Joan Breakey’s Blog

Diet and ADHD What is the diet? 1974 to 1990 In 1990 I asked ‘Is the diet right yet?

Which diet? For which children? Affecting which problems in hyperactivity? To what degree? For how long?

These questions require a detective approach.

I shall consider what has been reported in the research literature, what were the findings from the follow up of 516 families over the last 5 years, and what is important in 1990.

WHICH DIET?

The diet has changed since Feingold initiated the idea. The Low Additive and Amine, Low Salicylate Diet is a good starting point. It can be adjusted to suit the needs of different families. It is not just concerned with all additives, many are tolerated. Salicylates and amines are also important. What about milk, wheat, sugar and other foods? The relevance of these is found by investigation of the family diet history. Food exclusion is not the only option, sometimes limitation of a food intake is enough. The two old adages still apply here:

“It’s the dose that maketh the poison” and

“One man’s meat is another man’s poison”.

So don’t exclude any food from a child’s diet without good reason. The aim is to decrease the symptoms so the child is closer to other children, not to begin a lifestyle that is so preoccupied with everything about food that a different type of abnormality is created. Many issues related to diet not mentioned here have been addressed but have not been found to be important.

Different researchers use different diets, from just the main additive colours, to exclusion of many foods especially milk, wheat, and sugar. What is necessary?

1974 Dr Ben Feingold Allergist USA

The Kaiser-Permanente K-P Diet excluded:

Artificial colours in many sweets and drinks

Artificial flavours in many sweets and drinks

Aspirin - salicylate in tablets

Natural salicylates (information was incomplete) in many fruits

BHA (butylated hydroxy anisole) & BHT (butylated hydroxy. toluene)

(In the 25% who have allergies - remove these)

MSG* *mentioned but not emphasised

Food reintroduction - suggests reintroduction of fruit.

Provided the initial concept of a relationship between diet and activity, behaviour and learning difficulties.

Presumed allergies present in around 25%, recommended treat these.

‘Immaturity’ mentioned but not as important.

“Pattern was one of ‘turn-on’ and ‘turn-off’

These children are normal. Their environment is abnormal”

Research has shown the issue as a very complex one.

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Other influences -

1976 - The clinical ecology movement

Book - Clinical ecology, L Dickey, Editor

Grew out of earlier work by allergists especially Theron D Randolf

Elimination diets of various types,

Considered many symptoms including tension-fatigue syndrome

and included environmental factors.

1977 Dr Richard Mackarness Psychiatrist England

Book - Not all in the mind

Cave man diet excludes grains. Provided the idea that food, not additives, could affect mood in the general population.

1980 Mrs Maureen Minchin Victoria

Book - Food for thought

Over emphasised and excluded milk in many childhood problems.

1980 Dr Alexander Schauss

Book - Diet crime and delinquency

Emphasised sugar as the culprit

Said “Sugar makes the delinquent mind”; this was discounted

Years later said colours etc were probably more important.

Also implicated lack of nutrients as factors but mixed this with megavitamin therapy.

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1985 Dr Ann Swain Dietitian Sydney

Elimination Diet for investigation of hyperactivity, urticaria, &/or angioedema, mouth ulcers, migraine, rhinitis and asthma excludes

Artificial colours

Artificial flavours*

Aspirin - salicylate

Natural salicylates (conducted analysis, & double-blind studies)

in many fruit, vegetables, nuts, herbs, spices, tea & coffee

BHA & BHT preservative in some fats, oils and margarines

Benzoates ” in soft drinks, & some fruit juices

Sulphites ” in cordials, fresh salads, sausages

Nitrates ” in corned beef, ham and bacon

Propionates ” in most breads, crumpets & muffins

Sorbates ” in some cheeses

MSG (mono sodium glutamate) flavour enhancer in savoury foods

Amines - many types, many also contain salicylate; they include

- chocolate in sweets, drinks, cocoa, biscuits, topping etc

- cheeses (except fresh cottage and cream cheese),

- bananas, spinach, bacon, pork, canned tuna, herring, sardines

Vegemite, Bonox, beef extracts

(information on amines is incomplete at this time)

Brewers yeast - Vegemite, Promite, Marmite

Perfume, pressure-pack sprays, cigarettes & other strong smells *

And, in H/A children with GI symptoms -

Milk

Wheat and rye

Food reintroduction - developed capsule challenges or equivalent dose foods, and later guidelines for food reintroduction.

