Dr. Bob: I am worried about my child’s nutrition. She is a good eater, but she does not seem to be getting a well-rounded diet. Should I supplement it with vitamins? Will they provide the nutrients that her diet is lacking?
Answer: Before I answer the vitamin question, let me first address the issue of childhood nutrition. In previous columns I have strongly urged families not to engage in food wars where parental insistence on eating certain foods and child resistance to those foods meet an impasse and harsh words are spoken or punishments threatened. This latter scenario leads to counterproductive interactions and often rips at the fabric of the family. It is important to be calm, to suggest reasonable alternatives or reasonable inducements, and to maintain civility. But most important of all, one must anticipate issues and be proactive in terms of avoiding conflict.
I encourage you to engage your child in the food planning process. Also engage them in the food preparation and food serving processes. This lets them understand that life is a series of choices and actions that we can work on together.
As you do this, encourage the healthy habits of good nutrition. I’m sure that you already are working on other healthy habits – exercise, reading, sleeping, brushing teeth, common courtesy. Just like these latter healthy habits, eating a well-rounded diet is important for growth, development, school performance and health later in life. This latter point, eating now for a healthy life later, is not emphasized enough. Parents should model a healthy diet for their children.
A well-rounded diet consists of a mixture of carbohydrates, proteins, and fats. The MyPlate website (https://www.myplate.gov/life-stages/kids) provides great advice regarding the mix of fruits, vegetables, protein, grains and dairy. These five food groups will vary for each age range, so I want you to use this resource to guide the needs along the way.
For a school-age child, here are some recommendations from MyPlate – make one’s plate have at least fruits and vegetables every day; try whole grains (oatmeal, whole wheat bread, brown rice); mix up protein foods (seafood, beans, peas, lentils, nuts, seeds, soy products, eggs, meats, or poultry); encourage plenty of liquids; use low-fat milk for needed calcium intake.
Sugars, fats, and sodium need to be consumed in moderation. Their long-term effects (obesity and hypertension) from overuse will have impact in childhood and adulthood. It is so easy to say this yet so hard to cut back. Our society encourages (actually promotes) unhealthy diet choices with the intense advertising for certain foods and places to eat out of the home. It takes serious work on your part to plan and execute a diet for your family that is healthy. Your pediatrician can also be quite helpful for nutrition advice.
Now, to your question about vitamins. If your child eats a well-balanced diet of fruits, vegetables, protein sources, grains and dairy, vitamins are not needed. You noted that your child does not eat a well-rounded diet so in the interim, I would recommend a multivitamin. Almost any vitamin for children will do as the primary vitamin you are trying to provide is vitamin D. Please be mindful that you can overdo vitamin supplements and cause a host of other problems. Again, consult with your pediatrician about vitamins. Their expertise regarding nutrition and vitamins has been developed over time and modified as needed by changing science and environmental factors.
Dr. Saul is Professor of Pediatrics (Emeritus) at Prisma Health and his website is www.mychildrenschildren.com. Contact Dr. Bob at askdrbobsaul@gmail.com with more questions.