regular dental check-ups and inform your dentist of any changes or updates to your medical history. Additionally, using fluoridated toothpaste can help strengthen your teeth and help with sensitivity. It is also very important to have a balanced diet and ensure you are obtaining all your nutrients. Making sure you stay hydrated is also key! Since dry mouth is a common issue with GI conditions and medications, you can chew sugar free gum or lozenges to help stimulate your saliva. Finally, practicing optimal oral hygiene at home by brushing and flossing regularly is key!
Kids for Kids GI Project:
In addition to dental care kids can do at home, should kids and their families also tell their dentist of any GI conditions?
​
Dr. Pilcher:
It is absolutely necessary for kids and their families to share with their dentist if they are experiencing any GI conditions! In order to provide the best tailored care for our patients, a thorough medical history and understanding of your child’s GI conditions is vital. Being aware of any conditions allows us as providers and the dental team to create a safe and comfortable environment for your little ones. Additionally, certain GI medications can have possible cross reactions with drugs prescribed by the dentist. Therefore, it is very important for the dentist to be aware of any conditions and medications being taken so that any dental treatment does not affect their GI medication. Due to certain side effects of medications like dry mouth or oral hygiene challenges faced with GI conditions, the dentist can provide certain recommendations and treatment options that work best for you. Additionally, since certain GI issues cause the mouth to be exposed to increased acid, the dentist can provide you with suggestions on how to better protect your teeth, whether that means applying fluoride more frequently or recommending certain toothpastes. Due to the nutritional concerns associated with GI conditions, dentists can also provide nutrition guidance and recommend specific supplements if necessary.
​
-----------------------------------------------------------------------------------------------------------------------------
Discussion with Dr. Aviad Haramati
Professor of Integrative Physiology in the Departments of Biochemistry, Molecular & Cellular Biology and Medicine (Nephrology), and co-director of the CAM Graduate Program at Georgetown University Medical Center.
​
“Do things in a mindful way instead of a mindless way.”
- Dr. Aviad Haramati
On behalf of the Kids for Kids GI Project, I had the incredible opportunity to speak with Aviad “Adi” Haramati, PhD on the topic of the mind body connection, which is a key component to having good gut health.
Dr. Haramati is Professor of Integrative Physiology in the Departments of Biochemistry, Molecular & Cellular Biology and Medicine (Nephrology), and co-director of the CAM Graduate Program at Georgetown University Medical Center. Dr. Haramati has been a visiting professor at over 100 medical schools worldwide.
Dr. Haramati seeks to improve medical education across the globe, especially with regard to the intersection of science and mind-body medicine. Over the past 15 years he has advocated that mindful practices, together with group sessions, be integrated into the curriculum for training health professionals to improve learning and work environments at academic health centers.
Dr. Haramati shared some key points and helpful tips for the Kids for Kids GI Project community:
Mind-Body
The systems in our bodies are interconnected, and the influence of the mind impacts the functions of the body. The mind has the ability through various neural and endocrine (nerve and hormonal) connections to influence how that system functions.
Here are some interesting examples:
-
Heart rate can increase when a person feels stressed due to the body’s fight or flight response. By contrast, when a situation is resolved and the person gets a break, their blood pressure comes down as they relax.
-
Hands are colder when a person feels stressed, whereas a person’s hands will be warmer when they are calm and relaxed, as the blood vessels in their fingers will dilate.
Mind and the Gastrointestinal (GI) System
The GI system is especially prone to neural influences and stress. Factors can irritate the GI system and at the same time, factors can help calm it too.
Dr. Haramati discussed several wonderful techniques to help calm the mind and body
​
Visualization exercise
-
Begin to close your eyes and imagine a relaxing place (like a vacation or the spa).
-
Imagine how you felt so relaxed at that place and think about it for about thirty seconds to one minute.
-
While you’re doing that, do some deep breathing (breathing in through your nose, holding for three to four seconds, and then exhale through pursed lips- which extends exhalation by two to three times longer than normal).
-
Repeat your breathing, again and again, which slows you down.
-
Do this around five to six times.
This process slows down the sympathetic system (which constricts blood vessels) and raises the parasympathetic system (the relaxation mode).
Lemon exercise
-
Close your eyes and visualize yourself picking up and then biting into a lemon, pay attention to see how it looks/feels/tastes/smells.
-
By visualizing a lemon, the circuitry system released the response “I’m going to sense that, I’m going to start eating it.”
That process helps calm your system down. The suggestion of a certain smell can also trigger a calming response.
Listening to spa music
-
Play spa music for a few minutes to lower your stress.
Using your auditory sense, you can relax, you go to a warm place as your body temperature actually warms up.
Self-Awareness, Mindful Eating and other Gastrointestinal Considerations
There is a lot you may not know about yourself, your GI tract, GI health and disease. It all begins with noticing. Each of us must understand our own bodies through practicing self-awareness. It all begins with noticing and recognizing signs for the GI system.
Learn what your cues are and triggers for eating and how you feel. Like all else, eat in a in a mindful way, instead of a mindless way.
Some stress can be a good thing. When dealing with a stressful situation, our bodies use our resources in a better way. However sometimes when we have excess stress, we might not make good eating choices, and may be depriving the gut of important nutrients. So be aware of managing stress for best eating practices.
Another example of self-awareness with food is to try to notice when you eat if you’re being social or if you are actually hungry. Recognizing when you are actually hungry and when you are actually full is really important in terms of regulating your GI system as well. Know what your cues are and know what your triggers are. There are times where you might want to eat and there is no need to (sometimes you’re just bored), and there are times when you need to eat but you don’t because you’re too stressed.
Tip: Looking to make good choices around dessert time? You might have a real desire for dark chocolate and when you see it, you take it. This could be an example of a trigger food for you. Instead, try to take a tiny square of dark chocolate instead of eating the whole thing. That way you can satisfy your urge by eating the chocolate in moderation, and then you can have some berries, nuts, and more. And now you have a nice, decadent, but balanced dessert because you are satisfying your desire a little, but you are now more mindfully eating instead of mindlessly eating- because you’re limiting your trigger and eating something else/healthy with it.
We are so thankful to Dr. Haramati and we challenge you to do things in a mindful way instead of a mindless way, and to also see how can you decompress?
Interested in more on this topic?
Check out this interesting article from Johns Hopkins Medicine. https://www.hopkinsmedicine.org/health/wellness-and-prevention/the-brain-gut-connection
Please check back here for more doctor interviews and exciting news and events.