24: Helping Digestive Troubles and Gut Health For Kids with Samina Qureshi, RD

Welcome Samina Qureshi, a Registered Dietitian specializing in gut health and digestive disorders, to the podcast! Sarah and Samina discuss the importance of identifying common digestive issues in kids, and practical tips for managing GI distress and constipation. They discuss:

• How to identify food sensitivities or digestive difficulties in kids
• High fiber sources and ways to introduce them in kids' diets
• Foods and lifestyle changes to help with constipation
• Kid-friendly ways to help with GI distress and bathroom visits
• When and how to take probiotics (this may surprise you!)
• How a varied diet can support gut health and microbiome diversity

Resources mentioned in this episode: US Probiotic Guide
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Chapters

• 0:00 Introduction to Gut Health for Kids
• 4:55 Understanding the Connection Between Eating Disorders and GI Health
• 7:29 Common Digestive Issues in Children
• 10:29 Dietary Solutions for Constipation
• 13:22 Creating a Stress-Free Bowel Routine
• 16:02 Hydration and Medical Solutions for Constipation
• 18:53 The Gut-Brain Connection and Stress Management
• 24:54 Understanding Children's GI Distress
• 32:46 Navigating Food Sensitivities and Intolerances
• 41:34 Promoting Gut Health in Children

Transcript

Sarah Schlichter (00:48)
Samina Qureshi is a registered dietician and the founder of Wholesome Start LLC, a virtual practice based in Texas. She specializes in supporting individuals navigating both disordered eating and gastrointestinal conditions, such as IBS, SIBO, chronic constipation, MASLD, GERD, functional dyspepsia, gastroparesis, and celiac disease.

As the co-author of Comprehensive Nutrition Therapy for Co-Occurring Gastrointestinal and Eating Disorders, Simina provides a guidance for clinicians treating these complex and overlapping conditions. Her weight-inclusive and culturally-respective approach to nutrition empowers clients to gain relief from their digestive systems, ditch rigid diets, and build a more peaceful relationship with food. In her free time, Simina enjoys being outdoors with her two kids, husband and dog.

I know that is quite the intro, but we do keep things pretty basic in our conversation today. And we talk a lot about how we can really focus on diversifying our kids' gut and forming a healthy gut microbiome and some things that us parents can take away too. So without further ado, let's get to the interview with Samina.

Sarah Schlichter (02:06)
Welcome back everyone. It is the start of a new week here. We are recording right after Labor Day. So I feel like a four day weekend is forever when you have kids home with you. So I'm very much looking forward to talking to our guest today who is going to talk all about gut health and everything we need to know as parents to what we should be doing to improve that, how we can

set our kids up for success in that realm. And as we head into the fall season with lots of germs around, I think this will be very timely. So I will go ahead and let our guest, Samina, introduce herself.

Samina Qureshi (02:44)
Hi everyone. Thank you for having me, Sarah. I'm so excited to chat with you all about how to keep our little safe from bugs and also just support their bugs and their ecosystem.

I'm a telehealth dietician based in Texas. I specialize in supporting people with digestive health and nourishing their body without rigid diets, guilt or shame. And I'm excited to chat today.

Sarah Schlichter (03:08)
That's great. So you and I have been, I feel like we've talked on Instagram for a long, long time, but we finally just met in person in, when was that May? We went out to Nebraska together, which was a lot of fun, but I've been following Samina for a while and I love the non-diet approach that you take with your patients and just your inclusive approach to health. think it's very...

Samina Qureshi (03:20)
Yeah.

Sarah Schlichter (03:35)
just like a breath of fresh air, especially in this day and age when we're living, but tell us how, how did you get into gut health in the first place?

Samina Qureshi (03:44)
Yeah, so I think like when we were first chatting, I had opened my private practice, but I was working part time on my private practice and full time in corporate wellness. And that was a beast. I was traveling nationally to enroll people in both health insurance as well as do a comprehensive nutrition assessment and biometrics and all this crazy stuff.

to support people in managing population health risk management and reducing risk and all that great stuff, right? And with counseling thousands of people on a variety of different conditions, what I realized was one, that everyone equates thinness to health, which I very quickly realized was not true. And that

of the people that struggled with disordered eating and the relationship with food, almost all of them that I was working with also struggled with their digestive health. And I was like, where can I get continuing education on this? So I sought out continuing education to really learn how to support people in healing their relationship with food as well as their GI health, because you simply cannot expect your digestive system to flourish if you are not nourishing yourself adequately.

