Nutrition, Vitamins and Fiber
In my busy pediatric practice, I get questions from parents every day about nutrition and diet. Along with sleep, worrying about proper nutrition is one of the things that most parents struggle with. At some point or another, all parents wonder if their child is getting all of the nutrients and vitamins that they need. All kids have ‘good days’ and ‘bad days’ when it comes to eating. The most important lesson a child can learn related to food and eating is to eat when they are hungry and stop when they are full. These are lessons that a child learns early – there’s even some evidence that babies who breastfeed on demand do better at this than babies who are formula fed. I tell parents every day – “You decide what and your child decides how much.” The best way to make sure that your child is getting what they need is to offer them a variety of healthy foods, including fruits and vegetables, every day. The other important part of this equation is to allow your child to skip some meals or eat less than you think they should. If they aren’t hungry, don’t push them to eat, and do not offer them one thing after another to try to get them to eat. This will quickly become a game that ends with your child eating something less healthy.
Many parents ask about vitamin supplements for their children. If your child is eating a variety of foods, they will get all of the vitamins that they need. This doesn’t mean that it’s wrong or dangerous to give a vitamin supplement to your child, but it isn’t necessary for most children. There are some exceptions. Premature babies in the first several months of life and babies who are exclusively breastfed may need an iron supplement. For babies over six months of age who are mostly breastfed, I recommend making an iron fortified cereal like rice or oat cereal a part of their daily diet, or giving them vitamin drops with iron every day.
Since so many of the important vitamins and minerals that we need to stay healthy are found in fruits and vegetables, try to get your children to eat them every day. The reality is that most children are not too enthusiastic about veggies, and sometimes not too fond of fruits as well. In talking to parents, I have found that there are usually one or two or three vegetables, even the pickiest eaters. Typically, they will eat a certain vegetable for a while – a week, two weeks, maybe three? Then they switch and prefer another vegetable. This is “fad eating” and it’s how kids operate. I hear about it all the time – “My son will only eat broccoli,” or “All they want is peanut butter sandwiches,” or “As long as there’s a banana on the table, he’s happy.” If you have figured out what the “fruit or vegetable of the week” is, be sure to have it around and serve it often. When they move on to the next vegetable, start serving that one instead.
Some parents try to get their child to eat more vegetables by hiding or disguising them in other foods. There have been several cookbooks based on this idea with lots of these recipes. Personally, I think this teaches your child to be suspicious about what you’re serving. I think it’s better for your child to learn to eat the food than to get it because they think they’re eating something different (especially in the case of vegetables being hidden in cakes, cookies or other desserts). The best way to get you child to eat different vegetables and fruits is to have them around – a bowl of fruit on the table will ensure that whenever your child is hungry for a snack, there is something healthy available. Another important element is family dinners. This doesn’t have to be everyone, every night – this is challenging for busy families juggling work, sports and other activities. But your child should sit down with at least
one parent most nights, and be served what the parent is eating. Eventually, after they’ve watched you eat something a thousand times, they will try it. Show them a healthy diet, and over time they will copy it.
Vitamin D is an important vitamin for healthy bones and immune system. Vitamin D may also play a role in prevention of certain cancers and heart disease. It’s the latest vitamin to be featured in the news, because of the recent change in the recommendations for Vitamin D in infants. The American Academy of Pediatrics now recommends giving infants a vitamin supplement which includes Vitamin D every day. Older children and adults get Vitamin D from fortified foods such as milk, cereal and grains. You also get Vitamin D by making it in your skin, which happens when your skin is exposed to the sun. I recommend at least 15-30 minutes of sun several times a week, in the middle of the day, with no sunscreen or shading. In dark-skinned children and adults, or those who are usually covered up with little exposed skin, especially in the winter in climates with little sun, it can be difficult to make enough Vitamin D. In that case, a Vitamin D supplement is a good idea. Spending some time outside with your children is a great way to stay healthy – you’ll get some exercise and make Vitamin D.
Another important nutrient for children is Calcium. Calcium, like Vitamin D, is important for bone health as well as many other bodily functions like muscle contraction and brain function. The most efficient source of Calcium in our diet is from milk and dairy products. For most children, one to two servings per day of milk or dairy, combined with other sources of Calcium, is enough. Children who cannot tolerate milk or dairy because of allergy, lactose intolerance or a vegan diet can get Calcium from other sources such as fortified orange juice, tofu or fortified soy milk, greens such as bok choy, kale, spinach and broccoli, beans, figs, oranges and nuts.
Some parents worry about whether their child is getting enough fiber in their diet. Especially in the toddler years, when preferences run to starchy foods, getting enough fiber may be challenging. Many fruits and vegetables are high in fiber, another reason to encourage those. Whole grains are also a good source of dietary fiber. I recommend that you opt for whole grains as much as possible, including whole wheat breads and crackers, brown rice, whole grain cereal and oatmeal.
As your child grows and develops, they will have their own preferences and dislikes. Make sure that you offer a variety of healthy foods every day, and they will get what they need. There are many important lessons to be learned about eating and diet during childhood. Remember that your child is paying attention to what you do – model good eating habits for them, and they will follow your lead.
