Illustrations: Allison + Cam
Has your kid’s doctor ever told you to rely on bananas and applesauce when your child’s tummy is feeling off? Or recommended you give your picky eater a multivitamin? While paediatricians are top-notch when it comes to managing medical needs, it might surprise you to know they receive very little training in nutrition.
In a survey conducted at nine Canadian medical schools, 87 percent of students said their undergraduate medical program should dedicate more time to nutrition education. And in a test of American medical school graduates entering a paediatric residency program, researchers found that the new docs correctly answered just 52 percent of nutrition questions.
We asked parents to share some of the nutrition advice they’ve heard from paediatricians, and we’re busting the biggest myths here.
Myth: Sugar makes kids hyper
Fact: Generations of parents and paediatricians have complained that sugar makes kids bounce off the walls, but science doesn’t agree. Research simply doesn’t support the link between sugar and hyperactivity. Many parents swear they witness a sugar rush after their children eat candy. But consider the context: Sugar is usually doled out at birthday parties and holidays, when the frenetic excitement may be due to the special occasion itself, not the cake. Of course, just because the sweet stuff isn’t connected with hyper behaviour doesn’t mean it’s OK to let kids eat sugary treats with abandon. Consuming excessive amounts (more than 12 teaspoons, or 48 grams, of added sugars per day—about the amount in a chocolate bar) is linked to an increased risk of obesity, type 2 diabetes and heart disease.
Myth: Overweight children should cut carbohydrates
Fact: Obesity is multi-faceted, and treating it isn’t as simple as cutting out bread and pasta. Genetics, environment, physical activity level, family dynamics and socio-economic status all play a role in weight management, along with diet. But paediatricians read the same headlines about fad diets that we do, and it can be easy to think low-carb eating is the solution. “This advice is a dangerous message that can set kids up for eating disorders later on,” says Nishta Saxena, a paediatric and family dietitian at Vibrant Nutrition. She doesn’t recommend putting children on diets. Instead, she likes to get all family members involved in supporting one another as they work toward a long-term healthy lifestyle. “Everyone can benefit from eating more vegetables and reducing their reliance on processed foods,” says Saxena.
Myth: Multivitamins are essential for picky eaters
Fact: Can’t get your kid anywhere near broccoli? A multivitamin isn’t really an insurance policy against those missing nutrients. “In most cases, multivitamins are not necessary, and they give parents a false sense of security,” says Saxena. Her concern is that parents will rely on supplements to replace healthy foods, but multivitamins can’t stand in for a nutritious diet. Children need to learn to eat a variety of nourishing foods instead of popping pills for nutrients. Teach kids to create a balanced plate: Fill half with vegetables and fruit, a quarter with grains and a quarter with protein (chicken, beans, meat, etc.). That way, they’ll learn to eat well without pills.
Myth: Children don’t need vitamin D supplements—they get the nutrient from the sun
Fact: While it’s true that the body can convert the sun’s rays into vitamin D, most kids don’t get enough sun exposure, especially during cold Canadian winters. And although vitamin D is added to milk, kids often don’t drink enough to meet their needs. Children require a daily supplement of 600 to 800 IU. “I recommend vitamin D supplements for all children,” says Saxena. “I don’t suggest sun exposure because of skin damage, so food and supplements are the answer to ensure kids get enough vitamin D.” In addition to milk, foods that contain vitamin D include fish, eggs and fortified non-dairy milk alternatives.
Myth: Underweight kids should eat cookies, chips and ice cream to pack on pounds
Fact: It’s true that these treats contain lots of calories and will help kids put on pounds, but achieving a healthy weight is not that simple. The calories from processed and high-sugar foods won’t provide the nutrients required for growth and optimal development, and pigging out on junk food sets them up to have poor eating habits in the future. When it comes to helping kids gain weight, Sarah Remmer, a paediatric dietitian in Calgary, recommends full-fat dairy products, avocado, natural nut and seed butters, cheese and coconut oil—“whole foods without a lot of added sugar,” she says. These provide calories, plus lots of beneficial nutrients, such as protein, vitamins and minerals. It’s also important to remember that kids come in all shapes and sizes—sometimes eating more calories won’t make a significant difference in their growth curve.
