What's Missing from My Child's Diet?

Contributed by Eve Persak, Nutrition Advisor, MS RD CNSC CSSD

The fit of a child’s clothes or shoes. A child’s size in comparison to classmates or playground peers. Parents often rely on these external indicators to gauge the overall adequacy of their children’s diet.  But when it comes to internal development – bones, brain, immunity – they often worry if their daily meals and snacks provide everything a child needs. Their concerns are further fuelled by conflicting nutritional information floating around.

In reality, no two children are the same.  Different variables influence meal patterns and food choices in each household. Dietary needs also change as a child progresses from infant to toddler to child to teen. The likes of fussy eating, underlying medical conditions, food intolerances and allergies need to be considered too. 

As such, personalised nutritional therapy is often the most effective approach to assess the adequacy of a child’s diet. However, with recent food trends, common sensitivities, changes in food supply, there are specific nutrients that children increasingly lack.  Here are a few that I often see in my private pediatric nutrition practice:

Fats – especially omega-3 fatty acids (EPA & DHA)  

The nutritional composition of breast milk varies from mother to mother and even over the course of a single feeding. Almost half of the calories in breast milk (and standard formulas) are derived from fats. The percentages of dietary fats children require will decline gradually with age, but it remains higher than adults. Why? Children use fats just as adults do – for vitamin absorption, hormone production, cell, tissue lubrication, and more. Yet they require extra for their rapidly developing brains and nervous systems.

Insufficiencies in total dietary fat can occur – especially when babies are first weaned from breast milk or formula, and introduced to relatively low-fat solids such as grains, fruits and vegetables. Although, what seems more common as of late, are little ones – infants, toddlers, and children alike – with adequate total fat but less than sufficient EPA and DHA which are essential omega-3 fatty acids crucial for nervous system development.  Cold water fish such as mackerel, salmon, cod, sardines and tuna are the richest and bioavailable sources of these essential fatty acids, but families may serve these less often due to seafood allergies, concerns for mercury, or picky palates. Including supplemental EPA and DHA products specifically formulated for children or chia and flaxseed supplements in your children’s diet can help to ensure that their nutrition needs are adequately met.

Minerals – Iron & Calcium

Soil depletion and the increased consumption of nutrient-poor processed foods have made mineral deficiencies a rising concern for all age groups globally. Parents need to take extra care to ensure their children’s diets include foods that are rich in minerals, especially calcium and iron.

Calcium.  This mineral is particularly important from birth through adolescence. While adults require ongoing bone maintenance, young children and teens are actively building bone – in length, diameter and density. Dairy is considered the most concentrated and absorbable dietary source, however not all children can take dairy due to lactose intolerance or an allergy to cow’s milk. Picky children may also prefer sweeter-tasting juices and sodas to creamy milk.

Iron.   Sufficient iron is usually available in breast milk and formulas.  But as little ones consume less of these and incorporate solids, deficiencies can arise – especially if first foods aren’t iron-rich or fortified. Weaning from breast milk and moving on to calcium-rich beverages such as milk also poses challenges, as the high calcium intake can hinder iron absorption. Teens – specifically athletes and young women who have started menstruating – often fall short of the daily iron requirement. While red meats are the richest and most bioavailable sources, many families are wary of their long-term health risks and are beginning to lean toward plant-based diets.

Although less concentrated, green leafy vegetables are vegan alternatives of both of these minerals, but picky eaters often refuse them because of their bitter flavour. Before adding a supplement, consult a nutrition professional to evaluate your child’s needs and find out what products would effectively provide a suitable dosage.

Vitamin D:

Vitamin D is crucial for children to absorb dietary calcium and for bone mineralisation. So much so that international health organisations have recently increased their recommendations for the daily requirements for infants and children. Our bodies can manufacture this micronutrient from sunlight, but nowadays, children spend more time indoors for fear of overexposure to harmful UV rays, which can result in skin cancer. Food sources include eggs, cold water fish, and fortified dairy, but children with allergies to these foods or those unable to consume sufficient amounts may require a supplement to avoid deficiency. If you wish to explore supplementation, appropriate dosage is essential with vitamin D and other fat-soluble vitamins.  So seek advice from your healthcare provider or a pediatric dietitian before you change your child’s diet. 

Probiotics:

We often try to shield little ones from harmful germs with hand sanitisers and disinfectant cleansers.  Yet it’s important to make sure children’s bodies are chock-full of bacteria – the beneficial kind, that is.  A healthful gut microbiota not only alleviates digestive troubles (like gas and diarrhoea) but also bolsters immunity – giving little ones internal protection from pathogenic microbes.  Cultured yogurts and fermented vegetables are valuable food sources, but parents can also provide additional support from reputable, clinically-approved supplements formulated specifically for children. If your child has chronic digestive troubles, frequent illnesses, or follows a special diet, professional guidance on the most effective strain of bacteria and a therapeutic dosage should be considered. 

Fibre:

Fibre is also important for children as it is for adults. When considering cereal-based products, there has been a lot of attention on the type of grain (i.e. gluten- or wheat-free) and exposure to chemicals (i.e. organic- or GMO-free). Whether pancakes, breads, breakfast cereals, or crackers are ‘whole,’ unrefined and provide useful dietary fibre is often overlooked. Rather than offering whole fruits and vegetables, parents might remove fibrous skins or rely on juices and puree packs. Just like the rest of their bodies, children’s gastrointestinal systems are immature. Fibre is especially important to prevent constipation and feeding beneficial gut flora. Encouraging whole, intact fibre-rich foods is the first and best option, but for children with intolerances or fussy palates - including a supplement can be helpful.  Psyllium husk powder is child-friendly and can be easily added to smoothies, porridge, yogurt, or even soup.  However, before adding it to your child’s diet, it’s advisable to speak with a pediatric dietitian about the best fibre source, the appropriate dosage, and your child’s hydration needs.