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and acquiring the knowledge of what’s good and bad, overall, for their children’s diets. Despite these challenges, though, it’s crucial that children start eating well early, to maintain good gut health. Ms McGrice says health issues that can arise from poor gut health include constipation and diarrhoea, which “lead to embarrassment and toileting issues for children”, and the impact of gut health on the gut microbiota, which in turn impacts the gut-brain axis to influence “mental health, immunity and learning abilities”. Pharmacist proprietor Jana Pratico says the cause of “poorer” gut health in some children could be nutritional issues such as absorption and specific nutrient deficiency problems, or simply a lower quality diet. “Consequently, having a less diverse gut microbiome can predispose children to future absorptive or nutritional issues, as well as autoimmune and inflammatory disorders,” she said. In pharmacy, a variety of products are targeted at children and gut health. However, the first step is ensuring that a child’s diet is adequate to meet their dietary needs, ahead of considering medication or other products. Strengthening immunity During the COVID-19 crisis, people categorised as being at high risk of serious infection include the elderly and those with diagnosed chronic medical conditions, and also those with weakened immune systems.1 “As having a healthy and diverse microbiome is important to overall immunity, maintaining a healthy gut may assist in reducing a child’s risk of contracting COVID-19,” Ms Pratico said. The microbiota is tightly linked with the immune system, therefore influences the immune function greatly. Ms McGrice says a healthy link between the microbiota and the immune system depends on key nutrients being absorbed in the gut: “carbohydrates, which are essential for energy; protein, which is important for growth; fats, which are important for temperature regulation; and iron, which is important for immunity”. Undernutrition is well understood to impair immune function. The extent of impairment that results will depend on the severity of the nutrient deficiency.2 When an immune system becomes impaired, those issues referred to by Ms McGrice begin to appear. Although consuming the key nutrients can aid in strengthening the immune system, which may assist in the battle against viruses such as COVID-19, it’s still important to note that this isn’t the only way, nor the safest, to stay immune from respiratory issues. “The evidence shows that the best defences are practising social distancing, maintaining excellent hand hygiene and self-isolating if one happens to come in contact with anyone who is unwell,” Ms Pratico said. “Due to COVID-19 being a predominantly respiratory condition, parents of children with respiratory conditions, such as asthma, should be more vigilant with regard to practising social distancing and maintaining excellent hand hygiene, to reduce their child’s risk of contracting COVID-19 and potentially triggering their asthma.” YOUNG ONES 43 asthma symptoms in several studies. “There’s an association between a diet high in unhealthy fast foods and increased asthma severity, which may be due to too many of these foods leaving less room for healthy foods such as vegetables, fruits and wholegrains.” Dr Owens further highlights “links, particularly in adults, between obesity and asthma severity”. “Those with allergies to particular foods may have an asthma exacerbation triggered by exposure to those particular foods,” she said. “Sensitivity to preservatives such as sulphites in foods and drinks has also been linked to asthma symptoms in some children.” While the evidence linking nutrition and asthma development in children is minimal, Dr Owens still suggests that “we encourage children with asthma to maintain a healthy diet, which includes plenty of vegetables, fruit and wholegrains. This should be coupled with adequate exercise and fresh air”. The link to gastroenteritis Ms McGrice says poor gut health can lead to constipation and diarrhoea, which may consequently result in “embarrassment and toileting issues” for children. Gastroenteritis, commonly referred to as ‘gastro’, is an infection of the bowel that may cause diarrhoea, vomiting or both.3 Queensland Children’s Hospital notes that gastroenteritis is easy for children to catch, and is usually caused by a virus. One of the symptoms of gastroenteritis is diarrhoea, which occurs when the volume of intestinal fluid output is substantially increased, which overwhelms the resorptive capacity of the gastrointestinal tract.4 This process often leads to dehydration, signs of which in a child include infrequency of passing urine, and its darker colour. A child may also say they feel light- headed, dizzy or have dry lips.3 To combat the dehydration that is induced by diarrhoea, oral rehydration solutions are available and can help ensure the child remains hydrated. Queensland Children’s Hospital states on its Emergency website that such products, including Gluco-lyte, Gastrolyte, Hydralyte, Repalyte and Pedialyte, are available from most pharmacies. These oral rehydration products contain a balance of water, salts and sugar and are especially designed TO PAGE 44 A word about fat and diarrhoea The report, ‘Managing acute gastroenteritis among children: oral rehydration, maintenance and nutritional therapy’, states that certain guidelines have recommended avoiding fatty foods. However, maintaining adequate calories without fat is difficult, and fat might be beneficial to reducing intestinal motility.4 A pathway to respiratory issues Asthma, as a respiratory condition, puts people in the high-risk category when it comes to COVID-19 infection, and needs further exploration in terms of its link with the immune system and nutrition. Respiratory paediatrician and National Asthma Council Australia spokesperson Dr Louisa Owens says most children will “display symptoms \[of asthma\] by the age of five or six”. She says no clear evidence shows a strong link between gut health and asthma development. “There are many theories, however, regarding gut health, the development of a healthy immune system very early in life and the reduction in inflammatory conditions such as asthma,” Dr Owens said. Despite the lack of clear evidence for the gut health-asthma link, she said: “Diets which are high in fruit and vegetables are associated with less RETAIL PHARMACY ASSISTANTS • JUN 2020