Sarah Schlichter (04:54)
Totally. And I feel like those are very tricky conditions. Like, does one lead to the other or which one causes which? I mean, they seem like it can go either way, right? I they definitely, I see them hand in hand often.

Samina Qureshi (05:01)
I love that question.

You're so right. Yeah. So I think up to 98 % of those that struggle with eating disorders experience some type of GI disturbance or symptom. Right. And what we don't know, it's a chicken and egg situation. We don't know whether it be eating disorder, disorder of eating behavior caused the GI symptoms or did the GI system then with a prescribed medically necessary restrictive diet cause that

of pattern of eating that led to an eating disorder. We don't know, but we do know that they feed into each other. Right? If you have physical GI symptoms, it's going to impact the way you nourish your body and how you possibly feel about food.

Sarah Schlichter (05:43)
Mm-hmm.

Yeah, yeah, I can totally see that. And I used to work more so in this space working with clients on intuitive eating and a lot of running active clients and GI disturbances were very prevalent in that population too. And in my opinion, I think a lot of it correlated with under eating and over training and it just gets really messy. So hopefully today we can break it down and we are going to try to focus the conversation on kids. So

Samina Qureshi (06:11)
We did.

Sarah Schlichter (06:19)
Of course, we also have digestive symptoms too, and we want to flourish our GI tract as well. But I think it'll be helpful with kids in school and germs around to really focus on that. I guess leading into that, Samina, what are some problems you see or hear about when it comes to digestive health, and specifically kids these days? ⁓

Samina Qureshi (06:41)
Yeah, with kids, the number one thing that I hear is constipation. Right. And that can lead to so much discomfort for our littles. When it comes to tummy pain. They don't want to eat, And when they don't want to eat, parents man, it becomes so difficult. It's so hard. And so I think I think

Sarah Schlichter (07:01)
Mm-hmm.

Samina Qureshi (07:05)
You know, I have two children. I have a five year old and an 18 month old. So I relate to the struggles of feeding littles. It's not easy, right? And just because I'm a dietician and I know this stuff doesn't mean that my kids give me an easy time. It's hard every day. It's hard. But constipation is one that I see often and

I think you had mentioned, you know, I take an inclusive approach to nutrition. And what I mean by that is what foods can we add in that your children enjoy that will support them in meeting their hydration needs? We'll give them a little bit of that fiber, a little bit of joy and comfort so that they do want to eat that food and a little bit of variety with like taste, texture preferences as well.

And so what comes to mind is I think a lot of parents are like, my kids don't eat vegetables. That's why they're constipated. You know, there's a bunch of different ways to get fiber in your diet that doesn't have to be just like a head of broccoli on the table.

Sarah Schlichter (08:08)
Totally. And the thing that's coming to my mind is like, prunes, prune juice, because you hear that. But what are some of those high fiber or even just bowel friendly foods that we can be feeding our kids?

Samina Qureshi (08:14)
Yeah.

Yeah, so I guess I'll give you a little context on the prune juice for the listeners, right? I think it's almost like a, a wives tale, but something you've heard from many generations, if you're constipated, give your child prunes or prune juice or even yourself. The reason for that is because prunes are really high in sorbitol, which is a sugar alcohol that can help with laxation and kind of getting that bowel movement out. Other foods that are really helpful. So in research, it has shown that

two kiwi fruit a day has helped with improvements in constipation, So that means helping with just getting the bowel movement out, helping with hydration. It also offers you 100 % of your daily needs of vitamin C. So even if we are trying to avoid, you know, the icky germs from school this could be a great way to boost it up as well as meet your fiber needs.

Another one that I really like are dates. I think they're a really great option to give to children. They're very sweet. They can be very enticing. You can add peanut butter, make them in a variety of different ways to make them fun to eat. Applesauce can also help. It's hydrating. It does offer that fruit ⁓ juice and hydration as well.

I think anything really that your child enjoys. if you start to make a list and I think like, I do this because grocery shopping is hard. I have a bunch of different things to do and I need to know what I need to order that my kid is actually going to eat because if I have to throw another something new that I bought away, will be angry. Right.

Sarah Schlichter (09:59)
I think most of us

can relate.

