What should a parent do when their child firmly decides that “meat is murder”, or on the flip side, when chicken nuggets are the only acceptable nutrition source? Kids can often independently decide their own diet preferences, even if it upends household homeostasis. Children with certain conditions like allergies or autoimmune disorders may also require specialized diets, making mealtimes altogether stressful for some families. How can pediatricians support both freedom and health in pediatric diets to keep meals nutritious for all patients?
Conditions that Affect Diet Needs
Diet is a key part of a healthy lifestyle, and while most kids benefit from a broad variety of food groups, some allergies, syndromes, and medical conditions require a selective diet. This doesn’t mean that kids can’t enjoy a healthy diet -- with both nutrition and tasty treats included.
Celiac Disease + Sensitivity
While up to 40% of people possess both genes which put them at risk for celiac disease, fewer than this number will go on to develop the disease. Celiac disease in children can present in classic symptoms such as stomach upset and gas, but especially for the youngest patients, can result in more subtle symptoms such as poor growth. Also at risk are children with conditions such as Down syndrome, type 1 diabetes, and Turner syndrome.
There are tests for celiac disease, and patients can follow diets which include the key nutrients otherwise found in gluten products, like B vitamins, calcium, and iron.
Gluten and wheat sensitivities are more difficult to diagnose as there are not tests available for them. Families may find diets with less or no gluten a positive choice, but as with celiac disease, key nutrients and calorie intake are crucial for growth and health. Some celiac or gluten-sensitive patients may require a daily multivitamin to provide these nutrients in addition to a healthy diet. See HealthyChildren.org’s Gluten-Free Shopping Tips for Parents. Families may also benefit from support from others experiencing similar challenges in diet, which they can find through groups such as the Celiac Disease Foundation.
Allergies + Autoimmune Disorders
Other conditions that affect a child’s diet may result from an immune system reaction to otherwise perfectly healthy foods like peanuts, eggs, or soy. Whether allergies or immune disorders, there are important ways to keep kids safe -- and even to prevent symptoms in the first place.
A child with allergies can live a healthy lifestyle with a healthy diet which only excludes the food she is allergic to. Families can coordinate with their pediatrician and an allergist to determine healthy diet choices and safety precautions such as carrying and using an EpiPen, demonstrated in this helpful video from the Ann & Robert H. Lurie Children's Hospital of Chicago.
Intolerances to foods such as dairy are not the same as having an allergy. Lactose intolerance, for example, causes a child’s gastrointestinal system to react instead of their immune system upon ingesting dairy products. Sometimes intolerances are temporary, and sometimes they are lifelong. Just like with allergies and food sensitivities, it's important to ensure proper nutrition.
Autoimmune disorders and conditions like lupus, juvenile arthritis, and more can have effects on which foods are appropriate for a child’s lifestyle. Pediatricians and families may choose to work with a dietician to find the right balance of nutrients and foods that don’t cause or worsen symptoms of autoimmune disorders.
Diets or lifestyles chosen for cultural or religious reasons such as veganism, vegetarianism, and more can be perfectly healthy options for kids. Other diets which restrict certain food groups, however, even if popular, should be avoided until proper pediatric research is available or until a proposed diet is cleared by a child’s pediatrician or dietician.
Plant-based diets such as vegetarianism are healthy for adults and children when they are well-balanced. Parents can learn more about healthy balanced meals for plant-based diets here. The key in plant-based diets is to provide all of the nutrients kids need in the forms most beneficial to growing bodies. While some nutrients such as omega-3 fatty acids and vitamin A are available from plants, they are not always converted well in the body to provide the full nutritional value kids need. Pediatricians can help provide options for parents to ensure key nutrients are provided in kids' diets in their optimal forms, whether this is adding fish or eggs or providing supplements.
Overall, parents who decide on a vegan, vegetarian, or otherwise plant-based diet for their children should be extra cautious in ensuring that they provide meals with the nutrients growing children need, like calcium, iron, B vitamins, and protein. The Cleveland Clinic suggests that families keep a food journal describing what their kids eat. Parents can share this with their child’s pediatrician, and together, families can create a complete and balanced diet that provides the energy and nutrients required for a healthy body.
Pediatricians can also help provide answers when a child shows signs that their diet isn’t working for them. If they’re lethargic, irritable, or hyperactive, they may need to adjust their diet to suit their bodies’ needs.
Older kids may naturally want to experiment with new foods they don’t find at home, or feel uncomfortable in their family’s choice of diet -- their pediatrician is a great resource for exploring healthy alternatives, as well as navigating emotions about what it means to have a healthy relationship with food and their body. A healthy relationship with food might include routines, having fun and enjoying food, eating until satisfied, and leaving room for treats every once in a while.
Picky eaters come in all ages and sizes. When children are young, parents can help avoid phases of picky eating by introducing their children to a variety of foods with different textures, and tastes, and as they grow, kids can begin to choose their own healthy foods and help prepare them, helping them feel in control of their diet.
While proper nutrition is important, picky eating is a common challenge for parents, too. Parents who are at their wits’ end with choosy eaters may be comforted with advice that reframes the narrative: “What a little food critic you’ve got! She’s showing new independence which is totally normal for her age. As long as she can manage adequate nutrition every day or two, she’s going to be fine.”
Overall, the most helpful thing pediatricians can offer to parents about their child’s diet is reassurance. Pediatricians can help soothe worries over nutrition gaps and tummy upsets by offering tests to eliminate unique diet needs, healthy nutrition options for the whole family, as well as healthful strategies for the kids who may always prefer chicken nuggets over broccoli. Want to learn more about how early introduction to some foods could prevent allergies? Check out our previous post below to help families at risk of peanut allergies.