Even kids who eat healthily are vulnerable to nutrition deficits. There are a number of nutrients children are most likely to be short on. Sometimes supplements are needed, but many times, a few tweaks in the diet are all it takes.
The most common deficiency is iron. This remains a major challenge in developing countries, but it’s also still fairly common here in the U.S. According to the 2008 Pediatric Nutrition Surveillance Survey, nearly 15 percent of children 5 years and younger have iron deficiency anemia. Another vulnerable time for iron deficiency is during adolescence (for girls) when menstruation starts.
During the first few years, there is rapid growth and the body can have trouble keeping up if there’s not enough iron. While iron has many functions in the body, one of its key responsibilities is to carry oxygen from the lungs to other parts of the body. During rapid growth this process goes on overdrive. When women and young girls have their monthly period, they lose additional amounts of iron.
There are two stages of iron deficiency. When iron stores are depleted, iron deficiency occurs, but there are usually no symptoms. But once iron deficiency anemia sets in, the levels in the blood dip. Symptoms include tiredness, decreased immune function, impaired or slowed cognitive performance and glossitis (inflamed tongue).
The recommended amount of iron is 11mg for 7 to 12 months, 7mg for 1 to 3 years, 10mg for 4 to 8 years, 8mg for 9 to 13 years, 15mg for females 14 to 18 years, and 11mg for males 14 to 18 years. Food sources include meat, fish, poultry, beans, leafy greens, fortified cereals and breads.
Heme sources of iron (meat, poultry and fish) are better absorbed by the body than non-heme (plant sources). But by including non-heme with heme sources, you increase the absorption of the latter. Vitamin C also increases the absorption of non-heme sources of iron by 3 to 4 times. Some great food combos are vitamin C-rich fruit with fortified cereals and waffles, tomatoes with beans (think soups and burritos), and chili that contains meat, beans and tomatoes.
According to the Feeding Infants and Toddlers Study (FITS), 63 percent of toddlers and 37 percent of preschoolers fall short on vitamin E (infants actually meet or exceed their needs). Other studies have shown that most age groups don’t meet the recommended daily amount for vitamin E, which mainly functions as an antioxidant (protecting cells from the harmful effects of free radicals.) As a fat-soluble vitamin, vitamin E also needs fat to be absorbed.
While no one knows for sure, there is speculation that the increased use of lower fat products, such as salad dressings, may be one of the reasons vitamin E intake is inadequate. That’s because vitamin E is found in vegetable oils and nuts and seeds. Vitamin E deficiency is rare and symptoms have not been reported in people with subpar intake.
The recommended amount of vitamin E is 5mg for 7 to12 months, 6mg for 1 to 3 years, 7mg for 4 to 8 years, 11mg for 9 to13 years and 15mg for 14 years and older. Food sources include nuts, seeds, vegetable oils and avocado.
Crunchy nuts make great snacks for older kids. Avocado is the perfect substitution for mayonnaise on sandwiches. Wheat germ, a super source of vitamin E, is great in smoothies and baked goods.
Even though it’s called a vitamin, scientists tend to think of vitamin D more like a hormone because of its function. While vitamin D is needed to deposit calcium in bones, it also plays a role in many other bodily functions as every cell in the body has a vitamin D receptor. Inadequate intake has been linked to the development of certain cancers, immune-disorders, cardiovascular disease and diabetes.
While most conservative estimates show that 25 percent of the population has low blood levels of vitamin D, a study in the journal Pediatrics found that 7 out of 10 kids had blood levels that were inadequate. The reason for the discrepancy is that researchers have not come yet to a consensus on what blood levels are optimal.
For most of human history, people did not rely on food to get their vitamin D – they got it from the sun. With sunscreen, indoor jobs and obesity, most people don’t get the amount of vitamin D their bodies need. Consider that half an hour in the sun provides 10,000 IU of vitamin D – a glass of milk only contains 100 IU.
Rickets is the result of severe vitamin D deficiency and is rare but still reported. Low vitamin D status often goes unnoticed. Symptoms may include bone pain and muscle weakness.
The recommended amount of vitamin D recently increased to 400 IU for 6 to12 months and 600 IU for 1 year and older kids. Food sources include fatty fish, fish liver oils and fortified products such as milk and orange juice. The American Academy of Pediatrics (AAP) recommends that breastfed infants receive supplements of 400 IU/day of vitamin D, and older kids who don’t get enough through food supplement as well.
I once had the chance to talk to Karen Kafer, a registered dietitian at the National Dairy Council, and pick her brain. She explained how strong bones built during childhood and adolescence can help lower the risk of osteoporosis in later years. This bone-building occurs until we about 30 years of age, then the body stops adding new bone mass. So what we are doing during this time – eating well, getting enough calcium and exercise – can make the difference between a frail and a strong skeleton.