Samina Qureshi (10:01)
Right? Like I don't want to throw food away. It really hurts me. And so I make a list, right? Like, okay, I know that my kid likes oatmeal. Oats are a great option for supporting people and meeting their fiber needs. It's gentle on the stomach. It can be made in a variety of different ways. And Sarah can tell you all the fun ways to make little, you know, oat friendly, kid friendly foods, the fun little oat balls and like

bars and all that yummy stuff that you make. But yeah, I think oats are a really big one. Chia seeds as well. You can make your own chia seed pudding if your kid is okay with that texture. You're introducing them to new tastes and textures. It can also support you in meeting your kid's omega-3 fatty acid needs as well, which is so important for that brain development.

Sarah Schlichter (10:50)
Yeah, amen to that. mean, I don't think many kids are eating fish. Mine will once in a blue moon. So the omega threes are super important. So thanks for sharing that list with us. And again, back to your approach. I like that it's what can we add more so than what can we take out?

And in terms of diet, mean, diet plays a big role, but are there any other habits that you would recommend to parents who have kids maybe dealing with constipation or just discomfort in their GI system?

Samina Qureshi (11:19)
Yeah, absolutely. We all know that weekday mornings rushing off to daycare or school are chaotic, right? What can you do to reduce that tension in the morning, the stress load, because if your baby

I'm going to call them baby because they're all babies, right? If your baby is having GI issues, whether it's constipation or any other type of sensitivity or GI symptom, we don't want to stress them out even more with just the tensions of getting ready and scarfing down food and getting on the bus or heading to school, right? And with that, what I mean is allow yourself

prep ahead for time to create a bowel routine with your child. This means sit down on the toilet two minutes, use that little toddler stool. You know, if your child has grown and they're in high school and they don't need that little potty stool anymore, keep it there. The potty stool helps to elevate their legs to proper toileting position, which allows for their pelvic floor to relax.

and help the stool kind of come down and come out a little bit more naturally without having to put so much pressure with straining. Right? So always, yes. Same way. And if your child, you know, okay, we've made the routine before we get out of the house, you have to try and use the restroom. Doesn't matter if anything comes out. Let's just see what happens. If the kid's like, no, I don't want to, I don't want to do this because yes, we all have those children.

Sarah Schlichter (12:37)
Mm-hmm. Yeah, I've heard that with adults too, right? It kind of works the same way.

Samina Qureshi (12:58)
What I like to do is play a game and this game is actually really helpful in practicing deep diaphragmatic breathing, which is known to massage the digestive tract and help it relax and contract to get that bowel movement out or just calm the digestive system as well. And so we, we have a bubble wand in the bathroom and we blow bubbles because you have to take, yeah. So as you are, you know, dipping it, your child is going to take it.

Sarah Schlichter (13:20)
Hmm. So tell us more about that.

Samina Qureshi (13:27)
Deep breath.

an exhale to blow the bubbles, it's going to help take the stress away, They're going to do something fun and exciting, take their mind off of, mommy wants me to use the restroom and I know my poop hurts, it's pointy and sharp coming out, I'm thinking, I'm not thinking about that. So if as they are sitting on the potty with the stool, as they are taking their deep breaths with the bubble wand, their, their bowel movement might just come out without

putting that strain and pressure.

Sarah Schlichter (13:59)
Yeah, I love that. And as we all know, focusing on something too much, I mean, you tell a child to do something, they're going to do the complete opposite thing that you want them to do. It's just part of growing up, right? Don't look at the red crayon or don't pick up the red crayon. I'm going to go get the red crayon and color all over the wall. So in this instance, like we are taking the focus off of something to hopefully help them.

Samina Qureshi (14:08)
Thank you.

Yeah.

you

Sarah Schlichter (14:26)
help make it less stressful, guess is what you're saying, but help them focus less. Yeah.

Samina Qureshi (14:29)
help make it less stressful. Yeah, and if my

daughter, I mean, I am gonna use my daughter, sometimes she feels the urge to use the restroom, but she's too excited and she wants to keep playing or watching the show and she'll hold it, right? But if I see that she has that urge,

Taking action when the child first has that urge is the best thing you can do to say, hey, let's pause the TV or let's pause this game. We can come right back to it and let's go use the restroom because the longer that stool or that bowel movement sits in the colon, the more water is going to be reabsorbed into the body, which makes it drier and harder and pointier and more difficult to pass and painful for your child, right? So we don't want them to hold it in.

If we can get them comfortable to have that bowel movement before school, then they don't have to think about, am I going to be able to reach behind and wipe properly at school? You know, all of the things. I have a kindergartener, so this is our first time using the restroom without mama. yeah, there's a lot of things to think about. And the quicker we are to act on that need to use the restroom, the better they'll be for preventing constipation as well.

