Diet and Nutrition in the Child
Dietary Considerations
Caloric Requirements
Experts recommend that from birth to at least age 1, an infant’s diet consist of breast milk. Non-formula cow’s milk is not recommended especially prior to 1 year of age. This is due to its ability to cause allergies, gastrointestinal tract bleeding, and because it lacks sufficient vitamins and essential fatty acids vital for infant development. If formula must be used, limit it to 1/3 of the day’s total caloric intake.
Caloric requirements are:
- Infants: 80-140 kcal/kg/day
- Children: 40-90 kcal/kg/day
- Adolescents: 30-50 kcal/kg/day
- Barnes L. Infant feeding: formulas, solids. Pediatric Clin North Am 1985;32:355-362.
- The use of cow’s milk in infancy. Pediatrics 1992;89:1105-1109.
Are Children Getting Enough Fruits and Vegetables
A recent study shows that US children are not eating enough fruits and vegetables. In a week long study, eating habits of 168 preschoolers (group aged 2 and 5 years) were recorded. None of the children met the 5 daily servings of fruits and vegetables recommended. According to researchers, most children consumed just 2 servings of fruit and less than 1/2 of a serving of vegetables per day. Also, 1/2 of the total fruit servings generally were in the form of juice, which experts say, in excess can cause diarrhea, growth failure, failure to thrive, and obesity in some children. Researchers wrote, “Low intakes of fruits and vegetables were associated with inadequate intakes of vitamin A, vitamin C, and dietary fiber, in addition to high intakes of total fat and saturated fat.” High consumption of fruits and vegetables has been shown to significantly lower the risk of many types of cancers. The researchers urge parents to provide their children with a wide variety and abundance of fruits and vegetables and be role models for their children by also eating moderate amounts of fresh fruits and vegetables.
- Journal of the American College of Nutrition 1998;17:371-378.
The Truth Regarding Fruit Juices and Other Drinks
As stated in the “Are Children Getting Enough Fruits & Vegetables” above, fruit juices as well as other drinks can be harmful in the growing child. Fruit and non-fruit juices are high in simple sugars and deficient in complex carbohydrates, protein, fat and fiber. They also tend to be low in vital vitamins and minerals. This can result in the following:
- diarrhea and intestinal bloating (due to difficulty digesting fructose and sorbitol)
- caloric deficiencies (fill up on juice and not calorie dense food)
- nutritional deficiencies (fill up on “nutritionally empty” juice products)
- dietary imbalances (fill up on juice and do not eat adequate foods containing protein, complex carbs, fat)
Experts recommend adding small amounts of juice (2-3 tablespoons) to water if juice must be given to children. It should be noted that juice prior to bed contributes to the development of dental caries.
- Smith MM, Lifshitz F. Excess fruit juice consumption as a contributing factor in nonorganic failure to thrive. Pediatrics 1994;93:271-277.
Food Allergies and Intolerances
Food allergies and intolerances are common in infants and children. Foods that cause the most problems include:
- dairy products (i.e. cow’s milk and eggs)
- pork and fish
- citrus fruits
- wheat and yeast
- nuts
- soy products
- many food additives
Symptoms include diarrhea, vomiting, failure to thrive, runny nose, sneezing, asthma inducement, wheezing, and skin problems such as hives. As identifying foods causing the problems can be very difficult experts recommend slowly introducing infants and children to foods one at a time. This way problematic foods can be identified early on and with little question as to the food culprit.
Most commonly, cow’s milk is the cause and should be avoided, especially in those under 1 year of age. Soy or rice milk can be substituted for those allergic to cow’s milk.
Breast Feeding vs. Formula
It’s important for the new mother to understand the significance breast milk has on their baby’s health. A great number of studies have consistently shown babies fed breast milk (compared to formula) are significantly healthier with a much lower incidence of various infections and diseases.
Breast Feeding Reduces Infant Illnesses – A recent study has shown that breast feeding significantly reduces the occurrence of common infant illnesses such as respiratory tract infections, pneumonia, ear infections, and gastrointestinal disorders. In the 2 year study of 977 babies, a community program was implemented which urged women to breastfeed their infants rather than use baby formula. The program resulted in a significant increase in breastfeed babies – 54.6%, up from 16.4%. During this time, the number of babies who developed pneumonia in the first year of life declined by 33% and the cases of gastroenteritis decreased by 15%.
According to researchers, their results suggest that “breast milk itself or the process of breast feeding provides protection against infant illnesses.” The American Academy of Pediatrics recommends that mothers breastfeed their babies for at least one year, “and longer if mutually desired by the mother and child.”
- Pediatrics 1998;101:837-844.
Breast milk is better for premature infants – Experts believe breast milk contains a number of immune-boosting compounds which “jump-start” the infants immune system and assist the infant in fighting off infections. In this study, researchers found that preterm infants fed breast milk developed significantly fewer infections. 212 preterm, very low birth weight infants (under 3 pounds) were fed either breast milk or formula. After adjusting for all other factors, researchers determined that infants fed breast milk decreased their odds of infection by 57% – a dramatic decrease. Also, many immune system agents normally found in breast milk are in higher concentrations in the breast milk of mothers who deliver prematurely compared with mothers who delivery at term.