Provided the analysis of salicylates in Australian food

Researched a wide variety of conditions in a double-blind way.

Also showed individual variation in tolerance to additives and foods, and introduced the concept of target-organ sensitivity.

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RPAH (SWAIN, SOUTER, & LOBLAY) BOOK FRIENDLY FOOD JUNE 91 - AVOIDING ALLERGIES, ADDITIVES AND PROBLEM CHEMICALS.

This is a valuable book especially highlighting Salicylate and Amines in foods.

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1987 Drs Eggar, Graham, Soothill, Gumley, and Carter

(Eggar Paediatric Neurologist)

Their oligoantigenic diet excludes

Artificial colours

Artificial flavours

Some fruits Salicylates are not singled out - allows two of the following - apples, pears, bananas, peaches, apricots, and pineapple,

Some vegetables - cucumber, marrow and melon may be used

Preservatives - specifically mentioning

Benzoic acid

Nitrites

Propionates

Amines are not singled out - but the following foods are excluded

Chocolate

Cheese,

MSG, and the following foods -

Milk, beef

Wheat, rye, oats, corn, malt

Soy, beans, peas, peanuts

Eggs, chicken

Fish

Pork

Yeast

Smells are not mentioned

Food reintroduction - provides guidelines on food reintroduction from small to large quantities.

Provided further evidence that additives and foods can both be problems for hyperactive children.

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1988 Dr Kathy Rowe Paediatrician Melbourne

Diet free from azo dye additives, artificial colourings and preservatives excludes

Artificial colours

Artificial flavours are not mentioned, allows margarine

Salicylates are not singled out, the following are excluded -

Aspirin

Tomato sauce

Oranges, apples, tomatoes, strawberries

Tea

Coffee

Preservatives (but allows ham and bacon, breads, fats and oils)

Amines are not singled out but the following is excluded

Chocolate

MSG

Eggs

Fish, fresh or frozen

Canned tuna and salmon

Oysters, prawns, lobster

Peanuts

Sugar, limited added sugar is advised

Perfumes, perfumed toiletries, toothpaste and mouthwashes

Food reintroduction - it is advised that tea, coffee, bonox, fruit, eggs, fish and peanuts be introduced cautiously.

She provided discussion of assessment questionaries - most did not include areas that change with diet especially ’sleep’ and ‘gets high’. Designed the RBRI - Rowe Behaviour Rating Inventory.

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Breakey Dietitian Brisbane

The low additive and amine low salicylate LALS Diet excludes

Artificial colours and added natural colours

Artificial flavours and added natural flavours e.g. vanilla, lemon

Aspirin

Salicylates, combining analysis figures and reported reactions i.e. low salicylate golden delicious apples and lemons excluded

Preservatives (all except gallates)

MSG

Amines, combining research figures and reported reactions, exclude

Chocolate

Overripe bananas

All cheeses except cottage, cream, processed and mild cheese

Brewers yeast - greatly limit vegemite, promite and marmite

Most strong smells, paint, petrol, new carpet, cigarettes, glues, cleaning compounds, room deodorisers, crayons, felt pens and rubbers that smell, perfumes, perfumed toiletries and cosmetics, moulds, and strong flowers, (with variation between families).

Milk, wheat etc, limitation or exclusion is dependant on family diet history of problems with various foods.

Food reintroduction - test foods containing one additive trialed one at a time considering dose. Milk etc adjusted individually.

Provided feedback information from families using the diet, helped show more and less important exclusions.

Noted clinical issues of diet management, and the child on the

diet.

Noted individual variation in symptoms, diet needs, outcome or not, amount of change with diet in the various symptoms and family motivation.

Used the “Diet detective” approach where families were encouraged to report freely on the outcome in their situation, rather than using a strict diet and presenting for assessment in specific areas.

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STAGE 1 DIET TRIAL

If you have found by trial and error that obviously coloured and flavoured food affect your child that is step 1. The next step, if you want to help the child to the maximum he can be helped, is to seek professional help. If you are going to investigate diet do it properly. Some go for years with out of date information or even the wrong diet. Withdrawal often occurs. During the first week symptoms may get worse before they get better.