Sarah Schlichter (15:45)
Yeah.

Yeah, and I'm thinking many parents probably have this question and I'm curious your stance. Like you go to a pediatrician and they might say drink more water or maybe eat one of the foods you listed. You know, you typically get like a paper on it, but you also might hear give them Miralax or you know some other over-the-counter type thing. So weird and I'm thinking parents like well my kid won't go. I gotta help them go so we can get out the door and and go

Samina Qureshi (16:01)
Thank you.

Sarah Schlichter (16:15)
on our way. So where do you stand with those types of, I don't even know what to call them, solutions? They're not really a solution, but where do you stand?

Samina Qureshi (16:18)
Yeah.

Just ⁓ solution. Yeah, mean,

yeah, okay. So absolutely hydration is key, right? That's something I really haven't talked about. We have to make sure that our kids are adequately hydrated before they get constipated. It's a prevention thing here with meeting all these things and it can sound very overwhelming. But if your kid is still at the age where you're going into the restroom with them,

to either wipe or make sure to wash their hands or whatever it is. I know we're trying to have these nice independent children, but sometimes we've got to do some double checks. And so if you're noticing, hey, my kids urine is really concentrated yellow. Let's start to look at that urine color and see what is their hydration status. So what we want to see with our urine, even as adults and children, is for it to be that light lemonade,

little tinge of yellow color. What we don't want to see is that dark, almost concentrated yellow, dark, almost brown color, right? That means that you're possibly already dehydrated. And so anywhere in the middle is probably a happy medium to be a little on that side. So making sure that you're you and your child are adequately hydrated is going to be key, especially as you're adding in more fiber with foods.

We want to make sure that we're not adding more kind of cars to a traffic jam with that fiber, without having that adequate hydration, because too much fiber without hydration can lead to even more constipation and being more backed up. yes, hydration is key. Doctors, think pediatricians

they do hear you out and listen and want to provide solutions. And I think that's what we have to remember with the medical community and doctors in general is that their specialty is really providing medical solutions, which include medication. And so if you're continuing to come in and say like the constipation is not getting better, it's not getting better. And they have given you these lists of foods and things to try whether your child is able to

implement those into their routine and lifestyle or things are just too crazy. Miralax and these types of laxatives that are gentle and okay to use are there for these very painful situations. My child has been crying, they can't go to sleep. Because the constipation is so bad, the stomach pain is so painful. Absolutely use the Miralax. We have to just figure out when to use it.

And once you have then gotten that relief for your child and you're like, okay, they've had like bouts of bowel movements, I think they're clear. This is your prime time to start hydrating, to start introducing this variety of foods, to add in some more fruits, to add in some more carbohydrates that can provide fiber, whether it's like white whole grain bread,

rice or quinoa or oatmeal, even the instant oatmeal's are great. Right, so just little ways to add those in because again, when it comes to constipation, it's all about prevention.

Sarah Schlichter (19:33)
that's all so helpful. And I think kind of as you differentiated, like the medical advice comes from a doctor and it shouldn't necessarily be something you're diagnosing your child with. And you also gave us so many tidbits on nutrition. I think, mean, I've even gone through and I think it's normal for all kids to go through these phases, but my two year old, we were in a really rough stage that

And maybe you can tell me how young do bad associations start? Like if there is a painful bowel movement, do they remember that going forward? So it took us a long time to get out of that constipation cycle. And I should probably even do an episode on it. The things we did, but I'm curious, is that something that kids are associated with?

Samina Qureshi (20:07)
⁓

I think it can be learned. Yeah, yeah, absolutely.

And it's just like, what are you going to do to make the experience different? Whether it's rewards, stickers, you know, extra cuddle time with mama, whatever it may be to

change the association. How did you get through that?

Sarah Schlichter (20:47)
We were pretty consistent with diet and and we drank a lot of water. We moved around so I think it was more of a mental block for him, but we did do the MiraLax for a bit. Our pediatrician guided us and said you know this is the safest option but you have to do it consistently. They have to drink it all at once not like sip on it throughout the morning.

And I think just over time it became easier and more natural, but then we were heading into potty training. So she's like, you want to fix this before you start potty training. so it was kind of like one thing led to another, but I can't pinpoint what started it. so that was an odd thing for me. And I almost felt like I should be able to figure this out, but sometimes I think kids just go through things. And with some of the, the tips you're equipping us with today,

Samina Qureshi (21:28)
Okay, yeah.

