Medicine Mondays:Essential Fatty Acids and Children,

Hi Everyone,

Welcome back to Medicine Mondays.

Each Monday I'll post the answers to questions that I have collected over the week. If you have a question please feel free to send me an email or leave me a comment. I welcome every comment and hope to help answer some questions. Just remember that my advice is not a substitute for a physical exam and medical advice that your family doctor can provide.

Dear Dr. Cason,

For toddlers, is there a given amount of fatty acids they should have for good brain development? Are supplements available and ever necessary?With my daughters dairy, egg, and nut allergies, the fatty acids she can intake are limited. She eats a lot of avocados. What are other good sources?- Anonymous


Dear Anonymous,

When people talk about consuming fatty acids they are most likely referring to essential fatty acids (EFAs) They are called essential fatty acids because they cannot be made in the body from other substrates and must be supplied in food. These fatty acids are called Linoleic Acid (Omega -6) and Alpha-Linolenic Acid (Omega - 3).

In the body, essential fatty acids are primarily used to produce hormone-like substances that regulate a wide range of functions, including blood pressure, blood clotting, blood lipid levels, the immune response, and the inflammation response to injury infection.

You can get these EFA in supplements but since they are nutritional supplements and therefore not regulated by the FDA, there is no specific guidelines about what a safe amount is. I generally recommend that parents feeds their kids good healthy foods that will supply the EFA and don't worry about additional supplementation found in capsule form.

Most people forget that while eating Omega- 6 and Omega- 3 EFA are important what is more important is eating the right ratio of Omega -6 and Omega-3. Marion Nestle in Her Book, "What to Eat" points out that

Although these two essential fatty acids differ, the enzymes that work on them are exactly the same. This means that when you eat a lot of linoleic acid, Omega- 6, it can compete with the alpha-linolenic acid, Omega-3, for the enzymes that turn the alpha-linolenic acid into EPA and DHA, the two longer omega-3 fatty acids that seem especially good for health.

This means that it's important to eat the Omega -6 and Omega -3 EFA in the right ratio to prevent this competition. Nestle suggests eating balance of 6:1. Oils that have a good balance of Omega-6 to Omega- 3 are Flaxseed oil at 1:4, Canola at 2:4, Soy at 7:1 and a fairly good balance of these two EFAs can be found in Olive Oil at 9:1.

Most people get enough Omega- 6 without even trying. Examples are- Safflower oil,walnut oil, grass fed cow milk, olive oil, palm oil, sunflower oil, soybean, peanut oil and sesame oil to name a few. What they need to focus on is increasing their Omega- 3 intake.

Examples of food that have a good amount of Omega- 3 are oily fish, walnuts, flax seeds, pumpkin seeds, canola oil and soy. Omega eggs are also a good source of Omega-3 fatty acids and you can find them in your grocery store. The hens that lay these eggs are fed on healthier feeds, which results in eggs that contain omega-3 fatty acids. For a child that is allergic to nuts and eggs, I would focus on taking in a balance of salmon, flax seeds and canola and soy oil.

Soft Neurological Signs in Young Children and My Personal Experiment

Dear Dr. Cason,

I have a son who is 4 and also a twin. He twitches his fingers and does this circular motion with his hands when he talks, but mostly when he is excited.(his arms stay at his side).My doctor says its just a nervous thing and that he will learn how to control it, but it worries me. What do you think?- CS

Dear CS-

It sounds like what you are describing is neurological overflow or what others will call "soft" neurological signs". These soft neurological signs are often used to describe signs that are either difficult to obtain or interpret. It is commonly seen in immature nervous systems of very young children. Persistence of these signs beyond a certain age though may indicate a future problem with attention and/or learning disorders or other cerebral dysfunctions.

You can test your child for soft neurological signs a couple of different ways.

1. Ask your child to walk across a room on their tip toes. As they perform this look for tremors and "overflow" involuntary movements that occur with his hands and his face.

2. Ask your child to touch the tip of their finger to the tip of your index finger and then touch the tip of their nose again. Do this three times. As they perform this look for tremors and "overflow" involuntary movements that occur with their other hand and their face.

