Why Are Our Children So Sick? The Root Cause Most Parents Miss – Dr. Paula Kruppstadt, M.D.
INTRODUCTION: A GENERATION IN CRISIS
America is raising the sickest generation of children in its history — and it is not because of genetics. Rates of ADHD in children, autism, anxiety, depression, chronic illness, and neurodevelopmental disorders have climbed to unprecedented levels. One in six children in the United States is now diagnosed with a developmental disability. Childhood obesity, type 2 diabetes, autoimmune disease, and mental health crises are no longer rare exceptions — they are the norm. Something has gone profoundly wrong, and the answer is not found in a prescription pad.
In a compelling episode of the Go to Health health podcast, host Jonathan Marx sits down with Dr. Paula Kruppstadt, M.D., a board-certified pediatrician, Certified Practitioner of Functional Medicine (IFMCP), and founder of Hope for Healing (get2theroot.com) in Houston and The Woodlands, Texas. Dr. Kruppstadt has devoted her career to asking the question that most conventional physicians overlook: Why are our children so sick? Her answer is both sobering and deeply hopeful. The root cause most parents miss is not a single disease — it is a toxic environment colliding with a vulnerable biology, eroding children’s health from the inside out.
This article draws on Dr. Kruppstadt’s insights from the podcast, the philosophy and approach at get2theroot.com, and critical information about PANS and PANDAS from aspire.care to give parents a comprehensive, actionable understanding of what is making our children sick — and what they can do about it.
WHAT IS FUNCTIONAL MEDICINE AND WHY DOES IT MATTER FOR CHILDREN?
Functional medicine is a root-cause, systems-biology approach to health that asks not just “What disease does this child have?” but “Why does this child have this disease, and what can we do to address the underlying cause?” It is the foundation of everything Dr. Paula Kruppstadt MD practices at Hope for Healing, and it is the lens through which this health podcast episode is framed.
Conventional medicine excels at acute care — treating infections, managing emergencies, and diagnosing diseases. However, it is poorly equipped to handle the epidemic of chronic illness that now defines childhood health in America. When a child presents with ADHD, anxiety, or recurring infections, the conventional response is often medication management. Functional medicine, by contrast, investigates the root causes: nutritional deficiencies, gut dysbiosis, environmental toxin exposure, genetic vulnerabilities, immune system dysfunction, and chronic stress.
At get2theroot.com, the approach is organized into an intelligent, three-stage sequence: Lifestyle, Genetics, and Medical. This sequence is not arbitrary. Lifestyle modifications form the bedrock of all healing. Without addressing diet, sleep, movement, stress, and environment, even the most sophisticated medical interventions will fall short. Genetics provides the personalized roadmap, identifying where a child’s unique biology is most vulnerable. Medical intervention then becomes targeted and effective, rather than a blunt instrument applied to a poorly understood problem.
Dr. Kruppstadt is one of a small number of board-certified pediatricians in the world who hold the IFMCP (Institute for Functional Medicine Certified Practitioner) designation. This combination of traditional pediatric training and advanced functional medicine expertise makes her uniquely qualified to address the complex, multifactorial health challenges facing children today. Her practice, Hope for Healing, serves families across Houston, The Woodlands, and beyond, offering personalized care for everything from general pediatric wellness to complex neurodevelopmental and autoimmune conditions.
THE SICKEST GENERATION IN HISTORY: WHAT THE DATA TELLS US
The statistics are staggering. The United States spends more on healthcare per capita than any other nation, yet American children are among the sickest in the developed world. Consider the following realities that Dr. Kruppstadt addresses in her functional medicine podcast discussions.
The diagnosis rates of ADHD in children have risen dramatically over the past three decades, most likely due to better recognition and understanding. Today, approximately one in ten American children carries an ADHD diagnosis, making it one of the most common neurodevelopmental disorders in the country. Yet rather than asking why so many children struggle to focus, the default response is often stimulant medication.
Autism and ASD (Autism Spectrum Disorder) now affect approximately one in thirty-six children in the United States, according to the CDC’s most recent estimates. This is a staggering increase from one in 150 just two decades ago. While improved diagnostic criteria account for some of this rise, the sheer magnitude of the increase points to environmental and biological factors that cannot be explained by genetics alone.