Sarah Schlichter (21:35)
I especially like that bubble blowing trick to just try to keep them calm. And if you're stressed about it, which I was stressed about it, they're going to be stressed, right? They pick up on that. any other tips, I guess, for parents who might be stressed about their children's bowel habits?

Samina Qureshi (21:47)
Yeah. Yeah, I think, I mean, we're talking

about stress now, and I think it's a good time to bring up this gut brain access, right, which is we all have this neural pathway that connects our gut and our brain. And it's a bi-directional communication where our gut

Our gut communicates with our brain and our brain communicates with our gut. So if we are having these feelings of stress, it's absolutely going to impact our digestive system and how it functions and the symptoms that you experience. then those symptoms, just like you said with your, two year old kind of associating those symptoms then with what's going to come and kind of being scared and all of that stuff can impact your mood and how you feel and

it can be this vicious cycle. And so one thing, if you're noticing heightened just feelings about, okay, this is another thing that we have to manage and figure out as a family, I cannot stress deep diaphragmatic breathing enough. And so if you want to, we can do a little practice. This can be for adults or children.

⁓ with my daughter, what I like to do if we don't have the bubble wand is, and this is just really silly. It's just me and my daughter are very silly. So I inhale for four counts and I kind of put my hand like make a circle over my mouth. And as I'm inhaling and exhaling, I make a bubble. And once I blow the bubble all the way out, my hands reach the top, go, and it kind of.

deflates and flies away. I'll kind of, what it means in an essence is deep inhale for four counts, exhale for four counts. All right, so we can try that together and I'll count off. Okay, ready, set, go. Inhale, two, three, four, exhale, two, three, four. And for my adult patients, you know, I would like them to sit on the toilet.

Sarah Schlichter (23:40)
Okay.

Samina Qureshi (23:56)
practice that, obviously, without getting lightheaded. So it's not a constant deep inhalation and exhalation. It's just as natural as you feel without getting lightheaded. And for children, that's where that bubble blowing kind of comes in. And so if you're feeling stressed or anxious, this could be something that you can do that nobody will know you're doing to just kind of calm your nervous system.

Sarah Schlichter (24:22)
Yeah. And I think even just doing it here, it really does force you to just kind of be present and put those thoughts aside for just a minute. Like you're activating that parasympathetic state, right? It's just kind of forcing you to slow down and relax. So I think those tools can be great. My two year old, actually my, one of my older daughters was having some sort of crisis and was very upset about something. And my two year old,

Samina Qureshi (24:36)
Exactly.

Sarah Schlichter (24:52)
said, you have to breathe. And it was so funny to hear him recite that because we do say that in our house, like, let's go take a deep breath. So kids can learn it, right? I mean, they do pick up on that. So I also think it helps to have you as the parent or the caretaker guiding them through it and doing it along with them.

Samina Qureshi (24:55)
So.

Yeah.

Yeah, distractions are also very helpful, right? If you do have that child that has the aversion of going to the restroom because it's pokey and painful, can you put on a puppet show? Can you do something to take their mind off of, I'm using the toilet? And I think bubbles, bubbles are just like fun for everybody who doesn't want to pop bubbles.

Sarah Schlichter (25:33)
Yeah,

totally. So I guess we might have skipped over this, but I did hear you kind of mention, afraid of that painfulness or maybe their stomach's hurting. But what are some symptoms that parents could be on the lookout for that their child may be having some discomfort for GI?

Samina Qureshi (25:51)
Yeah, I mean, there's a variety of different conditions, whether it's like reflux, that can be a really hard one. Constipation, just stomach pain. ⁓ If you're noticing, and I'll talk a little bit more about like some red flags, So if you're ever seeing constant diarrhea, and what I mean by this is like very watery, the stool, has no texture, it's clear brown.

No food particles, just water after every time they eat. Definitely want to talk to the doctor about that. With diarrhea, it's really important for that child not to get dehydrated. So making sure that with all of that liquid that's lost, they're replenishing that. And then anytime you're seeing when you go to the pediatrician that their growth chart is kind of trending down, that they're having growth restriction or

just differences in their trends. You want to say like, well, they're eating fine, but I have noticed their stomach is upset or they're having pain and things like that. These are not things to be ignored. You can absolutely set up an appointment with your pediatrician and just talk through these things and say like, Hey, do you think something else could be going on? Cause you recommended Insure, you recommended getting the boost.

options to add more nutrition to my child's diet. We've absolutely done that and they're so on board. We're doing everything and we're not noticing anything change and they're still complaining of this GI distress, whether it's stomach pain, problems with using the restroom too much or not enough, blood in the stool, anything like that. We definitely want to talk to your doctor, especially if it's

It's accompanied by changes in their growth chart.

