Working with Children in Your Herbal Medicine Practice: Thoughts for Practitioners and Students

I began my journey with herbal medicine at the same time that I began my journey of motherhood.  Birthwork come closely on the heels of parenting and herbal work.  I gratefully remember every tidbit of information specific to treating babies and children that I learned from my early teachers of herbalism and for the writings of herbalist like Aviva Romm and Anne McIntyre who wrote fine books on these topics. When I began expanding my herbalism outside of the small circle of my family and close friends, the first class I taught was Herbs for Children’s Health, a class I still offer periodically.  Like most herbalists I know, who make a living practicing herbalism, I was trained and practice as a generalist.  I will see just about anyone and am willing to talk about just about any problem, but as a homebirth midwife and traditional Western Herbalist I have carved out a little niche for myself working with babies and children and teaching parents, herbal students and other practitioners about the unique health needs of babies and children and how to use herbs for and with them. I estimate that about one-quarter of my clients are little ones and in this article I will share with you some little tidbits I hope are helpful in preparing for and working with little ones and their parents in your herbal practice.

Get Ready, Get Set:  Crawlers, Roamers, Explorers, Toys and Tantrums (And Maybe Snacks)

If you don’t have children yourself or you don’t see many children in your practice, having toddlers and little children around can throw you out of your groove and feel a little disruptive.   It is true that working with little ones requires some flexibility on your part.

more foolishness

I schedule shorter appointments for individual children.  By virtue of not having lived as long, their stories are typically shorter we don’t need the same amount of time for intake. In my practice it is most often the mother who brings in her child. She may also bring her other children with her.   I typically spend the initial minutes of the consultation talking with the mother about what’s going on with her child.    When you practice Traditional Western Herbalism and you are used to getting lots and lots of information from your client about what it is like to live in their bodies, it is challenging to look at a little child, say 2 or 3, who has some significant health issues but can’t verbally explain to you what he or she is feeling.  You have to rely on the mother’s observations. Mama will tell you why she’s brought her little one to see you, but I always make sure that by the time we have finished talking I have asked her about sleep, mood and temperament, energy level, any history of accidents or infectious illnesses, the skin, allergies, digestion, elimination (both bowel movements and urination as she observes it), respiratory health, how often her child gets sick and what that is typically like I ask follow up questions whenever necessary.  I usually ask the mother her if she feels that her child is hot or cold, how her child sweats, what color or how concentrated the child’s urine is and if she has commonly noticed (or been told by a physician) that her child has swollen glands or tonsils? I find those particular questions to yield very helpful bits of information in assessing the child’s constitution or energetic pattern.  These questions get me thinking about hot and cold, damp and dry, a periphery that may need to be opened and relaxed or astringed, whether or not lymphagogues may be in order.  Mom may not have the answer to all of those questions and that’s ok.  She will probably think about them going forward and have an answer for you next time.  It’s also a wonderful starting point for a conversation with her that illuminates your truly holistic (not just natural) approach to health care.  If your client is a little bit older, you may try asking them questions directly. With older children I gauge their interest level in talking with me and adjust accordingly.  Remember that maturity level can vary greatly. There are some seven year olds who will gladly sit and answer your questions and others would much rather play with toys.  For older children and teens (or any child who shows interest in the interview) gear your questions directly to them and not to their mother. Honor their personhood. Sometimes when I know a woman is bringing in an older child I may ask her to email me any information that may be potentially embarrassing or discomfiting to the older child. I also speak communicate directly to older children how normal and common certain problems and affirm the young person’s health and wholeness whenever I can.  I believe that a young person, or any person for that matter, should not leave a consultation with me feeling that they are broken and maybe I will fix them.