Should the whole family go on the diet? If some other family members have allergies etc they might be interested in being diet detectives too. It is important that the child knows he is trialing the diet because he has problems. There is no place for the idea that a mother may want to trial the diet but not clarify with the child that she believes he has some problems. To manage cooking for everyone, it may be easier to begin with bland food, and then add usual flavours etc to the meals of those not needing the diet, or they will resent the changes. It is good for the child to see his parents eating normal food knowing that if he learns to handle himself as well as they do, he may aim for a normal diet in adulthood.

The diet trial should be run for 2 - 4 weeks strictly, to see if there is any effect and, if there is, to see the extent and limit of diet change. If there is any doubt at all a challenge during which all disallowed foods are reintroduced needs to be carried out over a week. If there is no change report this to doctor, and ask what other help is available, go back on a normal diet and put your efforts into managing other treatments well.

STAGE 2 INDIVIDUAL FOOD REINTRODUCTION

2 AIMS -

To find out if the substance is tolerated in any amount, and

To find out if foods containing small amounts can be included in the diet so it can be less strict.

In diet therapy you will obtain a list of foods such that each contains only one additive or substance to test. Only one food should to introduced to test each week. It can be eaten daily and problem areas monitored. If there is no reaction it can remain in. In small, very sensitive children or those with severe problems the dose of test foods can be low at first. Remember there is much individual variation in substances tolerated. If milk, or grains are to be investigated obtain information on how to test these.

Reactions may be: -

1 Immediate - in the very young (under 5 yrs), & the very sensitive

2 Delayed - up to 24 hours

3 Building up - over 3 - 5 days.

Most reactions are not clear, repeat with a varied dose at a later time. After trials decide on the amount and frequency the food can be used, considering what other foods are included occasionally. It seems that each child can cribb to a certain critical threshold and then symptoms appear.

Diet therapy is more than a piece of paper! It is not simple but neither need it be overwhelming, especially with professional help. If the diet works, stick to it so the child benefits. Test foods at home, even if unintended tests occur with help from neighbours, friends, classmates or relations as well!

When testing foods remember that symptoms may be due to a viral or bacterial infection, overtiredness, a smell, additional family stress, or in an occasional child, to an allowed food, so be watchful. Consider a total body load concept.

DIET THERAPY - FOR WHICH CHILDREN?

It is still not known which hyperactive children respond to diet. Only 2.5% of all children who attend Child Guidance Clinics with their many different problems, were referred to diet therapy.

It is reported that hyperactivity in boys versus girls is 4:1 to 6:1. In the 516 study group it was 6:1, but neither sex was likely to be better diet responders. There was an effect with age, with the proportion on responders under 9 years significantly higher than the over 9’s. If there was a family history of allergy, and where there was an intolerance to any food, (usually most noticeable in infancy) a positive outcome was more likely. In those who were referred to the dietitian good results were just as likely in families who had noticed no connection between food and behaviour. This can be because giving some high additive foods usually does not show change, even in a diet responsive child, before the LALS diet has begun, as the total load of additives and salicylates is usually high enough to mask any addition.

It was interesting to note that the children who reported problems with chocolate had a greater likelihood of presenting with activity or social problems, whereas those who reacted to milk were more likely to include physical problems (asthma, tummy aches etc). In the study group 48% had problems with some food - 24% with milk, 8% with grains, at least 30% with chocolate, and 11% with other common allergens. About half those numbers needed to exclude the food.

DIET - AFFECTING WHICH PROBLEMS IN HYPERACTIVITY?

The RBRI chart shows most areas - concentration, motivation in learning, perseverance, irritability, excitability, compliance, self-control, tearfulness, disruptiveness, attention span, ability to be reasoned with, restlessness, activity, aimlessness, co-operativeness, aggressiveness, control by parents, tantrums, and sleep. As well note immaturity (many are attending therapists for delays), and allergies - sinus, hay fever, asthma, eczema, reaction to insect bites, nausea & tummy aches, head aches, limb pains, and carsickness. Sometimes allergy and other symptoms in other family members change.

All the problems should be monitored during diet trial. Presenting symptoms do not all change by the same amount in one child, nor do all children change in the same areas.

Remember - food sensitive children can have other medical problems at the same time as being food sensitive. Your doctor is important. Do not get caught up in the idea that once you have found food to be important you look to it to solve all problems. Take care of the child; think carefully about any advice that may be hazardous. Children should not be given enemas.