Anxiety is now the most common mental health disorder among children and adolescents. Depression rates among youth have surged, particularly in the aftermath of the COVID-19 pandemic. Suicide rates among children and teenagers have reached alarming levels, underscoring the urgency of addressing mental health as a core component of pediatric care.
Chronic illness — including asthma, eczema, food allergies, autoimmune disease, and inflammatory bowel disease — affects a growing proportion of children. These are not isolated conditions; they are manifestations of a systemic dysfunction that functional medicine is uniquely positioned to address.
Dr. Kruppstadt’s message is clear: this is not a genetic crisis. Genes do not change this rapidly. This is an environmental crisis, and the good news is that the environment is something we can change.
THE GUT-BRAIN CONNECTION: WHY KIDS GUT HEALTH IS EVERYTHING
One of the most important and underappreciated insights in modern medicine is the profound connection between the gut and the brain. The gut is often called the “second brain” because it contains more than 100 million neurons and produces approximately 90 percent of the body’s serotonin. When gut health is compromised, brain health suffers — and vice versa.
Kids gut health is at the center of Dr. Kruppstadt’s approach to treating conditions ranging from ADHD and autism to anxiety and depression. The gut microbiome — the vast ecosystem of bacteria, fungi, and other microorganisms living in the digestive tract — plays a critical role in immune function, neurotransmitter production, inflammation regulation, and nutrient absorption. When this ecosystem is disrupted by poor diet, antibiotic overuse, environmental toxins, or chronic stress, the consequences ripple throughout the entire body.
Leaky gut syndrome, or intestinal permeability, is a condition in which the lining of the gut becomes damaged, allowing partially digested food particles, toxins, and bacteria to enter the bloodstream. This triggers a systemic inflammatory response that can manifest as skin conditions like eczema, respiratory issues like asthma, behavioral changes, cognitive difficulties, and mood disorders. Many children diagnosed with ADHD, autism, or anxiety have underlying gut dysfunction that is never investigated in a conventional medical setting.
At Hope for Healing, gut health is assessed through comprehensive stool testing, organic acids testing, and a detailed dietary history. Treatment involves targeted dietary interventions, probiotic and prebiotic support, and addressing any underlying infections or imbalances in the gut microbiome. The results can be transformative. Parents frequently report dramatic improvements in behavior, focus, mood, and overall well-being when their child’s gut health is properly addressed.
The relationship between gut health and neurology is also central to understanding conditions like PANS and PANDAS, where gut infections can serve as triggers for acute brain inflammation. This connection underscores why a holistic health approach — one that considers the entire body as an interconnected system — is essential for true healing.
DIET AND DETOX FOR KIDS: CREATING A CLEAN SANCTUARY
One of the most practical and impactful things a parent can do to improve their child’s health is to transform the home environment into what Dr. Kruppstadt calls a “clean sanctuary.” This is the foundation of detox for kids — not a dramatic medical procedure, but a thoughtful, systematic removal of the environmental and dietary toxins that are undermining children’s health every day.
The modern food supply is a significant contributor to the chronic illness epidemic. Ultra-processed foods, artificial dyes, preservatives, pesticide residues, high-fructose corn syrup, and industrial seed oils are ubiquitous in the diets of American children. These substances disrupt the gut microbiome, promote inflammation, impair mitochondrial function, and interfere with normal neurological development. Dr. Kruppstadt’s parenting tips in this area are straightforward and actionable.
Shop the perimeter of the grocery store, where whole, unprocessed foods are found. Focus on organic fruits and vegetables, particularly those on the Environmental Working Group’s (EWG) “Dirty Dozen” list, which identifies the produce most heavily contaminated with pesticide residues. Prioritize organic poultry and grass-fed beef to reduce exposure to hormones, antibiotics, and inflammatory omega-6 fatty acids. Teach children to read ingredient labels — if they cannot pronounce an ingredient, it is likely not real food and should be avoided.
Hydration is another critical component of a healthy lifestyle for children. Dr. Kruppstadt strongly advises eliminating fruit juices, which cause rapid spikes in blood glucose and insulin and contribute to the alarming rise in pediatric pre-diabetes and type 2 diabetes. After the age of three, children’s primary beverage should be water. Chronic dehydration is far more common in children than most parents realize, and it has significant consequences for energy levels, cognitive function, and mood.
