Food fads come and go. Consider how much the pendulum has swung from the low fat 90’s to the carb-conscious face of the new millennium. Similar to modern-day politics, food choices have become increasingly polarizing. There are those who don’t do dairy, vegetarians of all types, raw foodies, people who skip gluten, or all grains, and those who try not to eat “anything white.”
The question is how do these trends relate to children? Should parents invite their kids to adopt the latest food fad or not?
Whatever parents decide, they need to understand that children are not “little adults,” and there are important considerations when applying the latest food trend to a growing child.
History tells us not to go there
We know from history that children put on restrictive diets can experience impaired growth and even malnutrition. When a macrobiotic diet (a restrictive vegetarian diet that relies on rice, vegetables and beans with a small intake of fruit, dairy and nuts and seeds) was popular in the ’70s and ’80s, there were reports of young children not growing properly.
One of four case studies in the 1979 issue of the British Medical Journal, describes a 5-month old baby weaned to a diet of vegetables, brown rice and kohoh. At 10 months the child was less than the 3rd percentile for weight, had experienced developmental delays and was diagnosed with rickets, a severe bone disease. After she was given supplements (including vitamin D), and given a wider diet of fish, cereals and milk, her growth caught up.
In a 1989 study published in the American Journal of Diseases in Children, eight children were put on low-fat diets without medical supervision. Three of the children had nutritional dwarfing and five had weight loss or inadequate weight gain. The diets of children with dwarfing were the lowest in calories, fat and micronutrients.
Did you know most nutrient inadequacies don’t show symptoms until the deficiencies are more extreme? For example, a 2012 study following 7000 girls found the ones with the lowest vitamin D intake had the highest risk of fractures. If this study wasn’t done, most of the parents would have been clueless that their child was low in vitamin D, and that it affected bone health.
Children are growing, adults are not
A product deemed “healthy” or “natural” for adults, who are done growing, does not mean it will be healthy for children who are still growing. According to a 2009 study in in Pediatric Clinics of North America, there have been more than a dozen reports of Kwashikor (protein-calorie malnutrition typically found in developing countries) in children under two given milk alternatives.
Two examples of this were highlighted in the 2001 issue of Pediatrics. In one case, a 22-month-year-old was admitted to the hospital with poor growth, abdominal bloating, thin hair, skin lesions and irritability. He breastfed until 13 months and was transitioned to a fortified rice beverage, which was his main source of nutrition. Rice milk is very low in protein and coupled with poor intake it resulted in a diagnosis of Kworshikor.
The other case was a 17-month-year-old child breastfed until 10 months who had good food intake and was put on a non-fortified soy beverage along with a vegan diet. His diet provided no vitamin D because there were no animal products and his milk wasn’t fortified. He presented with severe developmental delays and poor growth and was diagnosed with rickets. In both cases, supplementation and adequate diets reversed the problem.
Did you know that the most important (and fastest) time of growth is the first two years of life? It is recommended babies stay on breast milk or formula the first year and transition to whole milk or fortified soy milk (or stay on breast milk) after one year. Some popular milk alternatives, like rice, coconut and almond milk, are low in protein or fat (or both), and may not always be fortified, so make sure you check with your pediatrician or dietitian to make sure they are appropriate to use.
Children experience different taste worlds
Another reason why voluntarily limiting diets isn’t good for children is they experience different taste and texture worlds than adults. Not only are their tastes sweeter and more sensitive to bitter, but they are also more sensitive to the texture of food. But taste buds and texture sensitivities mature with age and children gradually expand the foods they will eat over the years. So voluntary removing entire food groups, or classes of food can pose a problem.
Take the popular Paleo diet, which some parents are incorporating into family life. This diet excludes two food groups and one class of protein foods — dairy products, grains and beans. According to one assessment, a carefully planned Paleo diet can meet most needs except for calcium (671mg) and vitamin D but provides 4 times the RDA for protein and less than is recommended for total carbohydrates. Even with ideal intake (which is less than likely for, say the average teen), an adolescent would only get about half the calcium they need at a time that is critical for the formation of bones.
But what happens when a child dislikes the texture of meat or nuts? Because this diet doesn’t allow beans or grains, nutrients important for growth like iron and zinc will be harder to come by. Parents need to understand which nutrients are missing when entire food groups are removed from the diet and how to replace the missing items with food or supplements. This post can get you started.
Research shows that eliminating just one of the eight common allergens, especially dairy or wheat, can negatively impact dietary adequacy. And as the number of food allergens removed goes up, so does the risk of deficiency. It is recommended that children with more than one food allergy, see a pediatric dietitian to ensure adequate nutrient intakes.
Staying Conservative Until There’s More Research
I’m conservative when it comes to feeding children and want to see the research that shows a certain approach is appropriate for kids and their unique nutritional needs.
For example, we now know vegetarian diets can work well, but parents need to do their homework so they can provide a variety of foods and supplements as needed. In Fearless Feeding, we help parents understand their child’s nutritional needs at each stage, so they can meet those needs through foods and supplements if necessary.
I know there is a tendency to distrust “food advice” given from mainstream organizations like the government. But there is often much research that goes into those recommendations, which can’t always be said for the latest food fad.
Roberts, I.F., West R.J., Ogilvie D., and Dillon M.J. Malnutrition in infants receiving cult diets: a form of child abuse. British Medical Journal, 1979, 1, 296-298.
Sonneville, K.R, Gordon, G.M., Kocher, M.S., Pierce, L.M., Ramappa, A., and Field, A.E. Vitamin d, calcium, and dairy intakes and stress fractures among female adolescents. Archives of Pediatric &Adolescent Medicine, 2012, 166, 595-600.
Severe Nutritional deficiencies in toddlers resulting from health food milk alternatives. Pediatrics, 2001, 107;346.
Cordain, L. The Nutritional characteristics of a contemporary diet based upon paleolithic food groups. The Journal of the American Nutraceutical Association, 2002, 5 (3) 15-24.
Kirby, M. Nutritional deficiencies in children on restricted diets. Pediatric Clinics of North America. 2009, (56) 1085-1103