During this interview time hopefully our little friend is playing with the toys I keep in my consultation space.  It is very helpful to prepare a basket or bin with toys for your young clients.   If you are fortunate enough to have a large consultation space or clinic, consider having a corner or area devoted to children’s toys for different ages. This is really worth your small investment in money and space.  The toys feel welcoming to the child, it also usually buys you and the mom a little time and space to talk without a bored and/or apprehensive kid doing what bored and apprehensive kids do, (which is usually bug their mothers in ways characteristic to their ages and personalities).  Some kids are not interested in your lovely toy basket (sorry!). Some very little people have just learned to walk and crawl and they would like to walk and crawl all around your office or home and maybe rip the pages out of a magazine or pulls some books off the shelf.  Bold, curious, confident children of all ages have no qualms about checking out the rest of the house. These young extraverts may also have a lot of questions about your space.   Little kids also graze all day. That’s just what they do.  Moms are usually prepared for this and may have brought snacks.  These snacks may end up on your floor.  Sometimes mom doesn’t bring snacks and it’s almost lunch time. Sometimes junior has already toured your kitchen and has spotted the bananas on the counter, or opened the cupboard.  If it’s ok with mom, let him have a snack. Diapers may need to be changed mid consultation.  Babies may need to nurse.  If all this sounds like kind of a pain in the butt, think of it this way:  being a parent is hard, your hospitable gestures to this family is your gift as a person who serves, being generous of spirit will make you feel good and I promise it will not go unnoticed.    Moms talk to other moms—a lot— and if going to the herbalist is a fun and pleasant experience you will get referrals. I sometimes serve whole groups of moms where all the friends in the group see me, or lots of families from the same neighborhood, homeschool co-op or church.  At the end of the day, it’s good for business.

Tongue Assessment and Small People

Tongue Coat: The coat is primarily thin but is somewhat yellow towards the center/back.

After the intake interview I usually observe and assess the tongue. Many Western herbalists use tongue assessment. This is just as valuable with little ones as with adults. Virtually every child fours old and older will show you his tongue when asked.  Most three year olds will as well. With children under three this can be hit or miss.  If the toddler is apprehensive or timid, try lightening the mood and make yourself as non- threatening as possible.   Get down on the floor. Act silly. Stick out your own tongue. Get a mirror and offer to show the child his or her tongue in the mirror. Have mom stick out her tongue.  Smile a lot with sincerity. If the toddler doesn’t respond to your overtures and seems determined not to stick out her tongue, don’t push it. Respect her boundaries.  You will simply have to work without this information, relying more on your knowledge of the materia medica.  Remember that you can also gather some useful information about a child’s energetic patterns or constitution with the type of careful questioning and observations described in the previous section. You can visualize the redness and inflammation, duskiness in the complexion, pallor. You can ask to touch the child’s hand and feel for yourself the moisture level in the skin.

Be aware that babies one year of age and younger most often exhibit the tissue state described by Matthew Wood as damp/relaxed.  The whole system seems relaxed and prone to discharge.  They are soft and doughy.  The tongue is very wet with copious saliva.  They most often have dilute, copious urine (some moms using cloth diapers change them up to twelve times daily).  They drool, spit up, have loose stools, pee all the time.  I have come to view this as not pathological dampness but normal human baby physiological dampness. I don’t know what purpose it serves and would be very interested in the theories of others herbalists, but I am quite confident that it is normal. Of much greater concern to me is the less typical baby with a dry tongue.