WHERE DIET IMPROVEMENT OCCURS - TO WHAT DEGREE?

Research on the usefulness of the diet is variable, depending on how the group were selected, which diet was used, and the research design. All acknowledge some change in some children, and show that diet is certainly not useful for all.

It is time to look at what is happening in a new way, and acknowledge that the outcome is rarely an all-or-nothing effect. In some there is no improvement, in some partial improvement (they see an absence of bad days but no big improvement), and in some, improvement such that they are now within the normal range. In the 516, 10% did not respond, 80% improved with 55% achieving normal range, and 10% needed medication as well as diet therapy.

Overall - additives, amines and salicylates are better thought of as AGGRAVATING THE UNDERLYING TENDENCIES IN SUSCEPTIBLE CHILDREN. They do not CAUSE hyperactivity. Reactions and changes on the diet are CHANGES IN THE DEGREE OF SEVERITY of the problems not all-or-none effects.

DIET THERAPY - FOR HOW LONG?

Management changes with age from parents of preschoolers able to control everything, through to expecting early primary-school children to manage without supervision - they can’t - to late primary choosing food on camps, at sports and at outings, and beginning to take responsibility for diet decisions. Remember, the issue is not whether or not the diet has been broken, but whether the child is handling himself in an acceptable manner. The more effort the child makes to contain himself, and this improves with age, the more liberal his diet can be. Food eaten is no excuse for bad behaviour. The child is still responsible for his behaviour. He becomes a “diet detective” “to see if it will help him handle himself better”. A stricter diet is needed where learning difficulties are present.

In early teenage symptoms often change or worsen and stricter adherence is necessary for a couple of years. By then all diet responsibility should be moving from the parents to the child. This usually means difficult times in the family while the child tries too many problem foods to test out his need for the diet. Fortunately tolerance improves and older teenagers usually can have more liberal diet.

Research has shown that some adults with asthma, eczema, urticaria, irritable bowel syndrome, migraine and mood problems benefit from dietary intervention, and family members of hyperactive children report benefits. It is probable that children who benefit from diet in childhood will need to pay some attention to diet in adulthood, though the level of strictness may vary. Many are happy to accept dietary restrictions to relieve symptoms.

CAN YOU MANAGE WITHOUT HAVING DIET THERAPY?

Some people do. Each family know their child and family diet history. But more is gained from the dietitian’s knowledge of other families, diet research, nutrition, and from support in all the details of managing a special child on this special diet. It is also important to keep updating your information.

Why diet therapy is helpful:-

The diet is difficult

The child is usually difficult

Mothers have all the usual housekeeping problems.

Dads, in-laws, friends, relations, teachers and neighbours all have their views about diet for the child.

The dietitian -

Can apply the diet to the family, especially sorting out information from other sources, working out what applies in that family, so no unnecessary exclusions are made.

Can give ideas on how to minimise the time, and effort which are bigger costs than food expenses.

Can help the child understand the diet and use experience with all the other children being “Diet Detectives”

Can help support parents in fitting in the diet and managing the child on the diet.

Can provide ideas on managing social situations and parties.

Some children have “eating delay” or take longer to progress out of soft, bland foods, so are fussy. This may be related to immaturity, or to having felt uncomfortable after some foods in infancy. These children can be helped.

NUTRITIONAL ASPECTS

Three issues

1 - which exclusions are necessary?

what are the nutritional problems of those exclusions?

2 - how can weight be maintained?

most food sensitive H/A children are thin.

if you are considering whether to completely exclude milk or wheat, you are jeopardising nutrient intake, and usually total energy intake. Always watch the child’s weight. Seek help faster if there is no usual increase and straight away if there is weight loss.

3 - What about vitamins, minerals or herbal treatments? There is no evidence that using vitamins as medications is necessary. If there is some biochemical mechanism not functioning properly that results in food sensitivity, it is not logic to presume that nutritional therapy should help, apart from replacing nutrients that cannot be obtained from excluded food. We don’t think that way about diabetes, gout, or enzyme deficiency diseases.

Diet therapy is a negotiation process not a piece of paper.

You ask how much you can get away with, or how liberal the diet can be, and the dietitian shows what is most important to carry out, depending on how much you want the problems decreased. Some are happy to have the child not totally out of control, others want to put in the time and effort to get the problems decreased to a minimum.

