Pediatric Neurology and Gluten-Free Diets.

 

    I am now working and studying in the pediatric section of neurology. The good news is that it has basically nothing to do with Alzheimer's, which totally freaks me out. The bad news is that it has everything to do with parents who are trying to milk the system for everything it is worth and to have their offspring diagnosed with all sort of conditions for financial gain or for educational advantages. Usually it's educational advantages the parents seek. 

    One parent brought her eight-year-old child for a neurological evaluation. The exam didn't yield any tremendously informative results. Based both on in-office observations and on questionnaires completed by parents, the classroom teacher, and the after-school daycare provider, it's conceivable that the child might possibly have the most slight of attention deficits, but not enough of one that the attending physician who supervises me would be comfortable prescribing even the smallest dosage of any of the medications typically used to treat attention disorders. Furthermore, my conclusion based on a single day of observing the pediatric neurologist in question is that he's not particularly reluctant to prescribe medication for ADD or ADHD. 

     The pediatric neurologist told the mother that there are doctors who would prescribe attention medication for her child but that he wasn't comfortable doing so because in her child's case, the common side effects would likely outweigh any benefits. The side effects about which he was most worried were weight loss and interaction with the child's allergy medication. which, according to the mother, absolutely needed to be taken. The child was already bordering underweight, and stimulant types of medication used to treat attention deficit disorders frequently result in decreased appetite and subsequent weight loss.

     The mother wasn't as disappointed as I thought she might be at the doctor's refusal to prescribe Ritalin or another of the stimulant medications commonly prescribed for attention deficit disorders. (Non-stimulant medications are on the market but are less effective and present more harmful side effects.) I'm not certain precisely what the mother's actual objectives were in bringing her child to a pediatric neurologist. It surprised me that she didn't argue that point more. 

     As the appointment was winding down and the mother and child were practically out the door of the exam room, the mother mentioned to the doctor that the entire family was sensitive to gluten and that she needed a physician's directive so that the school would be forced to provide gluten-free breakfasts and lunches for her child. The neurologist told the mother that any directive from him ordering a special diet would be questioned and rightly so, as neurology and adverse reactions to gluten were for practical purposes mutually exclusive.

     The mother took exception to this and insisted that any medical doctor could prescribe a gluten-free diet for a child and that the school had no recourse but to adhere to the directive. The pediatric neurologist then told her that it shouldn't be any big deal to ask the doctor who diagnosed the gluten sensitivity to prescribe any special diet that was medically necessary. The mother then said that she herself had diagnosed the gluten sensitivity, to which she referred as Celiac Disease.  She had already done the hard work, she said. She merely needed a doctor to agree with her so that appropriate meals would be provided for her child. 

     In my opinion, the insistence upon  gluten-free products is a silly fad. Celiac Disease obviously exists in some people, as does other forms of gluten sensitivity in a relatively few people,  but not in the sheer numbers of people who claim it. What a person does or does not eat or provide to his or her children to eat is the person's own business as long as the person does not place a burden upon others to humor him or her in regard to adherence to whatever self-imposed diet the person has chosen. Asking a doctor to make a diagnosis out of his or her specialty in order to ask the school to go to extra trouble in accommodating the a child's diet when no evidence that it is medically necessary is placing an undue burden on both the physician and the school, in my opinion. 

     The doctor apparently shares my opinion. The mother pled her case for a full five minutes to no avail. my attending physician finally had to move onto his next patient in the middle of the mother's argument as to why the neurologist needed to prescribe the gluten-free diet. "How rude!" the mother exclaimed as she gathered her belongings and left with her child. As the mother pled her case to the receptionist, which was an exercise in futility as the receptionist had no power to authorize a gluten-free diet or anything else, the kid reached into the mother's oversized bag and pulled out a Hostess Ho Ho box. The child  removed a cellophane twin pack of the Ho Hos, ripped the cellophane with her incisors, and shoved a Ho Ho into her mouth. 

     I was too quick for her, though. I reached for the Ho Ho, pulled it out of the kid's mouth before she could take a bite of it, and exclaimed, "You can't have that! It has tons of gluten in it!"  If looks from either parents or their offspring could kill, i would be six feet under.