Pulse Testing and the Younger Crowd

I utilize pulse testing as a final aid in my attempts to match an herb or herbs with an individual. This is a non-diagnostic practice taught to me by Lise Wolff and Matthew Wood, where I attempt to let the client’s body lead the way, revealing what it likes, what it would prefer to work on, what feels good, restores the flow, and what has the potential to transform.  I pulse test babies and young toddlers in their mother’s arms.  I view the mother-babe as an energetic unit. Sometimes I test the child’s pulse directly while being held by the mother. Sometimes if the child is fearful or rejects the touch of a stranger or is simply too squirmy, I test the mother while she holds the child or even while she breastfeeds the child.  In my mind there is no clear cut-off moment at which time a child becomes separate from the mother,  although it is very fascinating to consider those boundaries and how they may affect pulse testing.  I sometimes wonder if a remedy is really a remedy that is more for the mother.  The bold, confident and brave child announces his own energetic independence by his own choice to simply hop up on the chair to be tested.  If the child is reticent or hesitant, I acknowledge his preference to remain connected to his mother during this process.  Again, you may need to remain flexible during this time. Be prepared to get down on the floor if you have to. Have some toys or books that the caregiver can show the child to distract them.  Be very selective in your remedies. You may only have a minute or two. Your little client may not have the patience to wait for you to test 30 different remedies in many combinations.  Be decisive. Give your gut instincts free reign.  Some little children feel very compelled to put their fingers in the drops of tincture.  Try giving the child the tissue and letting her wipe off the drops.  Some young children are very sensitive, just as some adults are very sensitive. Some children are able to articulate their feelings about certain herbs. The child may tell you that a particular herb feels good or feels bad. Listen to this as you would listen to it with an adult.  With older children and teens you can usually proceed with pulse testing just as you would with an adult.

Acute Care

In my practice I provide a lot of acute care to babies and children including care during fever, coughs, colds, sore throats, upper respiratory infections of all sorts, earaches/ear infections, thrush and other fungal infections, boils, pinkeye and the like.  I enjoy providing acute care.  It’s fun and gratifying.   Acute conditions require a little bit less of a precise determination of constitution and energetics and we have so many choices of various regional herbs and types of preparations.

The challenge is that in your capacity as a trusted adviser you will be called upon to help make the determination of when to go to the doctor.  Because one of my primary goals is empowerment of the client, I try not to allow the mother to hand authority over to me.  It can give you a boost to your ego to have someone else give you the mantle of expert and decision-maker, but ultimately it doesn’t help this mother become a more confident and competent steward of her child’s health.  I encourage you to explicitly put the decision back in her hands.  Answer questions, provide information, share your experience but listen for the feelings behind her questions.  Help her tease out what she really wants to do.  Sometimes women consult the herbalist or another natural health care practitioner really looking for someone to give them a permission slip to go the doctor. She is afraid for her child’s well-being but is conflicted about taking the child to the doctor because this makes her feel she is giving up on her natural health ideals. Mother guilt and pressure to be an ideal parent is rampant in our culture and this is especially true in idealistic natural parenting communities.   If you sense that she wants a permission slip from you, don’t be a jerk and try to talk her out of it.  Give the woman not only permission to go to the doctor with her sick little child but also give her your support and affirmation.  Tell her she should always trust her intuition.  Tell her that when she feels out of her depth, there is no shame in getting help.  Help her realize her choice is not a failure and that by walking through the door of the clinic she is not failing, nor does she have to wholeheartedly accept the physician’s view on things.  Going to a clinic to rule out something serious is a totally reasonable option. Help her formulate the questions she can ask her physician. Remind her that she does not need to have an uncomfortable conflict with her physician. She can take the prescription for antibiotics and choose not to fill it. Herbal medicine and conventional medication for acute illness are rarely incompatible. Help her make a plan to combine natural treatments and conventional treatments. She can utilize your consultation services and your products in addition to conventional care to create a individualized approach to health for her child.

If you do provide acute care or find yourself in the role of trusted advisor it is important that you are familiar with signs and symptoms that really ought to be checked out by a physician.  While this is not a comprehensive list, I would include:   an infant whose fever and lethargy makes them unwilling to feed potentially resulting in serious dehydration,  labored or rapid respirations that could be a sign of pneumonia, rash accompanied by fever. A fever and a rash could be a simple as a self-limiting case of hand, foot and mouth disease or fifths disease  or something more serious like measles or meningitis.  My rule of thumb is rash+fever= the doc should check it out!  Other symnptoms that should be assessed are  seizures or convulsions in a child who does not have a history of seizures and  blood in the stool that is not from an evident hemorrhoid.   There is no magic number on the thermometer at which a parent must take their kid to the clinic. Nor is there a magic number of days of coughing after which someone must go to the doctor. The overall impression of wellness or illness shown by a child is more important than the number on the thermometer or the number of day the child has been ill.