Any family using diet to help with problems are not helping the child properly if they do not have professional help including a dietitian.

CONCLUSION

The diet has been updated since Feingold - main changes are -

Symptoms that change with diet are not just hyperactivity. They include behaviour, social, learning, mood, immaturity, and allergic problems.

The most likely diet responders are those with allergy in the family, especially if the child reacted to some food in infancy, and who are under nine years. But others do respond.

Outcome is not all or nothing, change is one of degree. There is individual variation in presenting problems and response areas, in the amount of change and in the additives tolerated.

Joan Breakey Dietitian/Nutritionist

Presentation to the Division of Youth, Welfare and Guidance, and the Queensland Allergy and Hyperactivity Association 1990.

Outline of topics for webinar for PEAs
By specialist Food Sensitivity Dietitian Joan Breakey

NOTE: Webinars are intended to be run monthly. Please register your interest here for more details.

Overall PEAs have managed as best as they can for them. Each is different in the way the
issue affects their lives as adults. Using the ideas below each person can be more
sympathetic about their own situation and work out what small changes they may make to
make life easier.

• The webinar is for Joan to respond to issues raised by PEAs that are important to them. It will
not be a lecture. It is important that PEAs feel they can raise issues of how being a PEA
affects their lives. And to get the real life insights from a practitioner who has worked with
hundreds of PEAs

• PEAs could be forgiven for thinking their difficulties can’t be solved. After all their mothers
tried with them right throughout their childhood. On the other hand they could be forgiven for
believing there is some easy solution. They and their mother have often been told that
everything will go well if they just try some new idea. In fact the answer is that each person is
different so they can gradually find some helpful way for them

• The introduction of a diverse range of foods that many people manage is a big task early in
life so it is no wonder it can be very complicated and problematic for some. This can be for a
variety of reasons - family factors, nutrition, breastfeeding factors, the possibility of adverse
reactions, the baby being in distress, crying, waking at night, and others. Each baby is
different so in a way each baby is a picky eater. See Chap 1 of Fussy Babies.

• The idea of eating development was not widely understood until now so many PEAs did not
have the advantage of this knowledge. Now it is known it can be used. Where people have
problems with speech, coordination, reading or writing they are seen as having a
developmental delay and not judged. Yet where eating is concerned they are often judged
when the issues should be seen as part of eating development. See Chap 2 or Fussy Babies.

• Somehow those people with heightened discrimination about food and who become chefs or
food gourmets are not judged but PEAs are. The overlap of ideas here is important.

• Another important idea that is not well known is that many of the little problems that start to
show in infancy and continue in some form is food sensitivity, that is adverse reactions to
foods. The reactions can be tummy aches, rashes and other allergic symptoms, irritability,
frequent mood changes, sleep problems such as not settling, restless sleep, nightmares,
restless legs or waking very early, attention deficit hyperactivity disorder (ADHD), car
sickness, mouth ulcers, headaches and migraine. Fortunately diet investigation helps
determine what foods cause reactions and how to decrease the symptoms for people who are
susceptible. See Chap 3 of Fussy Babies, and Are You Food Sensitive?

• Supersensitivity is another important issue for many PEAs. The idea that some people are
supersensitive to smell, taste, light, texture, temperature, sound and some other inputs is not
understood in the general community at all. Most people think their degree of frustration with
smell or noise is much the same as others so they do not understand that for some one
particular smell or strength of smell can be so distressing that it means the appetite goes
completely. This is an interesting area to discuss.

NOTE: Webinars are intended to be run monthly. Please register your interest here for more details.

Helping small children understand that diet may affect their mood

If a very small child gets tummy aches, diarrhoea, or feels itchy with some foods it is relatively easy to help her understand the connection. It is a little harder when eating the foods means having trouble getting to sleep, or having nightmares. But it is even harder if the main symptom is ‘irritable, touchy or cranky’ or ‘tantrums’ or ‘demanding behaviour’.
The first step is to chat about it even if you don’t think the child understands all of what you say. It is right to say that diet has an effect: that on her special food she is not grumpy. You can also put it positively by saying that she is happier or ‘more her real self’ on her special foods. These words do not imply good or bad as whether we feel cranky or happy we still have to do the things we have to do, and just because we do not feel so good is no reason to talk crossly or hit someone. It is a gradual process to understand that how we feel is separate from what behaviour we have while in this mood. These are quite difficult concepts so it will take time to have them understood. You can say that an excluded food is a food we will ‘eat one day’ so we can see if it is one that makes her feel grumpy or cranky, and stop her being her real self.

