Nutritional Disorders Telehealth Network Project

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Correct Nutrient Imbalances and/or Deficiencies

Even though a child may carry excess weight, medical providers should consider the risk of micro and macro nutrition imbalances and/or deficiencies. Many children are consuming diets of poor nutritional quality and limited variety. Our goal is to provide strategies which will correct and/or prevent imbalances through food selection changes or supplements.

 
Background Education for Providers
Deficiencies or imbalances are going to vary widely from one child to another. Therefore, clinicians must assess the full range of nutrition for each child. Macro nutrient assessment includes estimating proportionality of carbohydrate, fat, and protein or distribution of food choice across the food groups. Micro nutrient assessment includes estimating intake of vitamins and minerals.
 
First, we encourage families to follow the recommendations of the USDA to meet their nutrition needs through their diet. Please refer to www.mypyramid.gov for age appropriate recommendations. This may require support by the clinician to help the family find and understand basic nutrition for a healthy diet. The second, and perhaps the easier strategy, is to supplement nutrition by adding a daily multi-vitamin/mineral.
 
Clinicians are advised that a child with a well balanced diet does not need nutrition supplementation (e.g., vitamin). Also, for families that require or desire a vitamin, NOT all vitamins are equal. Recently, gummy vitamins have increased in popularity but be advised that this product is nutritionally incomplete (does not contain a broad coverage of vitamins and minerals). Furthermore, clinicians should be aware of any herbal, holistic or weight loss supplements/products and any use of these products should be made known to the providers. These products may or may not have an affect on the nutritional or medical disposition of the child. Other products may pose a severe risk and need to be avoided.
 
Instructions for Provider
A primary practice is to recommend vitamins that are “COMPLETE” and should be designated as such on the label. Dosing of the vitamin should also be checked on the label. Generally, a toddler between 1-2 years of age is given ½ of a tablet, and children older than 2 years receive 1 full tablet. Above 12 years, children are recommended 2 tablets. Individualized micronutrient supplementation should only be provided in consultation with your medical treatment team.
 
In the overweight population it can be common to find a disproportionate intake of foods. Generally, this consists of high concentrations of carbohydrates and fats along with a poor intake of fruits and vegetables. To evaluate the risk of macronutrient problems, you can most easily compare the child’s current intake to the recommended intake from mypyramid.gov. You may also want to look in the appendix for additional resources of recommended intake of each food group. After the macro nutrition habits of the child/family are well understood, you can work with the family to substitute healthy food choices to promote greater balance across the food groups.
 
Supplemental Materials
 

 

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Page Updated 04/15/2014