When Doctors Get It Wrong

Mary Picket is an Associate Professor of Medicine at Oregon Health & Science University. She is also a primary care doctor, a Lecturer for Harvard Medical School and a Senior Medical Editor for Harvard Health Publications. So she knows a thing or two about health.

She is also the mother of a very active six year old young boy named Casey.

Neither Dr. Picket, her husband nor her pediatrician were ever concerned about Casey’s “choosy eating”. “Casey certainly has always taken in adequate calories. He is a bundle of energy, usually climbing across our furniture or racing around our home. What calories he misses at mealtime, he has always made up for by drinking milk”.

That All Changed
“In the second half of his kindergarten year, his learning curve flattened and he stopped showing interest in learning how to read. He stopped listening well at school, sometimes gazing off in a trance, or fidgeting badly during quiet times, incapable of paying attention. At other times he was dramatically hyperactive, disrupting the class or racing up and down trees and around his school. He was impulsive at home—hitting his baby brother over the head after only minor provocations.”

Casey showed all the signs of ADHD. In fact, the psychologist Dr. Picket took him to said, “I have never seen a rating scale like Casey’s from his teachers. He scored at the most extreme level for almost every question.”

Dr. Picket had also noticed Casey was regressing in the home. “He began sleeping in our bed again, he began to chew on Kleenex tissues instead of blowing his nose with them, and he chewed on small parts from his toys, like the tires from his Lego cars. He also began to chew the sleeves and the collars of his shirts, soaking his front with saliva and shredding his shirts as he chewed.” Therein was a clue to what was going on. As Dr. Picket said, “this chewing was not a typical part of ADHD. In fact, it was bizarre.”

Iron Deficiency or ADHD?

Being a primary care physician, Dr. Picket was aware that when someone has an iron deficiency they will often develop strange cravings.  For example, ice chewing is a symptom of a possible iron deficiency. So is Pica. (Pica is characterized by the eating of non food items such as paint chips). Low iron can also cause things such as restless legs syndrome.

But is there a relationship between ADHD and low iron? Well, yes. Children with ADHD generally have lower than normal levels of iron. Some have much lower levels.

Once the iron levels are brought back to normal these children show improvement in their ADHD symptoms. They become less hyper and are able to focus better.

However that doesn’t mean parents should start supplementing their ADHD children with iron. You should have your child tested and followed by a competent professional. Iron supplementation does not help children who have normal iron levels. In fact, it can be extremely dangerous and even lead to death.

For me the interesting part of this story is the relationship between picky eating and iron deficiency.

Many of the children I see who have the diagnosis of ADHD are also picky eaters.  Children who do not eat a variety of foods can become iron deficient.

Look at Nutrition First
The advice I give parents of children who have behavioral challenges is, “look at nutrition first”.  It is not uncommon for a child to get enough calories to grow but not enough nutrition to be healthy. This is a mistake I see pediatricians and parents make often. It is very easy to fall into the “something is better than nothing” trap. Unfortunately this is how children end up with nutritional deficiencies.

Counting on something such as milk to make up the difference doesn’t work. Children need to be eating the natural colors of the rainbow (artificial colors don’t count). Parents gasp when they see the food their children should be eating in comparison to what they are.

Understandably parents don’t want to spend their mealtime’s battling with their children. However, they don’t want their children to be unhealthy either. With more and more problems being linked to diet we are left with the choice to either deal with a little aggravation while teaching our children to eat healthy, or risk the side effects of an unhealthy diet.

Major Problems Arise
Having spent so many years working with picky and problem eaters I know that problems are often ignored until a major problem arises such as a medical issue.

Unfortunately once this happens parents find themselves caught in a whirlwind of emotion trying to get caught up. Some never do. It’s easier to deal with the picky eating before it gets to this point.

This is when strategies to combat picky eating come in handy.  The strategies vary depending on the child and whether he is a picky eater or a problem eater.  However, becoming a healthy eater is often one of the most helpful things that can be done.

Read Mary Picket’s article “For Some Kids, ADHD Behavior Is a Sign of Low Iron

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Isa Marrs is the Founder and Executive Director of the Where I Can Be Me® social skills program. She is a board-certified speech-language pathologist who specializes in pragmatic language (social skills) disorders in children. Read More