The American Academy of Pediatrics has long advocated the use of breast milk as the primary food source of newborn, full-term infants. In 1997, this advisory was extended to cover premature infants.
- Pediatrics Electronic Pages 1998;102:e38.
Breast milk lowers occurrence of diarrhea – Diarrhea is common in infants and small children. When diarrhea is severe or present with other symptoms the child should be evaluated by a doctor. Diarrhea can be naturally and safely treated in many cases by supplementing with either normal flora (the naturally occurring intestinal flora which become depleted with diarrhea and gastrointestinal infection). Also, bovine colostrum can be fed to infants to provide added natural immunity. Both supplements are safe and increase immunity within the infant/child.
Breast milk lowers occurrence of middle ear infections – This infection of the middle ear has been shown to respond to chiropractic care in many cases. Nutritionally speaking, children who breast feed dramatically lower their chances of suffering from otitis media. In one such study, infants breast fed for 4 months or more decreased their incidence of otitis media by 50% compared with non-breast fed infants. Also, in those infants who did suffer from a bout of otitis media, subsequent recurrence was twice as common in non-breast fed infants.
- Duncan B, Ey J, Holberg CJ, Wright AL, et al. Exclusive breast-feeding for at least 4 months protects against otitis media. Pediatrics 1993;91:867-872.
Breast feeding enhances intellectual development – Research has shown breast feeding can enhance intellectual development. In a study of 229 healthy infants, those breast fed infants consistently scored higher on psychomotor skills.
- Temboury MC, Otero A, Polanco I, Arribas E. Influence of breast-feeding on the infant’s intellectual development. J Pediatric Gastroenterology Nutrition 1994;18:32-36.
Childhood Obesity
The rate of childhood obesity has been rising significantly over the last 30 years. Studies have shown that obesity in childhood dramatically increases the odds of obesity in adulthood, a condition which compromises health and overall well being. Obesity is a difficult condition to treat as it requires a very high level of self-discipline in order to overcome. It is thus especially important to prevent obesity from occurring during childhood or seeking immediate and effective treatment if it does exist. Obesity is defined as weighing more than 20% of your ideal body weight.
If obesity is present or is becoming increasingly evident, nutritional and fitness counseling should be sought immediately. In addition, parents should be role models for their children – eating healthy and engaging in regular physical activity.
Nutritional Supplementation
Iron
According to the American Academy of Pediatrics, women should breast feed until at least the age of 1 year and should not feed infants under 1 year cow’s milk. Doing this can lead to deficiencies of iron. Generally speaking, iron supplementation is not recommended for infants; excess iron can cause retardation of growth, increased bacterial replication in infections, and can also compete for uptake with other essential minerals in the gut.
Vitamin A
Vitamin A (retinol) is available in liquid form and is also added to most baby formulas. Occasional supplementation in infants and children is recommended if deficiency is suspected. Research has shown a single dose of 100,000 IU (International Units) in children under 12 months of age and 200,000 IU in children over 12 months of age can reduce the risk of death from measles and, according to a study on Brazilian children, can help treat severe diarrhea.
- Butler JC, Havens PL, Sowell AL, et.al. Measles severity and serum retinol (vitamin A) concentration among children in the United States. Pediatrics 1993;91:1176-1181.
- Barreto ML, Santos LM, Assis AM, et. al. Effect of vitamin A supplementation on diarrhea and acute lower-respiratory tract infections in young children in Brazil. Lancet 1994;322(Jul 23):228-231.
Vitamin B’s
Vitamin B is passed to the fetus and to the baby (via breast milk) by the mother. Thus, if the mother is deficient so to can the baby become deficient. In the case of mothers with vitamin B deficiencies (more common in vegetarians and vegans), supplementation may be necessary for mother and child.
Vitamin D
Vitamin D is another vitamin in which there may be a deficiency. Generally, a deficiency is most common when the mother is a vegetarian and/or lacks adequate sun exposure. In both cases, supplementation of the mother and infant is recommended. Like vitamin K, vitamin D is usually given to infants at the time of birth.
Vitamin K
In some infants and neonates, including those with certain malabsorption disorders, vitamin K deficiency may occur. This can cause unexpected hemorrhagic disease (bleeding). Almost always, babies are given intramuscular vitamin K shots at birth to prevent this condition.
Zinc
Zinc deficiencies can occur in infants whose mothers are deficient in zinc or if there exists a problem with zinc uptake from the mammary glands in the mother’s breasts. Zinc deficiencies are also common in premature infants and children with malabsorption syndromes. Zinc deficiencies are generally not found in infants who breast feed, assuming the mother is not deficient. Signs of deficiency include:
- skin lesions (appear as diaper rash or candida)
- diarrhea
- growth failure
- alopecia (baldness)
- irritability
- anorexia