Nutrient Deficiencies in Kids’ Diets

By Whitney Crouch, RDN, CLT

Our children are often our greatest pride, our greatest challenge, and sometimes our greatest frustration. However, they are not small adults, and they often remind us of this around meal times when the plate full of veggies goes untouched, but the pizza is ravenously inhaled. Behaviors aside, children’s growing bodies are different from adults and require higher proportions of some nutrients.

As parents, we may know what our children should ideally be eating for breakfast, lunch, dinner, and snack times, but sometimes we just can’t seem to persuade our children to actually eat those veggies.

“Will my child be getting enough nutrition if she only eats a few bites of each meal?” “What if she relies heavily on processed, carbohydrate-rich foods?” “How can I support my picky eater in choosing a wider variety of foods?” These are valid concerns that many healthcare providers and dietitians hear from worried parents. Added to those questions is the recent government data that states, according to the 2011-2014 National Health and Nutrition Examination Survey (NHANES), many children are not meeting current nutrient recommendations.1 There are multiple factors why this is the case, and we will explore the food sources of nutrients, nutrient gaps, and strategies to help improve dietary intake of important nutrients in children.

Nutrition intake: Where are we today?

The 2015–2020 Dietary Guidelines Advisory Committee (DGAC) determined that several nutrients: vitamins A, E, and C; folate; magnesium; and iron (in adolescent females) were underconsumed in children relative to the Estimated Average Requirement (EAR) or Adequate Intake (AI) levels set by the Institute of Medicine. These were characterized as “shortfall nutrients.”1 In addition to the aforementioned micronutrients, fiber is another nutrient that is often underconsumed. Consider these daily recommendations for fiber range based on age, sex, and calorie needs:2

  • 14 g (age 1-3 years)
  • 17-20 g (age 4-8 years)
  • 22-25 g (age 9-13 years)
  • 25-31 g (age 14-18 years)

If your child falls into the category of a “frequent processed food eater,” he or she is likely not getting enough fiber each day, which can lead to difficulty producing regular bowel movements and could possibly lead to additional nutrient deficiencies and adverse health issues.

In children 2–18 years of age, milk has been shown to be the primary source of calcium, vitamin D, and potassium.3 Dairy products, especially milk and yogurt, also provide protein, saturated fatty acids (SFA), riboflavin, vitamin B12, and phosphorus. But over the past 30 years, fluid milk consumption has declined from 247 pounds per person to 154 pounds per person, with an increase in cheese and yogurt consumption.1 The increased cheese and yogurt intake has led to increased intake of saturated fat and sodium in the diet.4 Despite the decreasing trend in cow’s milk intake, younger children appear to be consuming adequate dairy, but many will decrease consumption as they age, especially girls, despite an increased need by volume. Reasons for milk intake decreasing as children become adolescents include beliefs around dairy (females may think dairy will make them “fat”, whereas males may think it will help them grow stronger), access to milk products (sometimes limited due to parental beliefs around dairy), skipping meals that would normally contain dairy, and more.5

As recommended by the USDA, children 2-3 years old should be consuming 2-cup equivalents of dairy per day, while 4-8-year-olds need 2.5-cup equivalents, and 9-18-year-olds should be consuming around 3-cup equivalents per day.6 The American Academy of Pediatrics (AAP) adopted the American Heart Association’s (AHA) 2006 guidelines, which recommend similar intake of 2 cups/day of reduced fat or nonfat milk for ages 2-8 and 3 cups/day of reduced fat or nonfat milk for ages 9-18 years.7-8

Significantly, children 9-18 years old actually have higher calcium needs than adults, requiring 1,300 mg of calcium daily to support increased needs for skeletal development leading up to and during puberty.9

Of note, while the AAP and AHA may be aligned on low or nonfat dairy for children ages 2+ years, recent studies have shown reduced rates of obesity when higher fat dairy is consumed, and no ill effect on adult blood lipids.10

When children are meeting the recommended intake for dairy, discretion should be used to serve children low-sugar products that are nutrient-dense. To reduce sugar and improve nutrient density, parents should limit their children’s intake of flavored milks, read product labels, and avoid purchasing yogurts (and other food products) with large amounts of added sugars. Greek and Skyr type of yogurt products can be great sources of protein and often provide 9 grams or less sugar per serving and without the use of artificial sweeteners.

Nutrient needs and portions

Parents usually have the best intentions at heart when it comes to their children, but if they don’t have enough information to make informed choices, can you blame them if their children aren’t meeting all of their nutrition needs?