Reducing screen time and increasing physical movement are also essential components of a healthy lifestyle. Many children today are dangerously sedentary, spending hours in front of screens that disrupt circadian rhythms, suppress melatonin production, and contribute to anxiety and depression. Encouraging outdoor play, sports, and movement is one of the most powerful interventions available to parents — and it costs nothing.
Finally, Dr. Kruppstadt shares a fascinating and simple detox hack for children: elevating the head of the bed by one-quarter to one-half an inch using a small block of wood. This practice supports the brain’s glymphatic system — the brain’s waste-clearance mechanism, discovered in 2014 — which operates primarily during sleep. The glymphatic system flushes toxins and metabolic waste products from the brain overnight. Elevating the head slightly allows gravity to assist this process, enhancing the brain’s natural detoxification capacity. It is a small change with potentially significant benefits for children with neurodevelopmental challenges.
STRESS, THE NERVOUS SYSTEM, AND THE FAMILY DINNER TABLE
Stress management is not a luxury — it is a medical necessity, particularly for children with chronic illness, neurodevelopmental challenges, or mental health conditions. Chronic stress activates the sympathetic nervous system (the “fight or flight” response), which suppresses immune function, impairs digestion, disrupts sleep, and promotes inflammation. For children who are already biologically vulnerable, chronic stress can be the tipping point that pushes a manageable condition into a crisis.
Dr. Kruppstadt highlights the family dinner table as an often-overlooked therapeutic tool. The body needs to be in a parasympathetic (“rest and digest”) state to properly digest food and absorb nutrients. When meals are eaten in a stressful environment — with arguments, screens, or rushed eating — the body cannot perform this essential function effectively. This contributes to poor nutrient absorption, gut dysfunction, and a worsening of the very conditions parents are trying to address.
Creating a calm, connected dinner experience is a powerful parenting tip and a form of stress management that costs nothing. Dr. Kruppstadt recommends asking children simple, positive questions at the dinner table — such as “What was the best part of your day?” — to cultivate gratitude and shift the nervous system into a parasympathetic state. This practice not only improves digestion but also strengthens family bonds and supports children’s emotional regulation and mental health.
Meditation and mindfulness practices are increasingly recognized as effective tools for managing anxiety and depression in children. Even brief, age-appropriate mindfulness exercises can help children develop the capacity to regulate their emotions, reduce stress, and improve focus. For parents, modeling these practices is one of the most powerful things they can do to support their children’s mental health and holistic health.
Evaluating extracurricular activities is another important consideration. Many children today are overscheduled, exhausted, and overwhelmed. Dr. Kruppstadt encourages parents to ask honestly whether their child actually wants to participate in each activity, and to prioritize rest, play, and family connection over achievement and busyness. A child who is chronically exhausted and stressed cannot heal, regardless of how many supplements they take or how clean their diet is.
PRECISION GENETICS: UNDERSTANDING YOUR CHILD’S UNIQUE BIOLOGY
One of the most powerful tools in Dr. Kruppstadt’s functional medicine toolkit is precision genetics testing. While we all have genetics, genes do not always have to express themselves — the environment plays a massive role in determining which genes are activated and which remain dormant. This is the science of epigenetics, and it is central to understanding why some children develop ADHD, autism, or chronic illness while others in the same family do not.
Precision genetics testing identifies specific genetic variations called SNPs (Single Nucleotide Polymorphisms) — small differences in the genetic code that act as “rate-limiting steps” in the body’s biochemical processes. These variations can affect how the body handles inflammation, how cells produce energy (mitochondrial function), how the body detoxifies environmental toxins, and how the brain regulates neurotransmitters.
For children with ADHD, autism, ASD, dyslexia, or other neurodevelopmental challenges, identifying these genetic vulnerabilities provides a roadmap for targeted intervention. Rather than applying a one-size-fits-all treatment protocol, Dr. Kruppstadt can use the results of a simple cheek swab to design a personalized wellness plan that addresses each child’s unique biological needs. This approach embodies the core principle of functional medicine: personalized, evidence-based care that honors the individuality of each patient.
The results of this approach can be remarkable. Parents who have struggled for years to find answers for their children’s ADHD, autism, or chronic illness often describe the precision genetics consultation as a turning point — the moment when the pieces finally came together and a clear, actionable path forward emerged.