“Many children and adults (with the exception of children 1 to 3 years old) aren’t getting the amount of calcium recommended for their age group – and some have particularly low intakes,” says Kafer. “For example, only 15 percent of females age 9 to13 years and 13 percent of females age 14 to18 meet their calcium needs – and that’s from all sources, diet and supplements.
According to a study published in the journal Pediatrics, by the time a girl reaches 19, she’s drinking three times more soda and 25 percent less milk than she did as a child. Right when calcium needs to shoot up and peak bone-building occurs, calcium intake declines, with soda and other sweetened beverages replacing calcium-rich milk.
The recommended amount of calcium is 700 mg for 1 to3 years, 1000 mg for 4 to 8 years, 1300 mg for 13 to 18 year olds. Symptoms of calcium deficiency most likely won’t show up until later in life.
According to the Dietary Guidelines for Americans, potassium is a shortfall nutrient in the American diet. The FITS study indicates that young children also come up short.
Potassium is an electrolyte involved in cellular and electrical body functions. It is essential for the health of tissue, cells and vital organs. As electrolytes, sodium and potassium work together as a ‘team.’ Too much sodium can increase blood pressure, while potassium has the opposite effect. Adequate potassium in the diet also decreases the risk of kidney stones and enhances bone health.
Nutritional health experts speculate that low potassium levels are due to less-than-adequate intakes of fruits, vegetables and dairy products and too many processed foods and sweetened beverages.
Recommended amounts of potassium include 3g for 1 to 3 years, 3.8g for 4 to 8 years, 4.5g for 9 to 13 years and 4.7g for 14 to 18 years. Because potassium is contained in so many foods, an overt deficiency caused by diet is rare. Yet moderate reductions in potassium can increase the risk of high blood pressure.
Essential fatty acids
It’s important to note that many kids are not getting the right types of fat and, in some cases, may not be getting enough total fat. According to the FITS study, total fat intake in children 5 and younger is actually below “acceptable macronutrient distribution ranges.” But it’s the imbalance of the types of fat that children are consuming that is problematic.
Fiber is the indigestible part of carbohydrates that plays an important role in health. Most Americans don’t get enough, and that includes children. Beans and peas are the star players when it comes to fiber, followed by fruits, vegetables, whole grains and nuts. Fiber helps with feeling full, prevents constipation and has other benefits.
When people consume too many processed foods, like white bread, juice, meats, and not enough fresh foods, fiber intake lags behind.
The adequate intake for fiber is 14 g per 1,000 calories, or 25 g per day for women and 38 g per day for men. Most Americans get only 15 g per day.
Polhamus B, Dalenius k, Nackentosh H, Smith b, Grummer-Strawn l. Pediatric Nutrition Surveillance 2008 Report, Atlanta GA: US Department of Health and Services, Centers for Disease Control and Prevention: 2009.
Butte NF, Fox MK, Briefel RR, Siega-Riz AM, Dwyer JT, Deming DM, Reidy KC. Nutrient intakes of US Infants, toddlers, and preschoolers meet or exceed dietary reference intakes. J Am Diet Assoc. 2010; 110: S27-S37.
Kumar J, Muntner P, Kaskel FJ, Hailpern SM, Melamed ML. Prevalence and associations of 25-hydroxyvitamin D deficiency in US children: Nhanes 2001-2004. Pediatrics (doi: 10.1542/peds. 2009-0051.)
Striegel-Moore RH, Thompson D, Affenito SG, Franko DL, Obarzanek E, Barton BA, Schreiber GB, Daniels SR, Schmidt M, Crawford PB. Correlates of beverage intake in adolescent girls: the National Heart, Lung, and Blood Institute Growth and Health Study. J Pediatr. 2006 Feb; 148 (2):183-7.
Maryann Tomovich Jacobsen, MS, RD is a Registered Dietitian with 15 years experience in the field of nutrition. Based in San Diego, Maryann works as a freelance writer and is the founder and editor of “Raise Healthy Eaters,” a popular blog about family nutrition. Since the creation of her blog in early 2009, Maryann has become a well-known family nutrition expert. Her blog has been featured on Technorati’s Top 100 for health and family and she has been named “Expert Curator” by Organized Wisdom’s Medical Review Team. Maryann has been quoted in leading newspapers and magazines, including the ChicagoTribune, Parents, American Profile and Harmony; her articles have appeared in CookingLight.com, The Los Angeles Times, Today’s Dietitian and Today’s Diet and Nutrition. For more information, please visit www.raisehealthyeaters.com
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