Sarah Schlichter (27:35)
Yeah, that's good to know. And obviously younger kids are seeing the doctor more regularly than older kids for their checkups, but older kids are able to probably communicate some of those things a little bit more easily too. So I think it's just good to be honed in on bowel habits for kids. know, for younger kids, you're probably seeing all of it anyway, but I'm pretty curious about

Samina Qureshi (27:42)
That's true.

Sarah Schlichter (27:59)
How do parents know if and when there could be a sensitivity or an intolerance? And is that something that the doctor, the pediatrician would then recommend? How does that look?

Samina Qureshi (28:12)
Yeah, sensitivities and intolerances. mean, that should be addressed with your pediatrician and they should be referring you to an allergist right away. Right? I have a really good friend who's the allergist here at Texas Children's in Houston. And there's a lot of misinformation out there with

with intolerances or sensitivities. And so don't take one of these at home tests as your ticket to say, hey, my kid is sensitive to X, Y, and Z. The doctor will believe the symptoms that you're experiencing. The dietician will believe your child's symptoms. We don't need an extra test that has no validity.

and for you to waste hundreds of dollars about. Yes, go ahead.

Sarah Schlichter (28:55)
And you're talking about, yeah,

I was going to say you're talking about the tests that show like the IgE's, is that right? And we don't have to like get the IgG. Okay. So for parents, so that's like the immunoglobulin G.

Samina Qureshi (29:04)
the IGG.

wait, yes. Yes, that's the IGG.

Yes, yes. So these are from different companies and they'll say like, submit your saliva to this company. And they'll tell you which foods you're sensitive to. And that sounds very promising because then you can just say, I'm going to cut out all these foods for my child, but

What happens when most of the foods that your child is eating are on that list?

How are you going to rebuild their diet to support meeting their nutritional needs, to make sure that they have enough energy to concentrate and school and grow and do all the activities that they love doing? And are those food restrictions even necessary? Right, so it's always important first and foremost, go to your pediatrician if you suspect food intolerances, they will refer you to an allergist. An allergist will hopefully have a contact with a dietician for you to partner with.

Sarah Schlichter (29:49)
Mm-hmm.

Samina Qureshi (30:08)
because there they can truly test with proper allergy testing. And I will even say the allergist friend of mine who told me this, allergy testing is not an exact science. It is accompanied by your child's experience. So understanding and learning their symptoms as well. And with their clinical experience, the doctor is able to then

diagnose and understand what's going on.

Sarah Schlichter (30:35)
Mm-hmm.

Yeah, I mean, I was going to say the same thing. just, they can also, a dietician can also help you fill those nutrition voids, right? And say, here are some complimentary foods that also offer calcium, iron, you know, fill in the blank. So, so that piece, I think is super important. so if you are overwhelmed, try not to do this by yourself. Again, as Samina said, it should be done in association with your pediatrician who then refers you to an allergist.

Samina Qureshi (30:46)
Absolutely.

Mm-hmm.

Sarah Schlichter (31:05)
And I'm also thinking if parents really are questioning this, maybe having like some sort of chart to kind of say, you know, my child eats dairy and experiences these symptoms, like having it written down so they know it's kind of not just a one time thing, because as you've already mentioned earlier, just a child being stressed could be the root cause of some of this GI distress.

Samina Qureshi (31:12)
Okay.

Yeah,

absolutely. think having a food and symptom journal could be really helpful for you to do as the parent, right? So if you're saying, okay, every day after breakfast, I give my child a granola bar and a glass of milk straight to the bathroom diarrhea, right? Or vomiting or unable to use the restroom, whatever it is, just blogging these symptoms and see if you see any trends. I think one off

You know, anytime our child is sick, the parents, we get very heightened, right? Our red flags go off and we're like, woo, how can we come in to protect this child and save them and make sure everything's okay? That's amazing, right? But what can we do to take a step back and really look at the data if we have it? This happened once, let's see if it happens again. Let's see if we can.

track any patterns so that we can take this information to the doctor and say, I've noticed this. And is there any further testing that we can get to determine lactose intolerance, to determine celiac disease, to see X, Y, and Z, right? And if they need to be referred to a pediatric gastroenterologist then that's also an option.

