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ANAHEIM, Calif. – Many pediatricians were in the dark about their Muslim patients observing Ramadan fasting, according to a survey from Michigan.

Fully 64% of Muslim parents surveyed in the state (511 of 801) hadn't told pediatricians that their children were fasting during daylight hours of the month-long Ramadan holiday, reported Emman Dabaja, MD, MPH, of the University of Michigan CS Mott Children's Hospital in Ann Arbor.

Despite the large Arab population in the state, 61% of pediatricians surveyed there (164 of 268) said they knew little to nothing about fasting, Dabaja told attendees at the annual meeting of the American Academy of Pediatrics.

Education of parents and training of pediatricians are key to protecting the health of Muslim children who fast during Ramadan, Dabaja said in an interview with 番茄社区app.

"Be aware," she advised colleagues. "Understand the lifestyles of your patients so you can give recommendations. As you get closer to Ramadan time, ask your families: Are you thinking about fasting?"

Ramadan is an annual Muslim holy month that occurs at a different time each year depending on the lunar calendar. For example, it began on April 1 this year, while next year it begins on March 22. Many Muslims observe the holiday by fasting from dawn to dusk, a period that can last for 15 hours when Ramadan occurs in the summer. According to Dabaja, adherents are supposed to avoid all food or drink by mouth, including water, outside of meals after dusk and before dawn. Medication is also not allowed.

There are exceptions to the fasting requirement such as for the sick, the elderly, and women who are pregnant or lactating. The youngest children don't take part, she said, but it's common for kids to begin fasting when they reach puberty. Dabaja, a Muslim American, said she started fasting at age 9.

While it could be "pretty dangerous" for parents to allow their children to fast without consulting a medical professional, especially for kids with diabetes, she said: "We don't want anyone to think ill of us, so a lot of Muslim patients may not necessarily tell their pediatrician that they are fasting. They may not share why that is so valuable and important and why they would like their child also to partake in that."

The researchers began the project in 2017 after noticing that the medical literature focused on Ramadan fasting in adults and didn't address children. They conducted an online survey of 889 parents in the Detroit area (84% female, 80% Arab/Arab American, average age 39). Of 820 whose children fasted, 75% said their pediatricians gave them no information about how to protect their children's health during Ramadan.

In another survey of 52 Muslim parents of children with diabetes (92% type 1), 27% said their children fasted during Ramadan (average age 11). "We didn't find that those kids particularly had worse glycemic control," Dabaja said. "They didn't have more ED [emergency department] admission, ED visits, or hospitalizations. So they were actually just as well as the other kids."

The researchers also surveyed 280 pediatricians and family medicine specialists (52% residents, 7% fellows, 41% attendings). Of the pediatricians, 68% were female and 58% were white, 13% were Arab/Arab American, and the rest were mostly South Asian/South Asian American or Asian/Asian American.

Most (53%) said they were extremely or somewhat uncomfortable discussing fasting recommendations. Most (74%) never provided guidance about upcoming fasting, even though 52% said they had at least a moderate amount of exposure to Muslim patients. (The number of physicians who responded to questions in each of these categories ranged from 262 to 279).

In another part of their research, Dabaja and colleagues began providing 45-minute lectures to train pediatricians about fasting in Muslim children prior to Ramadan. Over 4 years, 138 physicians took part, and nearly 75% of those in the 2022 group (n=57) said afterward that they had an advanced or good understanding of fasting practices.

Dabaja advised colleagues to provide guidance about safer fasting, such as prioritizing proteins over carbohydrates or desserts during meals and watching out for dehydration and dizziness. "We ask people to recognize that their children's sleep schedules may be different. They may be sleeping later because they're eating later, or they may be waking up much earlier. You may need to have your child take a nap in the afternoon."

As for fasting children with diabetes, she suggested advising parents to be on the alert for symptoms and – if feasible – test glucose levels more often than usual for children without continuous glucose monitors. Medical professionals might also want to adjust the long- or short-term insulin of these patients, she added.

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