Role of Nutrition in Child Development
The Problem: How to Help Kids Grow Taller
Lack of Nutrition-Related Knowledge
Did you know that majority of parents get most of their feeding and nutrition-related advice from their child’s pediatricians? Perhaps you are one of these parents. Although your pediatrician is likely very skilled at what they do, there are some areas of your child’s health and development that pediatricians do not specialize in - including feeding and nutrition.
That’s because majority of medical professionals, including pediatricians, are only required to take minimal training on nutrition. Pair with this the amount of time between when your pediatrician underwent their formal training and now, and it is no wonder why there is outdated information being disseminated. The quality, depth, and evidenced-based nature of advice given from pediatricians to parents, particularly of lean children, is creating a problematic deficit in how to nourish a growing child. This lack of nutrition-related knowledge with both parents and pediatricians is the first problem we see.
When our children are infants, we often read, research, and reflect on available nutrition-related information before starting solids and to monitor their projected growth. Sometime after this, our children establish their own eating habits and developmental patterns. If a child grows appropriately, parents often take it from there to determine which feeding behaviors work within their family and may only minimally discuss feeding with their child’s pediatrician. When there is a growth concern present however, parents naturally become confused about what additional role they have in nourishing the growing child. They rely on their pediatrician’s advice and assume it to be a best practice. Unfortunately, instead of coming up with an action plan that actually nourishes our growing child in the most effective way possible, such ideas and answers point parents down a problematic path giving them a near-sighted view of “progress.” This leads to the second problem of trying to promote growth (i.e. weight/height) detached from health-promoting behaviors.
Emphasis on Weight and Height, Apart from Overall Health
Weight and height are valid, objective measurements for if/whether and how well our children are growing. (source) Where these growth parameters miss the mark, however, is in evaluating whether or not the habits being adopted (in attempts to promote growth) are wise ones to use during such early, impressionable years of a child’s life..
We know that as our children age, they begin to establish eating habits based around the feeding styles they are most often exposed to. Initially, we assume we are doing our smaller-sized children a service by catering to their any and every request. By permissively allowing them to eat whatever they want, whenever they want, for the sake of “just getting calories in,” we assume we will see progress. Unfortunately, such advice inadvertently gives parents permission to practice flawed feeding behaviors..
With a knowledge deficit in place and heightened concern over a child’s growth patterns, parents often take to this advice without evaluating the long term implications for their child’s overall health ahead of time. Rather than promoting growth using health-promoting habits, parents start to allow their child to eat a diet made up of unstructured meals and snacks from foods that lack the nutrition their growing bodies need. Soon, families find themselves stuck. Before their child ever reaches their best growth potential, parents see that the habits they have been using are creating other undesirable effects on their child’s overall health. This is why an emphasis on what the evidence says is crucial to finding our solution.
The Science: Is Height Genetic?
A child from small-statured parents is likely to be a small-statured child. This is at no fault of the parents. This is simply genetics, and something that all children big or small are equally subjected to. Within each person’s natural predisposition, however, we know that up to 80 percent of the difference in height is determined by genetic factors (source). The remaining portion of a child’s growth potential can be influenced by environmental effects, mainly nutrition. When we can maximize a child’s nutrition, we too maximize their growth potential of height.
"Genetics give you a range of how tall you may be, but nutrition determines where you fall in that range. Ensuring a child is nourished with the proper macro and micronutrients prior to puberty could impact their final adult height." -Professor Raanan Shamir, M.D.Diseases, Schneider Children's Medical Center, Professor of Pediatrics.
Importance of Nutrition for Kids
A common theme throughout the literature is the well-documented role that nutrition plays in a child’s growth and development. Providing the main building blocks for bones, muscles, and tissues, parents tend to understand at least on a basic level that carbohydrates, protein, and fat are necessary components in the diet. Since not all calories are equal, we too have to acknowledge that beyond these macronutrients (being carbohydrates, protein, and fat) our growing children also need micronutrients (like vitamins and minerals) to maintain healthy functioning.
"Although research continues to consider there being ‘open questions regarding the exact combination of macro and micronutrients required for optimal growth,’ we know that micronutrients such as zinc, iron, iodine, and vitamins have important roles in the growth process."
Other research articles remind us that a “deficiency in energy, protein, iron, vitamin A and zinc can lead to decreased weight gain and stunting of linear growth.” (source) while promoting nutrients like protein, calcium, and vitamins A and D can promote height (source) . Getting even more specific,here is a growing body of evidence that supports the positive effects of milk proteins on linear growth in healthy children, including whey protein (source) So many parents might ask, why not just add in extra milk instead of water for the growing child?
Whole cow’s milk offers the fat content and amino acids composition (i.e. type of protein) that has been studied as more effective at promoting growth than other proteins (source) However, we also know that too much milk in a growing child’s diet can have the opposite effect and inhibit growth.
As infants, children consume an exclusively milk-based diet (via breastmilk or formula). As solids were introduced and our children become toddlers, however, their milk intake should have drastically declined to make room for other nutritious foods in a child’s diet. When this doesn’t happen, a child’s excessive milk intake can compromise a child’s iron status as well as their overall nutritional and growth status. That is largely due to milk crowding out other nutrient-rich foods. So although milk can be a nourishing addition to a growing child’s diet, parents also need to keep beverages in line with a child’s overall feeding behaviors to promote versus inhibit their overall intake.
This is why traditional pediatrician advice to add in typical over-the-counter oral supplements can also do more harm than good. They assume that more is better when it comes to added calories, instead of recognizing that not all calories are equal, nor are all ways for adding calories equally effective for promoting growth.