Sarah Schlichter (32:45)
Okay, so now that we have all of this information, I think it'd be helpful to talk about what can we do to kind of better our gut health. So aside from maybe food sensitivities, but more so just focusing on everyday gut health for our kids. How can we be promoting that microbiome? I know there is so much on probiotics for kids. I see ads on my Instagram all the time.

So can you talk to us about that and should kids be taking them and if so, are there more effective strains? ⁓

Samina Qureshi (33:21)
Yes, so I'm going to say something that may blow your mind to the listeners. Maybe Sarah already knows, but probiotics are not something that anybody needs to take long-term willy-nilly.

They're not like, ooh, let me just take this probiotic multivitamin strain for my gut and everything's going to be okay. Nobody should really be doing that. Probiotics, if you need to take them, you're taking a specific strain and dose to help with a specific symptom.

So just.

Sarah Schlichter (33:50)
I think that is eye-opening

for a lot of people because they think just as part of their multivitamin, I should be taking my probiotic every day.

Samina Qureshi (33:58)
Yeah, no, that's unnecessary and too much of a good thing in this case can absolutely impact your symptoms and make them worse or even start something that wasn't there before.

Sarah Schlichter (34:09)
Can you tell us a little bit more about that?

Samina Qureshi (34:11)
so we all have probiotics from when we were born on our skin, in our bodies, in our digestive tract. And if we want to support them, the best thing we can do is eat a variety of foods. Right? And this doesn't mean that every single day you have to eat like 30 different types of fruits and vegetables and grains and all of these things. It really comes down to like

just naturally eating with the seasons. I see in the grocery store, cherries are on sale because it's cherry season. I'm gonna grab a bag of cherries. seem to be, you know, my children like them. It's great. it's apple season. We're gonna switch to apples now. look, the cauliflower looks really good. So it's just getting that variety when you can and what fits your budget and access to food as well. It also means

switching it up. I know our kids are creatures of habits. When it comes to routine, we like to stick to it. It's easy. We don't want to change things up, but it does mean that trying something different at home for breakfast, lunch, dinner, or snacks, even if it's not the main meal, but having something different on the table to just see if your children looks at it, smells it, says something about it, touches it, licks it, eventually takes a bite.

Sarah Schlichter (35:33)
All

those things we talk about with picky eaters, repetitive exposure, right?

Samina Qureshi (35:37)
Uh huh.

Yeah, that repetitive exposure and just saying like, Oh, this is normal to have these little mini bell peppers on the table before dinner to see like if anyone wants a snack or just crunch on something crunchy. Let's see who wants the yellow one who wants an orange one who wants the red one, right? Which color do you want today? Make it fun. So add variety where you can. And when you can, we know it's difficult. And

Sarah Schlichter (35:49)
Mm-hmm.

Samina Qureshi (36:05)
When it comes to probiotics, you can absolutely get them from food form. We don't need to rely on supplements. So you can get them from fermented dairy sources. You can get them from yogurt, kefir, cottage cheese even has it these days. I Good Culture is a brand. know, not sponsored, but there's a variety of them. Yes, so we've cut

Sarah Schlichter (36:27)
Mm-hmm. And cottage cheese is just in its moment of extreme growth right now,

Samina Qureshi (36:32)
Codder cheese is everything. And there's a variety of different options, right? If you don't like dairy, there's non-dairy options, there's sauerkraut or kimchi. There's a lot of cultural dishes that are pickled that may not have the live active cultures written on there because that's just not what they do, but they may have probiotics in there. yeah.

Eating a variety of foods, getting probiotics from food as well could be a great option for you. And then staying hydrated, getting enough sleep, trying to reduce the stress, moving your body in fun ways, all of the things that we try to do to support your health.

Sarah Schlichter (37:12)
Yeah, I think that's so helpful. So it sounds like you're saying obviously the biggest part of the biggest piece of the puzzle is the child's diet and in day in day out. So if we can introduce variety, we are already introducing new forms of prebiotics, some probiotics. So all of that is going to do its job. So I have two questions and I don't know the first one. I don't know if you'll know the answer. Maybe you will. Is yogurt or the fermented foods

Samina Qureshi (37:28)
Yes.

Sarah Schlichter (37:41)
Is that enough? Like for a child in their probiotic needs? Is that enough if they're just eating that during the day?

Samina Qureshi (37:49)
Yeah, yeah, we don't need to overblast them.

Sarah Schlichter (37:51)
more than enough. Okay.

Second question, it sounds like, we don't need to be kind of over killing this and maybe it's situational.

