Pediatric Autoimmunity: How to Diagnose and Treat

Autoimmune diseases are on the rise across the globe, and they’re now the third most prevalent disease category in the United States. While autoimmunity has seemingly tended to impact middle-aged females, childhood autoimmunity is a significant growing concern. It’s estimated that 5% of kids worldwide have at least one autoimmune disease, many of which are living with multiple autoimmune conditions.

Aside from a lower quality of life, pediatric autoimmune diseases predispose kids to a whole host of health problems from cardiometabolic conditions to cancer to mental health disorders. Conventional treatments offer some relief but often don’t address the root causes of autoimmunity. In this article, we’ll delve into how integrative providers uncover underlying causes. And how holistic interventions and traditional therapies can be combined to improve both quality of life and health outcomes. 

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What is Pediatric Autoimmunity?

The immune system, made up of innate and adaptive components, is designed to protect us from intruders like microbes, but also to neutralize toxins from the environment and do away with our own potentially cancerous cells. To do this, the immune system must be able to distinguish between what’s foreign and what’s self. In kids with autoimmunity, the lines are blurred, so the immune system ends up making antibodies that attack various cells and tissues of the body. If this inflammatory cycle continues unabated, kids can end up with serious health consequences.

There are over 100 identified autoimmune diseases, some of the most commonly known in kids include:

• Type 1 diabetes—the immune system attacks the beta cells of the pancreas preventing insulin production.
• Celiac disease—the immune system goes after gliadin, a protein in gluten-containing foods, which damages the lining of the small intestine leading to malabsorption.
• Juvenile idiopathic arthritis—the immune system produces various inflammatory markers that mainly assault the joints leading to degenerative changes.
• Pediatric lupus—the immune system attacks various tissues like the lungs, skin, and kidneys but also impacts the nervous, hematologic, and cardiovascular systems.

While we don’t yet know exactly what causes kids to develop autoimmune diseases, research suggests there may be a complex interplay between environmental triggers, genetics, and increased intestinal permeability.  

Challenges in Diagnosing Pediatric Autoimmunity 

People with autoimmunity tend to go years with troubling symptoms before getting an accurate diagnosis. This may be due in part to symptoms that are relapsing and remitting, the lack of definitive diagnostic indicators, and symptoms that mimic other disorders. It may be even trickier with kids because they often can’t accurately relay the symptoms they’re experiencing, which can include:

• Brittle hair or hair loss
• Dizziness
• Dry eyes or mouth
• Fatigue or feeling unwell
• Low-grade fever
• Skin rashes or lesions
• Stiff joints
• Weight loss

Traditionally, autoimmune disorders are diagnosed based on exclusion. If a child has the symptoms of autoimmunity, the provider will complete a thorough physical exam including family history (especially of autoimmunity), medical history, and surgical history. In addition, the following tests may be ordered:

1. Blood tests including antinuclear antibody (ANA), rheumatoid factor (RF), complete blood count (CBC), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), anti-cyclic citrullinated peptide (anti-CCP), and complement proteins
2. Magnetic resonance imaging (MRI) or ultrasound
3. Biopsy

Diagnosing a pediatric autoimmune disorder can be challenging but early identification, along with the appropriate treatments is extremely important for preventing long-term complications. 

Root Cause Diagnostics in Pediatric Autoimmunity 

Conventional methods to determine a pediatric autoimmune diagnosis are limited and often non-specific. Functional medicine providers employ conventional testing but also map a patient’s unique story to identify the potential antecedents, triggers, and mediators of autoimmune development. 

A thorough patient history, including information about exposures during pregnancy, genetics, delivery type, feeding mode, trauma, toxin exposure, adverse food reactions, infections, diet, and medication usage is the foundation for diagnosing and treating autoimmunity in pediatric patients. Functional medicine testing may include genetic tests, comprehensive stool analysis, blood panels to assess nutritional status, saliva and urine testing, and breath tests.

Interventions for Managing Pediatric Autoimmunity

Standard treatment for pediatric autoimmune conditions often includes strong medications to reduce inflammation (non-steroidal anti-inflammatory drugs, disease-modifying anti-rheumatic drugs, and biologics), suppress immune system function (corticosteroids), or alter immune system activity (intravenous immunoglobulin). While these can be necessary and very effective, they do come with serious side effects.

Integrative treatments, on the other hand, are tailored to the patient based on their specific root causes. When root causes are targeted, it’s possible to reverse negative symptoms, reduce or eliminate the need for medication, and improve long-term outcomes. 

Increased intestinal permeability may be a root cause of pediatric autoimmunity. Restoring the integrity of the lining of the small intestine through diet, lifestyle, and supplements may be one way to achieve healthier immune system function.

Dietary Modifications

Adverse food reactions and an ultra-processed diet both contribute to gut dysbiosis, which increases inflammation, upregulates zonulin to promote intestinal permeability, and triggers an immune system response. Pediatric autoimmune patients may benefit from an elimination diet and reintroduction to identify food allergies and sensitivities. Once this process is completed, integrative providers may recommend a personalized anti-inflammatory, nutrient-dense meal plan to keep inflammation under control, optimize gut health, and ensure nutrient needs are met for proper immune system function. 