Educating about Normal and Teaching Acceptance

Not everything in life needs an herb.  This can be hard for herbalists to face sometimes, but it is true.  Not everything can or needs to be fixed and this is sometimes hard for the contemporary natural Mama to understand.  Some things are just kind of normal, no matter how annoying it is, or how much it stresses out mom and dad.  Babies wake a lot in the night in spite of our cultural obsession with sleeping through the night.  Babies are sometimes fussy, just like grown-ups babies sometimes feel crabby and pissed off.  They are not always allergic to something that mom ate.  A four year old boy who wets the bed, probably doesn’t have a problem, especially if his dad wet the bed too as a child.  They grow out of it.  Everybody gets sick a couple times a year.  Eight year old boys have A LOT of energy.

What does the herbalist do when faced with the possibility that the most issue is really the mom’s anxiety or unrealistic expectations? I keep three key concepts in mind when dealing with these types of situations:  empathy for the mother’s struggles, affirming the child’s wholeness, and common sense.   Let the mom know that you know it’s really hard when her baby wakes often to feed or whatever the issues is.  If the child seems really healthy, well and normal to you, convey this kindly and repeatedly if necessary and offer common sense advice and non-overwhelming steps she can take make everyone in the family feel better.  Many times has a consultation for a baby or child in my practice been expanded to include a quickie consult for mom.  Some nervines like Motherwort, Blue Vervain,  or many others can take the edge off the anxiety and tension caused by the struggles of mothering and make the whole situation a lot more manageable.

Forms of Herbal Medicine for Babies and Children

I primarily work with tinctures, even with babies and kids. I love tinctures for their potency, convenience, ease of storage and administration for the client.  I give tinctures to just about everyone over the age of one.  I feel that precision that comes from a constitutional and energetic approach with tongue assessment, pulse testing and specific indications allows me to use sublingual drop doses most of the time.  I really don’t worry about the tiny bit of alcohol, even when I use doses more in the range of .5 to 1 ml.    For acute illness, there are many more possibilities including yummy sage tea with honey, elderberry syrup, blossoms in the bathtub to treat a fever, an aromatic chest rub made with essential oils, drops for earaches.  Tiny infants are meant to be exclusively breastfed. Avoid exposing babies to any unnecessary foods, herbs or drugs during the first six months of life. Their little guts and little livers and little immune systems are just starting to get warmed up.  When herbs are necessary begin with the gentlest preparations and the lowest possible dose. Start with weak teas.  Tea should be cooled to lukewarm and given to baby in doses from 1-3 teaspoons.  In situations like colic, coughs, digestive upset, use small doses every 1-3 hours.  Herbal baths can be an effective alternative to internal use of remedies.  Baths are especially beneficial for fever or for any problem characterized by tension or emotional upset. Move to higher doses or stronger preparations when necessary for instance, I will use tinctures such as diluted Black Walnut for thrush or one or two drops of Yellow Dock for reflux.

tincture

Working with babies, children and their caregivers can be fun, gratifying and profitable for you as an herbalist although it does present some challenges.  Educate yourself on breastfeeding, normal infant behaviors, acute infections of all sorts including warning signs requiring physician consultation and chronic health issues childhood such as eczema, ADHD asthma etc. Be flexible and open in your manner and approach. Good luck!

See my companion post, A Materia Medica of Herbs for Children.

This article was originally published in Plant Healer Vol IV, Issue IV (2014).  I enthusiastically recommend  subscribing to this awesome herbal medicine publication. 

One Comment

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

%d bloggers like this: