Steve is a close friend, brother, colleague, was my daughter’s Pediatrician, is an amazing artist, musician and true Renaissance man. We are honored to have have him share his wisdom as a guest blogger and here in this interview with us.
Stephen Cowan, MD, FAAP is a board-certified pediatrician with 20 years of clinical experience working with children. He has a subspecialty in Developmental Pediatrics and is NY certified in Medical Acupuncture.
He is a fellow in the American Academy of Pediatrics, a member of the AAP Committee on Children with Disabilities, a member of the Autism Research Institute’s DAN practitioners and a member of the American Academy of Medical Acupuncture. He is a co-founder and advisory board member of the Holistic Pediatric Association. He is co-founder of Riverside Pediatrics, in Croton, New York, where he incorporates alternative therapies in the treatment of common childhood disorders. He is the founder of The Holistic Developmental Center for Children, in Mt. Kisco NY, where he offers holistic consultations and treatment that include biomedical alternatives, acupuncture, biofeedback, meditation. He specializes in the diagnosis and treatment of chronic pediatric problems such as Attention Deficit Disorder, Autistic Spectrum Disorders, migraine, Tourette’s syndrome, asthma, allergies and chronic digestive disorders. He is a clinical instructor at NY Medical College and has lectured internationally on the holistic management of chronic problems in children. Understanding the child as an inter-related part of family and environment is the central focus of his practice. This approach respects the inseparability of mind, body and spirit and promotes a deeper understanding of what it means to be healthy.
Frank Lipman: You have been a pediatrician for 20 years. Are you seeing a change in the types of problems kids are presenting with?
Stephen Cowan: Increasingly in my practice I am seeing more and more children with chronic conditions (asthma, inflammatory bowel disease, adhd, autism spectrum, tourettes, migraines), that are directly related to a breakdown in “resilience” due to chronic stress exposures.
Frank Lipman: Now I know you are seeing these things in your practice, the “walking wounded” as you call them, which I suppose is to be expected in our high powered adult society and certainly these “Functional Somatic Syndromes” as Jeff Bland defines them all exist on a continuum, but the wake-up call for me is seeing the rise in these debilitating conditions in “high-strung” children.Â What do you think the problem is?
Stephen Cowan: Fundamental to my understanding of what is going on here is the idea that conventional medicine has everything backwards! By treating symptoms according to independent organ systems, (and of course independent SubSpecialists) there is a progressive breakdown in the management of a patient who can only get at best 50% better.
Now, Western medicine has made miraculous advancements in managing acute health conditions, but has made a gross mistake in applying the same emergency-medicine thinking to chronic conditions.
In fact, we see how so-called “alternative therapies” have been typically relegated to the margins of medicine; treating the ‘not-so-sick’ and the chronically ill, exactly because Western medicine does not know what to do here.
This actually is not fair to such practices as Chinese Medicine which was originally developed for acute care and preventive care.Â Nevertheless, you and I have seen how simple changes in diet and lifestyle can have far reaching effects on health maintenance and well-being. While they might not seem heroic in the light of ER-style doctors, in the big picture, it is all these so-called ‘Functional practices’ that give the power back to the patient in creating the conditions for real fitness.
For children, this means looking at patterns of cumulative toxic stress.
Frank Lipman: What do you mean by “cumulative toxic stress?”
Stephen Cowan: Whenever I teach, I always ask, what is the difference between an adult and a child. Quite often there is silence from the audience as if they had never been asked this before! Someone will say something like ‘children are smaller than adults,’ but in fact children are not just small versions of adults. The fundamental difference is that children are actively growing, changing, molding themselves to their surroundings in an effort to most efficiently survive.
This molding or “pruning” is defined by the degree of “plasticity” an individual has. In part this is dependent on a child’s specific constitutional temperament. A child resonates in a specific way with his or her environment. Epigentics determines how hereditary predispositions will be expressed. The trick in children is learning how to maintain or improve this plasticity.Â I prefer the term “tuning” to “pruning”.
Stress is a fundamental aspect of life. There is an optimum degree of stress that helps stimulate growth. Too little and there is stagnation. Too much and there is exhaustion.
We expose our children to a host of stressors, which they cannot help but “tune” to. These include the obvious exposures of industrial toxins that are a part of our modern society; heavy metals, preservatives, artificial additives, high fructose corn syrup, food coloring etc.Â In addition, we know that there are dietary stressors inherent in the kind of foods we eat on a chronic basis and the way in which we prepare and eat them. eg. fast food. Just as a child does, food too resonates with stress, literally capturing xenobiotic stressors within it, which are then passed on when digested.Â While many so-called alternative practitioners regard eliminating toxins and promoting healthy diet as the two pillars of good health, I feel this is merely the tip of the iceberg. There are many stress studies that regard lifestyle as primary in determining our degree of resilience – that is, how well we recover from stress.
With this in mind, there are five major “domains of exposure” that I use to “tune a child”. These are:
Each of these domains can be a significant stress factor for the growing child OR they can be opportunities to promote a child’s flexibility.
Frank Lipman: What are you thoughts on vaccinations?
Stephen Cowan: Nowhere is this concept of “tuning your child” more evident than in the way we vaccinate children. While the development of vaccines has certainly prevented a host of terrible diseases, the pressures of national public health policy have driven us to apply the same ‘assembly line mentality’ that big industry has found profitable to the way we “protect” our children. This makes no attempt to consider the specific conditions of an individual child’s life in a particular moment in time.
Simply regarding a child as being 15 months old as the only criteria for receiving a particular immunization seems to lack any sensitivity to the state of the individual. In my view, stimulating the immune system to respond to a specific pathogen is indeed a powerful tuning that requires great care and attention.
Making sure that a child is well prepared to receive a vaccine may seem like an unnecessary precaution but I have found it can have far reaching effects on both a child’s growth and development. Certainly we know that excess stress suppresses the immune system, stimulates gastrointestinal inflammation and pushes adrenal discharge. When a child’s immune system is repeatedly stressed without being given time to recover, there is a real risk of breakdown in the pliancy of the system, resulting in chronic patterns of disharmony.
Taking the time to ask about what your child is resonating with- (e.g. what are the stress factors in the 5 domains above) BEFORE considering giving a particular vaccine will permit the practitioner to recognize, from a holistic perspective, whether this is the optimum stress for a child. For example, if a child was recently being treated with antibiotics or is recovering from a gastrointestinal bug, it is best to allow complete recovery before giving a “shot” since the GI system is the predominant center of the immune system in a child.
Getting to know a child’s life certainly takes time and consideration. Often I will set up an immunization schedule that best suites the child’s needs. While this is not always practical in large health clinic settings, it is certainly an optimum way to practice.
Vaccinations are like education, quite literally, teaching the immune system how to protect itself from a specific pathogen. Allowing a child to recover from a vaccine injection will give the body/mind a chance to digest the lesson before hitting it with another one.
Frank Lipman: Is there anything that can be done to “tune” a child to vaccinations?
Stephen Cowan: There are a number of herbal and homeopathic medicines that can be given before an immunization to help tune the child to respond in the healthiest way.Â These include homeopathic ‘Thuja’, or the Chinese herbal ‘Windbreaker’.
I will often use acupressure or acupuncture before a vaccine to prepare the body/mind to receive and recover from the stimulation as well.Â Giving Tylenol before a vaccine may be the single worst thing one can do, since it may not be necessary and it affects the liver’s capacity to detox.
Respecting the delicate balance maintained by the young developing child allows both parent and practitioner to fine tune a child to the most harmonious way of living in our world with pliancy and fitness.Â As the Buddha said, “achieving balance is like tuning a lute, too tight and the sting will break, too lose and the instrument is unplayable.”
Frank Lipman: You are an extremely talented artist. How does this affect your practice of medicine?
Stephen Cowan: As a painter, the world expresses itself through me, as a new vision, a synthesis of my experiences. This is a spiritual practice that has been a fundamental part of my life since I was very young. As the son of a painter, I was given the gift of seeing patterns in the world that were not always evident to others. We do this in medicine as well, but all too often get stuck in the details without seeing the “big picture”. Creating art, in a sense, allows me to develop what Shunryu Suzuki called “beginners mind” which is particularly important to me in maintaining a connection with children in my practice. Seeing the world as if for the first time is in itself revitalizing. Painting, sculpture; playing music, gardening, all play a role in tuning me in to this higher spiritual existence. These compliment my long-standing practice of Taiji and meditation. In a way, they all sensitize me to being fully present for my patients. Indeed, because the field of medicine can be so stressful, I find that if I have been working particularly hard, these practices are a necessary refuge that re-tunes my sensibilities. I often suggest these practices to my medical students, but they typically look at me as if I had three eyes (in fact I do). I cannot help but feel that without this level of practice in our lives, we are merely two dimensional practitioners getting two dimensional results in our patients.
As Eugen Herrigal says, “The hand that guides the brush has already caught and executed what floated before the mind at the same moment that the mind began to form it and in the end the student no longer knows which of the two, mind or hand was responsible for the work.”