Myth: Milk causes excess mucus for kids with colds
Fact: Milk is a viscous fluid, and it can certainly cause a slight thickening of saliva after taking a sip—but saliva shouldn’t be confused with mucus. Studies have tested the effect of milk consumption on mucus production and have found that milk makes no difference. If milk appeals to your child while he or she is sick, Remmer says to go right ahead and continue offering it with meals. “It’s nutrient-dense and helps prevent dehydration,” she says. And rest assured, it will not make your kid’s cold any worse.
Myth: Kids with diarrhea should follow the BRAT diet
Fact: The BRAT (banana, rice, applesauce, toast) diet can be found in medical books from as far back as 1926 and was historically recommended for treating kids with diarrhea. Although there’s no clinical evidence to support it, BRAT is still ubiquitous in both paediatrics and parenting. Sure, it makes sense in theory—BRAT foods are easily tolerated, so they won’t exacerbate diarrhea. But in practice, a diet containing just four foods is too restrictive and won’t provide the many nutrients the body requires to heal. Sick kids need a variety of nutrients, including protein. “The BRAT diet is fine for a day or two, but it’s not nutritious enough to support children with prolonged stomach bugs,” says Remmer. Children can still eat plenty of other nutritious foods, like whole-grain pasta and rice, fruits and vegetables, lean meats and yogurt.
Myth: Constipated kids should stop eating bananas
Fact: The old wives’ tale says bananas will bind you, but there are no studies to confirm it, and Saxena says it’s simply not true. “Soluble fibre, which is found in bananas, is actually quite beneficial in managing constipation.” Bananas also contain prebiotic fibre—the stuff that feeds friendly probiotic bacteria in the gut and keeps the digestive system running smoothly. The better way to treat occasional constipation? Give your kid more fluids, encourage physical activity and ensure they get plenty of fibre from bran cereal, vegetables, fruit, beans and nuts.
Myth: Cow’s milk is essential for kids
Fact: The stealth marketing of milk makes it seem indispensable, and paediatricians often toe the line. While the nutrients found in cow’s milk—including calcium and riboflavin—are essential for kids, they’re also present in many other foods. If your kids don’t like milk, follow a vegan diet or have a milk allergy, they can get many of the same vitamins and minerals (but less protein) from fortified non-dairy beverages, like soy, rice or almond milk. The bottom line? Milk is a convenient way to get a host of vitamins and minerals, but it’s not the only way.
Myth: Introducing certain foods at an early age increases a child’s risk of food allergies
Fact: Advice on the optimal time to introduce allergenic foods, like peanuts, eggs and fish, has changed over the years and so has paediatricians’ advice. The old rules suggested restricting these foods until age three, for the practical reason of delaying exposure to an immature immune system. But more recent research shows this doesn’t actually work and that the early introduction of allergenic foods is actually beneficial in preventing food allergies. Now, guidelines say allergens like eggs, peanuts and fish can be introduced with any other foods as soon as a baby starts eating solids, usually at six months of age.
Sometimes you need an RD, not an MD Paediatricians are incredibly valuable when it comes to caring for kids’ medical needs, but they shouldn’t be your go-to sources for nutrition, since it’s not a large part of their training. If your child has been diagnosed with a condition that has a strong dietary component—such as celiac disease, obesity, Crohn’s, colitis, a food allergy or diabetes—then it’s best to work with a dietitian who specializes in paediatrics. “Dietitians can help parents navigate challenging mealtime dynamics, picky eating and medical issues to make sure their children are well-nourished,” says Sarah Remmer, a paediatric dietitian in Calgary.
For nutrition advice, look for a registered dietitian or the initials RD or PDt (professional dietitian, or DtP in French). The title “dietitian” is protected across Canada; “nutritionist” is regulated only in Alberta, Quebec and Nova Scotia. Your doctor can refer you to a dietitian, but no referral is required, and your visit is covered by insurance when you go to a dietitian based out of a hospital or family health centre. Find a dietitian near you at dietitians.ca/find.