Your two-year-old refuses to eat dinner, your adolescent decides to become a vegetarian and your elementary school child only wants junk food for lunch. How to respond can be a dilemma.
Proper nutrition for children is important for their physical and mental development. Kids need to have a well-rounded, varied diet with specific emphasis on various food groups at specific ages to promote growth.
Nutrition Requirements and Concerns
Infants need human milk or formula during the first year of life. Complementary foods should begin at around six months of age. The introduction of iron-fortified cereals, vegetables, fruits and pureed meats should be encouraged with a transition to mechanically safe “people” food by one year. Spices and fats are appropriate at this age. Healthy fats (olive oil, fatty fish, avocado, etc.) are necessary to promote brain and nerve development during the first two years of life.
Toddlers and preschool children have ever-changing appetites. Kids who may not eat a lot one day may gobble up food the next. They are growing in spurts, and their appetites reflect this trend. Along with a diet that has a variety from all food groups, children at this age need to have the appropriate amount of dairy in their diets to promote strong, healthy bones and teeth. Foods containing increased fiber are important in toddlerhood because fiber aids in digestion, prevents constipation and may help to prevent heart disease.
School-age children begin to develop specific tastes for sugars, fats, and sodium. The school cafeteria and fast-food restaurants may not offer the healthiest choices. You need to educate and offer healthy choices for all meals. Packing lunches may help keep your child on a nutritious, healthy track. Family dinners around the table — minus any screen time — promotes healthier eating and family interaction.
Adolescents may be a challenge at this age, and mealtimes can be an issue for some. Most adolescents make great nutritional choices, but with busy schedules and school activities healthy eating may not always occur. Limiting fast-food choices and not skipping meals help limit poor picks. Also, some adolescents may develop weight concerns. Children at this age need to consume enough calories, calcium, protein and iron-containing foods to promote their active lifestyles, as well as their growth and development.
Children also need to be well-hydrated throughout the day. Milk and water should be their first choices. Fruit juices and soda should be limited or excluded.
Do Kids Need More Than Food?
What if your children are not eating healthily? Do they need vitamins, supplements or other food additives?
According to the American Academy of Pediatrics (AAP), healthy children with a diet that includes all four food groups in a day are getting the recommended daily requirements to promote growth and development and do not need vitamins or other supplements.
Necessary Vitamins and Minerals
But there are a few vitamins and minerals that do need to be added to children’s daily diet, according the AAP. All breastfed babies need to have 400 international units (IU) of vitamin D daily for the first year of life. Babies who are formula-fed need this supplement also if drinking less than 32 ounces of formula a day. Children and adolescents require 600 IU daily. Vitamin D is essential to promote the absorption of calcium and phosphorus needed for bone growth. A deficiency in Vitamin D may increase the risk of bone fractures and, in children under two years of age, can lead to rickets, a bone-softening disease. Megadoses of vitamins, for example, A, C or D, can produce toxic symptoms, such as headaches, nausea, rashes or other severe adverse effects.
According to the National Institutes of Health (NIH), scientific evidence does show benefits from specific supplements that aid in promoting health, such as vitamin D and calcium. Before you decide to give supplements to your children, check with their healthcare provider to be sure the supplements will not interfere with prescribed medications, surgical procedures or any current health condition. Review the current research about the supplement from reliable sources, such as the NIH, Food and Drug Administration (FDA), Federal Trade Commission (FTC) and Centers for Disease Control and Prevention (CDC).
According to the FDA, unlike drug medications, which they must approve before marketing, dietary supplements do not require premarket review or approval. The companies manufacturing dietary supplements don’t have to provide evidence that their products work or are safe and effective. Also, the supplement’s labeling and packaging may claim the product addresses specific nutritional deficiencies, helps with immunity or supports health, but it cannot claim to diagnose, treat, cure or prevent disease, per FDA regulations. These products may not be in the best interest of kids’ health.
The National Center for Complementary and Integrative Health (NCCIH) lists what you should know about dietary supplements in children:
1. Natural does not mean safe.
2. Federal regulations for dietary supplements are less strict than the over-the-counter products.
3. The quality of the supplements is not regulated and may contain contaminants.
4. Supplements may interact with medications or have unwanted side effects.
5. Emergency room visits occur often due to overdosing and no child-resistant packaging.
6. Homeopathic immunizations have not been proven to provide protection against diseases in children.
7. Some supplements have safety issues: Saint-John’s-wort interferes with medications such as birth control, antidepressants, seizure medication and cancer treatments.
8. Hidden ingredients in supplements promoting bodybuilding may contain steroids or steroid-like substances, which may lead to liver injury, kidney failure, stroke or other serious conditions.
9. Dietary supplements do not promote long-term weight loss. Some contain excessive caffeine or herbs, which may affect heart rhythms.
10. It is best to walk with your provider about the effectiveness and risks of supplements and vitamins before giving them to your child. Topics to discuss may include:
* Melatonin may be safe, but long-term effects are unknown.
* Probiotics may not be risky, but there is limited evidence on their effectiveness.
* Omega-3 supplements may cause diarrhea, indigestion or belching.
* Vitamin supplementation for children is not necessary.
In December 2017, the FDA proposed a new risk-based enforcement priority for homeopathic products and has issued warnings regarding several products. Many homeopathic products being marketed for diseases and conditions are ineffective and may cause harm due to poor manufacturing or ingredients. Homeopathic teething tablets and gels that contain belladonna, for example, can cause a serious adverse event (seizures and death) in children younger than two years of age. Zinc containing nasal products may cause the loss of the sense of smell. Homeopathic asthma products are not effective in treating asthma. Other products may contain an ingredient called nux vomica, which contains strychnine, a highly toxic poison.
It’s important to be aware of the pros and cons of complementary medicines for your kids. Talking with their provider about your concerns and learning the facts will enable you to make the best choices.
Jo Ann Serota, DNP, CPNP, FAANP, IBCLC, is co-owner of Ambler Pediatrics, Ambler, PA. She is president of the NAPNAP Foundation, past president of NAPNAP, corresponding editor of primary case studies for the Journal of Pediatric Health Care and a Ready, Set, Grow advisory panel member.