PANS AND PANDAS: WHEN THE IMMUNE SYSTEM ATTACKS THE BRAIN
One of the most important and underdiagnosed conditions in pediatric medicine today is PANS and PANDAS — a category of conditions that Dr. Kruppstadt discusses at length in her health podcast appearances and that is comprehensively documented at aspire.care, the website of ASPIRE (Alliance to Solve PANS and Immune-Related Encephalopathies).
PANS stands for Pediatric Acute-Onset Neuropsychiatric Syndrome. PANDAS stands for Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections. Both conditions involve misdirected immune responses that result in neuroinflammation — inflammation of the brain — leading to a dramatic and often terrifying onset of psychiatric and behavioral symptoms.
WHAT ARE PANS AND PANDAS?
PANS is a clinical syndrome defined by the sudden, encephalitic-like onset of obsessive-compulsive symptoms and/or severely restricted food intake, along with at least two concurrent cognitive, behavioral, or neurological symptoms from the following categories: anxiety and separation anxiety; emotional lability and/or depression; irritability, aggression, and/or severe oppositional behaviors; behavioral or developmental regression; sudden deterioration in school performance; motor or sensory abnormalities including tics; and somatic signs and symptoms including sleep disturbances, enuresis, or urinary frequency.
PANDAS is a subset of PANS in which the triggering infection is specifically Group A Streptococcus (GAS). PANDAS requires the presence of OCD and/or tics, an age of onset between three years and puberty, an acute and episodic (relapsing-remitting) course, and an association with neurological abnormalities. GAS infections can occur in many parts of the body — not just the throat. Perianal strep, skin infections, and sinus infections can all trigger PANDAS.
In layperson’s terms, PANS is best understood as an umbrella term for many different triggers that create inflammation in the brain, leading to sudden and severe behavioral changes. It is a medical disorder with both physical and psychiatric presentations. The key distinguishing feature is the abruptness of onset — parents frequently describe their child as having an “overnight personality change,” going from a healthy, happy child to one who is consumed by obsessive-compulsive behaviors, extreme anxiety, or dramatic behavioral regression.
THE TRIGGERS OF PANS AND PANDAS
PANS can be triggered by a wide range of infectious, metabolic, and inflammatory causes. According to aspire.care, post-infectious autoimmunity and/or neuroinflammation are found in more than 80 percent of PANS cases. Known infectious triggers include upper respiratory infections, Group A Streptococcus, mycoplasma pneumonia, influenza, Epstein-Barr virus, herpes simplex virus, parvovirus, COVID-19, and tick-borne illnesses such as Lyme disease. Metabolic disturbances and psychosocial stress can also trigger PANS.
Dr. Kruppstadt emphasizes that PANS and PANDAS can occur without a fever, and the triggering infection may be subtle or even undetected. An old, lingering infection in the gut, sinuses, or skin can serve as a chronic trigger, perpetuating neuroinflammation and sustaining the psychiatric symptoms. This is why a thorough infectious workup — including throat cultures, perianal cultures, and comprehensive blood work — is essential for any child presenting with sudden-onset neuropsychiatric symptoms.
The neurology of PANS and PANDAS involves the immune system producing antibodies that, rather than targeting the infection, mistakenly attack the basal ganglia — a region of the brain involved in movement, behavior, and emotional regulation. This misdirected immune attack causes the acute neuropsychiatric symptoms that define these conditions.
RECOGNIZING THE SYMPTOMS OF PANS AND PANDAS
The symptoms of PANS and PANDAS are wide-ranging and can be easily mistaken for primary psychiatric disorders. This is one of the most dangerous aspects of these conditions: children are frequently diagnosed with OCD, anxiety disorder, ADHD, or even autism, and prescribed psychotropic medications, without anyone investigating the underlying infectious or inflammatory trigger.
The hallmark symptom is the abrupt, acute onset of obsessive-compulsive behaviors or severely restricted eating. This is not a gradual worsening — it is an overnight change that parents immediately recognize as something profoundly wrong. Alongside the OCD or eating restriction, children may exhibit extreme anxiety and separation anxiety, severe emotional lability and mood swings, intense irritability and rage, behavioral regression including baby talk and tantrums, sudden deterioration in academic performance, motor tics and vocal tics, sensory processing difficulties, ADHD-like symptoms including hyperactivity and impulsivity, executive functioning decline, brain fog, urinary frequency or bedwetting, sleep disturbances and night terrors, and in severe cases, visual or auditory hallucinations.