Calorie and portion needs change as children grow. Below is a quick reference guide to better layout children’s evolving nutrition needs. Parents’ intuition and knowledge of their child’s habits are the best gauge of a child’s daily needs.

FOOD GROUP 2 year olds 3 year olds 4-5 year olds
Fruits 1 cup 1-1 ½ cups 1-1 ½ cups
Vegetables 1 cup 1-1 ½ cups 1 ½-2 cups
Grains 3 ounces 3-5 ounces 4-5 ounces
Proteins 2 ounces 2-4 ounces 3-5 ounces
Dairy 2 cups 2-2 ½ cups 2 ½ cups

(www.choosemyplate.gov, 2018)

*Older children’s needs are higher and based on age, sex, height, weight, and activity level.6

Portions:11

  • ½ cup of fruit: ½ cup mashed, sliced, or chopped fresh fruit; ½ cup of 100% fruit juice (try watering it down 50% with ½ cup flat or sparkling water); ½ small banana, 4-5 large strawberries
  • ½ cup vegetables: ½ cup mashed, sliced, or chopped vegetables; 1 cup raw, leafy greens; ½ cup vegetable juice (choose low-sodium versions); 1 small ear of corn
  • 1 ounce grains: 1 slice bread; ½ cup cooked oatmeal, rice, or pasta; 1 6” tortilla
  • 1 ounce protein: 1 ounce cooked meat, poultry, or seafood; 1 whole egg; 1 tablespoon peanut butter; ¼ cup cooked legumes (pinto, kidney, black beans; lentils; peas)
  • ½ cup dairy: ½ cup low-fat or nonfat milk; 4 ounces low-fat, low-sugar yogurt; ¾ ounce cheese

In the second part of this two-part series, we’ll discuss filling the nutrient gaps and provide helpful ideas to get picky eaters the nutrients they need.

References

  1. O’Neil CE et al. Food Sources of Energy and Nutrients of Public Health Concern and Nutrients to Limit with a Focus on Milk and other Dairy Foods in Children 2 to 18 Years of Age: National Health and Nutrition Examination Survey, 2011-2014. Nutrients. 2018;10(8):1050.
  2. Office of Disease Prevention and Health Promotion. Dietary Guidelines 2015-2020. Appendix 7. Nutritional goals for age-sex groups based on dietary reference intakes and dietary guidelines recommendations. https://health.gov/dietaryguidelines/2015/guidelines/appendix-7/ Accessed December 5, 2018.
  3. Keast DR et al. Food sources of energy and nutrients among children in the United States: National Health and Nutrition Examination Survey 2003–2006. Nutrients. 2013;5:283–301.
  4. Thorning TK et al. Whole dairy matrix or single nutrients in assessment of health effects: Current evidence and knowledge gaps. Am J Clin Nutr. 2017;105:1033–1045.
  5. Racey M et al. Barriers and Facilitators to Intake of Dairy Products in Adolescent Males and Females With Different Levels of Habitual Intake. Glob Pediatr Health. 2017;4:2333794X17694227. Published March 21, 2017.
  6. United States Department of Agriculture. Choose MyPlate. https://www.choosemyplate.gov. Accessed December 5, 2018.
  7. Gidding SS et al and endorsed by the American Academy of Pediatrics. Dietary Recommendations for Children and Adolescents: A Guide for Practitioners. Circulation. 2005;112:2061–2075.
  8. Dietary Recommendations for Healthy Children. American Heart Association. https://www.heart.org/en/healthy-living/healthy-eating/eat-smart/nutrition-basics/dietary-recommendations-for-healthy-children. Reviewed April 16, 2018. Accessed January 6, 2019.
  9. Calcium. National Institutes of Health, Office of Dietary Supplements. https://ods.od.nih.gov/factsheets/Calcium-HealthProfessional/. Published 2018. Accessed December 10, 2018.
  10. Beck AL et al. Full fat milk consumption protects against severe childhood obesity in Latinos. Prev Med Rep. 2017;8:1-5.
  11. Fulgoni VL et al. Foods, fortificants, and supplements: Where do Americans get their nutrients? J Nutr. 2011;141(10):1847-1854.
Whitney Crouch, RDN, CLT Whitney Crouch is a Registered Dietitian who received her undergraduate degree in Clinical Nutrition from the University of California, Davis. She has over 10 years of experience across multiple areas of dietetics, specializing in integrative and functional nutrition and food sensitivities. When she’s not creating educational programs or writing about nutrition, she’s spending time with her husband and young son. She’s often found running around the bay near her home with the family’s dog or in the kitchen cooking up new ideas to help her picky eater expand his palate. Whitney Crouch is a paid consultant and guest writer for Metagenics.
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