Jake

By eight months of age with the onset of walking, Jake began screaming and whining when frustrated. By 21 months of age he developed a significant sleep problem. According to his mother, "nothing helps his behavior--either a positive or negative approach." His pediatrician described him as a "typical boy--terrible two's." Ritalin was started even up to triple the typical dose for a 5-year-old but was stopped after one week because it did not help his hyperactivity.

Previous evaluations included the recommendation for a parenting skills class, a developmental evaluation, and allergy testing which was completely negative for foods. Jake's mother did carry out an elimination diet which definitely improved his behavior, especially tantrums. Diet included milk only with cereal, but Jake "drinks the milk and doesn't even eat the cereal." His cravings include ketchup, chips, grape and apple juice.

Physical examination was within normal limits except for a mildly allergic appearance to the nasal turbinates. The keys to the history of an allergy/behavior connection include frequent loose bowel movement, history of recurrent ear infections, positive response to an elimination diet, and Jekyll and Hyde type behavior. It was my observation at the initial evaluation that this was a child completely out of control with a very capable mother.

At the time of the initial evaluation, I recommended the elimination of milk, grape and apple juice, potato chips, tomato and a reduction in wheat intake.

At the follow-up visit three months later, the interview started with Jake's mother saying "thank you for giving me back my baby." This child was so calm and under control that I had to look at my initial office notes to realize that this was the same child. Jake's mother had removed the craved foods that I recommended and also started food immunotherapy for 19 allergic foods.

The response was absolutely dramatic. He was described as being more in control, pleasant and you can reason with him. His diet also was changed based on the allergy testing to eliminate pork, and to continue restricting tomato, potato chips, milk, grape and apple juice.

Other improved medical problems included his speech being easier to understand, firm bowel movements, decreased aggressiveness, crying and an improved attention span. Prior to being a patient in my office, Jake was constantly eating. This has markedly decreased.

At the next follow-up visit seven months after the initial evaluation, Jake continued on the same diet and was described as being "pleasant, rational and more in control."

This child represents a wonderful example of an out of control child whose behavior is directly affected by what he ingests. Without his mother's intervention in seeking out an allergy evaluation, this child was headed for marked difficulty in his relationships with friends, family and eventually in school. The fact that he did not respond to high dose Ritalin points out that for this child, medication was not the answer.

The key to the child showing such dramatic improvement in so short of time was the fact that the mother knew Jake's history well. I listened and interpreted what approach might be of benefit. Once again, listening, using common sense and clinical judgment, as well as looking for underlying reasons has resulted in an excellent medical result.

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