Food with too much smell ’stinks’!! Variation in the food industry.

The child who thought all smells ’stink’ is very sensitive, but most food sensitive people are wise to be wary of food that has strong smells.

Food suppliers are giving mixed messages. They want to invite buyers to try more flavours but at some level they must know that these greater amounts are too much for some!

This is shown by one advertisement that described Ketchup as ‘old school’, mustard - something ‘you can do better than’. The advertisement suggested you ‘go to the next level by using “Stinkin” good green chili’ as a condiment! If the food industry wants their ‘hotter’ suggestions to be ’stinkin’ then it does seem there is a trend to overflavouring our food!

It is to be hoped that those in the food industry who are aiming for mild good quality food flavour will also keep supplying food that normal and gourmet food sensitive people can enjoy!

In fact this is happening. There does seem to be new interest in plain foods with good quality flavouring. In an article entitled “What’s Posh Now?” discussing desirable foods for restaurants, a reviewer noted that a meal may be based on a plain food such as organic carrots, admittedly served with comte-infused curd, mild spices, and quinoa. But this does show that there is a move back to mild, good quality foods, and this is a good thing from the food sensitivity point of view. Of course food sensitive people would still want only a touch of additional flavours.

Parents judged when 7-year olds have eating problems. Is this eating delay?

(We encourage your contribution. Please feel free to add your reply with feedback /comments below.)

A recent study reported that infants who had began lumpy solid foods after nine months were more likely to have more feeding problems at age seven than those who started them before nine months. These children also ate less variety of foods. The authors recommend that professionals advise parents to encourage the progression from purees to lumpy foods from as early as six months, and to increase the variety of foods.
But being told that you should have done something does not mean it could have been done if you decided that at the time. Many parents know it is not as easy as it sounds. Here we can stop and think about what these results may mean. What if it was reported that parents who did not encourage a variety of words in infancy were more likely to have children with speech problems at age seven. We would immediately say that we know that all children learn to speak at a different rate and some still have speech problems at age seven. We know that problems occur even if parents encourage talking by talking to their baby all along the way.

If we use the important idea that eating is also a developmental process then we would begin to think about eating in a different light. We could then recognize that all children learn to eat a variety of foods at different rates.

The problem is that eating development is not one progression but many developmental pathways. Parents need to know all about eating development and how know about how to manage all aspects to encouraging each of them separately.

There is taste development, texture development, temperatures development, and many others including smell, thickness, thirst, chewing, amount of food, time between meals, and managing gagging developments. And it can get more complicated when blending all of these progressions with all the other developmental processes occurring at the same time! These are explained in detail in the new book Fussy Babies
We might agree with the researchers that the more parents encourage a shift from puree to lumpy foods early, and encourage a variety of tastes, the more it helps eating progression. But we feel frustration when we know that even when parents do their best difficulties of one sort or another about accepting foods still occur. And we know that those who were fussy or picky eaters in infancy are more likely to still have problems at age seven. We might ask these researchers to appreciate that eating is just as complex a developmental process as any other developmental achievement such as speech. We can think that parents whose children have eating problems should not be judged, just as we do not judge parents whose children have speech or any other developmental disorder.

Joan Breakey

(We encourage your contribution. Please feel free to add your reply with feedback and comments below.)

It is interesting just how supersensitive some children are! One little girl was reported by her mother to notice smells in particular. She disliked smells to the extent that she noticed all smells as negative because of their strength in her awareness. So instead of saying “I smell something” she said “I stink something”. We can listen to what children are saying and say how cute it sounds. and we can learn to be aware that they may be telling s something important about how the world affects them.

(We encourage your contribution. Please feel free to add your reply with feedback and comments below.)

Fussy Babies written by specialist Food Sensitivity Dietitian Joan Breakey clarifies the introduction of solids and food sensitivity, and reveals new information about eating development and supersensitivity. Fussy Babies will help you understand why your baby may be struggling and provides practical recommendations that you can do put into place immediately and start seeing results.

You’ll also discover preventive approaches so fussy babies are less likely to becoming fussy children. The principles included in Fussy Babies can help your baby get off to a great start for the rest of their life. For more information or to purchase click here