Lifestyle Factors: Sleep and Activity

Among other important purposes, sleep is intimately tied to immune system development and function, and poor sleep may be an influence on autoimmune disease development. Caregivers and pediatric patients should be educated on healthy sleep habits including following a routine sleep schedule, avoiding bright lights and electronics before bed, early morning natural light exposure, and avoiding heaving meals before bed. The amount of sleep pediatric patients need in a 24-hour period varies based on age: 

• Newborns: 14-17 hours
• Infants: 12-16 hours
• Toddlers 1–2 years old: 11–14 hours
• Toddlers 3–5 years old: 10–13 hours
• School-Age 6–12 years old: 9–12 hours
• Teenagers 13–17 years old: 8–10 hours

In addition to healthy sleep, pediatric patients with autoimmune diseases need to participate in regular physical activity. Exercise enhances gut microbiome diversity, increases the levels of beneficial gut microbes, and reduces inflammation both systemically and in the gut. Additionally, physical activity improves blood sugar regulation and cardiometabolic risk factors, which may be a concern for some kids with autoimmune diseases.

Kids ages 3–5 need to be active throughout the day. Those ages 6–17 need a minimum of 60 minutes of moderate-to-vigorous physical activity each day including aerobic exercise, and muscle and bone-strengthening exercises. Some autoimmune disorders create swelling and discomfort in joints and impact muscle strength, so referring patients to an exercise professional for tailored interventions may be helpful.

Dietary Supplements

Children with pediatric autoimmune conditions are often lacking in important nutrients. Dietary supplements can be harnessed to address these deficiencies but also to target and reduce inflammation and support healthy immune system function. Dietary supplements may not provide significant benefits on their own, but when used in combination with other therapies, may be an important part of the treatment plan: 

• Omega-3 fatty acids may help to lower inflammation and act in a prebiotic manner for commensal gut bacteria. 
• Vitamin D helps to regulate immune system function and may improve autoimmune disease symptoms. 
• Probiotics may help to reduce intestinal and systemic inflammation, improve the gut microbial environment, and protect against an overzealous immune system response. 

Mind-Body Practices

Pediatric patients with autoimmune diseases often have a dysregulated stress response. They may experience medication side effects and pain, miss out on events with peers, have numerous doctor visits, and generally feel unwell, all of which impact stress levels. Helping kids learn how to manage their stress may go a long way to reducing inflammation, improving gut barrier function and the immune response, and helping improve their quality of life. 

‍Yoga may help to improve stress and gastrointestinal symptoms, as well as pain; mindfulness meditation may reduce inflammation and improve immune system function; and biofeedback may help to reduce symptoms of depression and anxiety.

Integrative Therapies and Their Efficacy 

Adding integrative therapies to the comprehensive treatment plan may be helpful for kids with autoimmune diseases. Acupuncture is safe for children and may improve autoimmunity through its ability to regulate both the adaptive and innate immune systems and through gut microbiome modulation. Acupuncture may also improve the stress response and reduce pain. 

Herbal supplement options include ginger, which has shown efficacy in autoimmune conditions like rheumatoid arthritis, psoriasis, and lupus. And curcumin, which may help to reduce inflammation and improve immune system function in pediatric patients with autoimmune conditions. 

Various homeopathic remedies are available but don’t have enough research or safety data to support their use in children. 

Family and Caregiver Support 

Pediatric autoimmune disorders impact the physical and mental health of not only the child but the entire family unit. Families and caregivers need to have a plan for managing the emotional and logistical challenges of having a child with an autoimmune disease. 

Autoimmune disease support groups are an excellent opportunity to express concerns and fears with others who have shared experiences, as well as to seek out additional resources. Other ways to seek and provide support include: 

• Family meetings where every person can open up about their feelings, provide support for the patient, or discuss the treatment plan
• Family game nights to relieve stress
• Family meal planning sessions where each person gets to choose some favorite options for the anti-inflammatory meal plan
• Family or group outdoor activities to help meet physical activity requirements
• Online or in-person educational opportunities like anti-inflammatory cooking classes, learning more about autoimmune disease and new treatments, ways to reduce or manage stress, or how to improve sleep
• Family therapy with a professional counselor to learn healthy coping strategies

Future Directions in Pediatric Autoimmune Care 

Receiving a pediatric autoimmune diagnosis can be devastating for the patient and caregiver. Some autoimmune conditions may go into remission and never recur, but others are more serious and have lifelong impacts. A personalized approach that investigates and targets the root causes of autoimmunity with diet, lifestyle, integrative therapies, and supplements offers hope for more comprehensive healing and better outcomes for kids. 

While there’s currently no cure for autoimmunity, emerging research on the importance of the gut microbiome in autoimmune disease development and symptom reversal provides a novel approach to treatment. And artificial intelligence models may be able to accurately diagnose autoimmune conditions more quickly in the future allowing for earlier intervention. 

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Key Takeaways

Pediatric autoimmune diseases are on the rise.

Genetics and environmental triggers are important factors, but increased intestinal permeability may also be to blame.

Conventional treatments offer some relief but don’t target root causes, like poor gut health.

A comprehensive, multidisciplinary approach that marries traditional options with integrative therapies like diet, lifestyle, acupuncture, and supplements offers hope for symptom reversal and a better quality of life for kids with autoimmunity.