Remember again, that the presence of these signs may or may not indicate future problems. The best thing you can do is discuss your concern with your pediatrician and if you are still concerned, they can refer you to visit with a pediatric neurologist who can evaluate your child and offer specific recommendations.

I hope this helps. I couldn't find any specific ages in which these soft signs should be gone. Most articles suggested that beyond age 5 or 6 was concerning for other conditions. Now as luck would have it I have a 4 and a 6 year old. They are both full term and otherwise developmentally on target.Tomorrow I shall do my own little experiment and let you know what I found!

*Warning* This is not a true "experiment" and one should take it as an interesting task and not necessarily indicative of how other 4-6 year olds will perform.

*11/18/08 Update*

Standing at the bus stop today I had a chance to test my children. The older 6 year old certainly did well. The four year old splayed her fingers a little as she touched her nose and had difficulty with balancing as she did the tip toe walk.I wouldn't necessarily call this a soft sign but she did show less coordination. I would expect her to get better at this and have no worries about her development overall.

I'd be curious what other people found out! Let me know by leaving me a comment.

The Cold and Flu in Pediatrics

Dr. Cason,

Danger has had a cold for just over a month now. It was REALLY BAD for about a week and a half but now is just kinda there. She has a couple of coughing fits a day, usually while sleeping and always has a runny nose and last week a very mild rash formed on her chest and back of her neck. I took her to the public health nurse and she said it was fine. When do I need to be concerned about it? Do I need to be concerned about it?- Nikki

Hi Nikki!

You did the right thing by taking Danger in to be evaluated. You should expect her to be feeling better in a few days, most upper respiratory tract infections should resolve by one to two weeks. If she persists with her symptoms or suddenly develops focal signs such as a fever, ear pain or worsening cough, then return sooner.

I'm not sure what's going on with the rash. It could be a mild form of eczema- which can flare when kids are sick. If it is spreading or your child has a fever and looks very ill then seek medical attention immediately.

At this time of year we see a lot of cold and flu symptoms in children. Most kids just need a little monitoring and plenty of fluids. Two previous posts that I have written on the subject are:

1. Cold and Flu Season- When to Take Your Child to the Doctor

2.The Flu in Children

I hope she feels better!

Sheila Cason MD

Eye Color in Children

Hi,

Welcome back to Medicine Mondays. This week I'm going to talk a little about eye color.
The following question from a loyal reader

Dear Dr. Cason-

Danger has blue eyes, but since the hubs and I both have green eyes,
his parents have green and brown and my parents have green and brown
what are the chances that her eyes with stay sooo blue?
If they are going to change will they usually do so by a certain age?- Nikki

Dear Nikki-

Great question! I have always wondered the same and have anxiously waited to see what color eyes my children would have.

You may remember learning about dominant and recessive traits (Patterns of Mendelian Inheritance) in high school. You learned that there are two copies of each gene that we inherit from each parent. For a recessive trait to show through, we must inherit two copies of the gene that codes for that trait - one from both our mother and father. Well we used to think that 'blue' was the recessive variant of the eye color gene, and 'brown' was the dominant variant. In other words, we used to think that a person's eyes would be brown even if they only inherited one 'brown' gene from either parent and blue only if they inherited both 'blue' genes from each parent.

Well now you can forget about these nice linear rules when it comes to eye color. It's not that easy. We now know that eye color is a polygenic trait which then determines the amount and type of pigments in the eye's iris.

Color variations among different irises are typically attributed to the melanin content within the iris. Most babies are born with blue eyes because they contain low amounts of melanin. As they get older their melanocytes darken and their eyes change color. By six months of age most babies will have their eye color set, but you can see some gradual changes in the color all the way up to 3 years of age.

In general, you can probably still say that blue eye color is recessive but truthfully the color of one's eyes are controlled by a variety of genes. You'd be hard pressed to accurately predict what color eyes your child will have. You'll have to wait until she gets a bit older. Personally all three of my kids had bright blue eyes. My oldest kept hers and the two little ones now have green eyes! They are all sooo pretty!