Physical signs can also be present, including dilated pupils, piano-finger movements, peeling skin on the hands or feet, a red anal ring (indicating perianal strep), and a strawberry tongue. These physical signs are important clues that an infectious process is driving the neuropsychiatric symptoms.
PANS is a spectrum disorder — symptoms can range from mild, where a child can still attend school, to severe and life-threatening, particularly when extreme food restriction or suicidality is present. The disease course is typically relapsing and remitting, meaning symptoms may improve and then return, often triggered by new infections or stressors.
DIAGNOSING PANS AND PANDAS
PANS and PANDAS are clinical diagnoses, meaning they are based on a thorough review of the child’s medical history, current symptoms, and physical examination — not a single test. They are diagnoses of exclusion, meaning other neurological and medical conditions must be ruled out before the diagnosis is confirmed.
The diagnostic process, as outlined by aspire.care, involves three key steps. The first step is a comprehensive medical and psychiatric history and physical examination. Parents are encouraged to compile a detailed timeline of infections and the onset of neuropsychiatric symptoms before the appointment. Tracking tools are available at aspire.care to help families document symptom onset, severity, and secondary flares.
The second step is laboratory testing to identify infectious triggers and assess immune system function. Basic labs include throat and perianal strep cultures, anti-streptolysin O (ASO) titers, anti-DNase B, mycoplasma pneumoniae antibodies, Epstein-Barr virus panel, Lyme disease testing and co-infections, HHV-6, and a comprehensive immune panel including immunoglobulin levels and CBC. Additional testing may include ferritin, vitamin D, thyroid function, organic acids testing, stool testing, and plasma amino acids.
The third step is imaging or other testing to rule out other conditions. Depending on the child’s presentation, this may include MRI, EEG, EKG, or polysomnography.
Dr. Kruppstadt, who was appointed by Texas Governor Greg Abbott to the Pediatric Acute-Onset Neuropsychiatric Syndrome Advisory Council, is one of the leading experts on PANS and PANDAS in the country. She advises parents whose children experience an overnight personality change to become fierce advocates. Do not accept a purely psychiatric diagnosis without demanding a thorough investigation of infectious triggers. Direct hesitant physicians to resources at aspire.care or pandasppn.org.
TREATING PANS AND PANDAS: A THREE-PRONGED APPROACH
Treatment for PANS and PANDAS, as outlined by the PANS/PANDAS Research Consortium and detailed at aspire.care, involves a three-pronged approach that addresses all aspects of the condition simultaneously.
The first prong is symptomatic treatment, which provides relief from the most distressing psychiatric and behavioral symptoms. This may include Cognitive Behavioral Therapy (CBT) and Exposure Response Prevention (ERP) for OCD, psychotropic medications used with a “start low and go slow” approach, behavioral interventions, and school accommodations such as 504 plans or Individualized Education Programs (IEPs).
The second prong is treating the source of infection. For PANS and PANDAS flares triggered by an infection, the underlying infection must be treated thoroughly. This typically involves antimicrobial treatment — antibiotics for bacterial infections, antivirals for viral triggers, and antifungals when indicated. For PANDAS, prophylactic antibiotic use may be recommended to prevent recurrent strep infections and reduce the frequency of flares.
The third prong is treating immune system dysregulation and neuroinflammation. This may include anti-inflammatory medications such as NSAIDs or corticosteroids, Intravenous Immunoglobulin (IVIG), Therapeutic Plasma Exchange (TPE/Plasmapheresis), and other immunomodulatory agents. The choice of immunomodulatory treatment is based on the severity of symptoms, the disease trajectory, and the results of laboratory testing.
At Hope for Healing, Dr. Kruppstadt offers comprehensive care for children with PANS and PANDAS, addressing immune system dysregulation, infectious triggers, and environmental factors in a coordinated, personalized treatment plan. The goal is not just to manage symptoms but to address the root causes of the neuroinflammation and restore the child’s health and quality of life.
ASPIRE (aspire.care) is a vital resource for families navigating PANS and PANDAS. The organization provides educational materials, provider directories, symptom tracking tools, family stories, and advocacy resources. Their mission is to improve the lives of children and adults affected by PANS, PANDAS, and other immune-related encephalopathies by closing the gap between symptom onset and access to treatment and support.
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