Samina Qureshi (38:17)
Yeah.

Sarah Schlichter (38:01)
Like maybe we're getting ready to go on a trip and we know that digestion is a lot harder when we're away from home or maybe it's a stressful season for my kiddo. He's starting kindergarten, you know, like fill in the blank as a parent. You, that might be a time where you could use this tool, but to your point, it's not something you're taking every day for the rest

of your kid's life, like it may be let's do this for a week or a month and then we can reevaluate

Samina Qureshi (38:28)
Yeah.

Sarah Schlichter (38:29)
or switch it up. Is that kind of how you would describe it?

Samina Qureshi (38:32)
Yeah, absolutely. And this is a tool that I'm going to let you know about that I use as a dietitian to see which probiotics I should recommend for certain symptoms. If you're a parent or other dietitian or health practitioner looking here, listening here, us probiotic guide.com is the Holy grail of where to find adult and pediatric

even vaginal health, know, probiotic information. It tells you the exact probiotic strain that you should be looking for for constipation, for IBS, for antibiotic associated diarrhea prevention, for C. diff, right? For a variety of different things that you or your children may be struggling with. And then it provides a brand name of which one you should get that has those strains and doses in there.

Sarah Schlichter (39:20)
So that way you are taking a targeted approach and it's not like just a one size fits all thing because we know there are so many options and to your point earlier, you could actually be doing more harm if you're getting too much of one that you don't necessarily need.

Samina Qureshi (39:24)
Yes.

Yeah, and what I mean by that is, let's say for example, your child is constipated, right? They haven't had a bowel movement in two weeks. It's just sitting there. It's continuing to pack in, pack in, pack in. We don't want the good bacteria, even if it's good, going up into your child's digestive system, out of the small intestines, into the stomach.

into the esophagus, right? We don't want small intestinal like bacterial overgrowth to happen. So if you're constipated and then you're taking probiotics on top of that, yes, there are certain probiotics that may help with constipation. That's not what I'm saying, but we don't want to take these multi-strain random concoction of billions of probiotics and take them forever because

Too much maybe, too much.

Sarah Schlichter (40:27)
Yeah, and then once you fix that constipation, you're still taking the same ones, right? And then maybe for another issue, you're still taking the same ones.

Samina Qureshi (40:32)
Yeah.

the issue has resolved, you definitely want to discontinue. Like you don't need to survive off of just taking that probiotic. Your body will adjust and you know, you will add in these variety of foods, hydration movement, rest, et cetera, so that your digestive system can function optimally for your trials.

Sarah Schlichter (40:56)
And hopefully that's helpful for parents to know they don't have to be spending a ton of money every month on these probiotics, because it can get pricey, especially if you're buying all the different kinds of strains or trying everything. So it sounds like Samina is trying to help us simplify it a little bit. Let's look at the diet. Let's look at the root cause, the patient in front of us before kind of adding on all of these interventions.

Samina Qureshi (41:15)
you

Yes, I love that word, simplified, because while we guess we want to include more things, sometimes supplements are not necessary to the extent we think they are.

Sarah Schlichter (41:33)
Okay, Samina, this episode has been so, so helpful. So in summary, what is the thing parents should do if stress about GI disturbances or symptoms are creeping in this time of year and they want to handle it correctly? What is something that parents can do moving forward?

Samina Qureshi (41:54)
Yeah, with the plethora of information we have access to, it can be really overwhelming. So I think to streamline the process, make sure that you're doing the best thing for your child, making sure that you are tracking symptoms and taking this information to your pediatric dietician, as well as

pediatrician, their doctor can be really helpful in piecing together this information to provide a solution for you guys. Right? If you then need a referral to an allergist or a pediatric GI doctor, awesome. Then you then have another avenue to go to. But doing it alone, it can be very overwhelming. So please get the support you need.

Sarah Schlichter (42:33)
Well, thank you so much for your time and tell us how people can follow you, they can reach out if they want to learn more about you, where can they go?

Samina Qureshi (42:42)
Yeah, so I am on Instagram. If you guys want to follow me, I'm inclusive.ibs.dietician and my website is www.wholesomestart.com. I'm here to support you in finding relief from your GI distress without rigid diets, stress, guilt, or shame.

Sarah Schlichter (43:04)
And we will have all of that in the show notes as well as that US probiotic website that Samina mentioned. So yeah, if you have any questions, she is the expert. So make sure you reach out to her. Thank you, Samina.

Samina Qureshi (43:18)
Thanks for having me.