Children’s Eating Habits
Unlike in developing countries, children in developed nations grow up with access to more resources (such as macro- and micronutrients). This means that their avoidance of certain foods, and thus inadequate intake of certain nutrients, is not due to a lack of availability (as it is with malnourished children in developing countries). Instead, it is behavioral.
Several studies have evaluated how kids who are smaller on the growth chart tend to eat and in doing so, identified a few common behavior trends. First, there is some research that found, “these lean children had distinct eating patterns: they ate more slowly, reached satiety faster, had a lower responsiveness to food and enjoyed food less than the normal, healthy controls” (source) .
This Study goes onto say that this, “might explain the lower absolute amount of calories consumed, and thus the lower intake of other nutrients. Another explanation could be that these lean children consume less diverse food because they have less interest in and enjoyment from food, and this might inadvertently impact their intake of micronutrients.”
The predisposed challenges to getting not only calories but also quality calories into a growing child further demonstrates the need for effective interventions that optimize each bite and every eating opportunity to the fullest.
The Solution: Methods & Foods That Help Kids Grow
I have worked with hundreds of families who need to put added weight on their kids. For some, adding butter to everything appears to get the job done (when we look at the problem in light of increasing calories in the diet alone). I know there are also a lot of families out there though who don’t feel comfortable approaching feeding their child this way nor find it effective, particularly when the problem persists longer than from one pediatrician well check to the next. That’s because the solution to helping instill healthy habits in our children must consider more than calories alone.
Recreate the foundation for feeding.
In order to take more control over what foods are offered, when such foods are given (with a feeding routine), and where such foods are offered (to eliminate all day grazing or mindless eating in front of a screen), parents must establish a Division of Responsibility in feeding.
With kids who are smaller on the growth chart or even considered “Failure to Thrive,” this can seem like a very counterintuitive approach to “get the calories in.” Feeding experts and dietitians alike, however, agree that this is the best practice approach for feeding all children, including the growing child. That is because as parents and children learn what their role is in the feeding relationship, each is able to thrive and more fully optimize their own potential for what, when, and where food is offered (the parent’s role) or if/whether and how much food is eaten (the child’s role).
As parents establish a Division of Responsibility in feeding, parents can begin to hone in on what is offered. Although fat will have the greatest impact on adding calories to a child’s diet, added butter alone will not help your child reach their growth potential.
Optimizing each bite by adding both fat and protein.
This will promote calorie-dense foods, as fat has more than twice as many calories per gram than carbohydrates or protein. It also acknowledges that protein is, "one nutrient that is especially well-characterized as a building block. It is stored primarily in muscle and collagen, but it is not just a supporting player. Protein and its component amino acids function as hormones, enzymes, and transporters of other nutrients.’ That’s why supplementing protein can be important for helping your young child grow if they’re not getting enough.” (source)
Ideas for how to optimize the calories in each bite using fat and protein can be found in suggestions like those shared here .
Come up with a routine for when food is offered.
By creating a daily eating routine for their child and family, parents can begin to turn snacks into “mini meals” and space meals/snacks two to three hours apart. By lessening the frequency of low-calorie, nutrient-poor foods being offered (i.e. optimizing each bite) and lengthening the time between eating opportunities to allow children to develop an appetite (i.e. preventing grazing), parents help position their child to feel hunger in a way that promotes both eating and growth.
Fill in the gaps.
Snacks are intended to fill in the nutritional gaps that kids don’t otherwise eat enough of in their diet (source).. Although “snack foods” is a common misnomer for this, parents can instead choose nutritionally-dense options, like milk, and offer strategically over the course of their child’s day. Instead of milk crowding out other nutrient-rich foods or being something a child sips on all day, parents can plan it into their child’s diet. This creates a nutrient-packed snack or bedtime shake that can help promote more of the nutrients children need for growth. By adding products like Healthy Height to a small (4-ounce) volume of milk (instead of water) at snack time or to a peanut butter banana smoothie at bedtime, parents emphasize their growing child’s need for protein, fat, vitamins and minerals without ruining their appetite for foods first.
If you are concerned about your child’s growth and unsure if and how to intervene on the modifiable aspects of their growth potential, like nutrition, this article should give you a clearer sense for how to get started.
By identifying some of the most common problems in families who need to nourish the growing child, sharing some of the science behind their nutritional needs and yet behavioral tendencies towards poor intake, we can begin to see why the following tips are families first-line of defense to helping kids grow but the right way.
Here is a summary of what we discussed in this post:
- Start with feeding behaviors first. Practice a Division of Responsibility in feeding even/especially with the growing child.
- Optimize each bite by adding high calories extras to each food offered. Add fat and include protein as often as possible to promote growth.
- Commit to a set feeding routine. Offer real, high calorie foods first at every mini-meal. As needed, supplement with the right mix of nutrients to nourish growth (through products like Healthy Height). This should not replace food but rather help fill in the gaps that kids don’t get enough of through food alone.
If you have questions about your child’s specific growth patterns or eating habits, ask your pediatrician for a referral to a local dietitian. Or, feel free to reach out to me about my virtual services so that together, we can come up with an action plan to better nourish your growing child!
Nutrition to Help Kids Grow - and Sleep!
Every year our team of Pediatricians at Schneider Children's Medical Center have 20,000 visits from children with issues relating to growth. Our doctors wanted to find a non-invasive way to help children grow and the nutrition in our shake mix is the result of their efforts. The nutrition in our shake mix was shown in a clinical study to promote growth in 6 months, as well as improve sleep patterns in kids who take at least 1 serving per day.