By Emily Hirsch, MS, RD
Emily has over 12 years experience in the field of nutrition. In her writing, she strives to bring lackluster research on health and nutrition topics to life. She loves writing about GI health and women’s issues.
Adequate nutrition plays a vital role in the growth and development of children.
Because of our plentiful food supply, many US children are well-nourished or even over-nourished. Despite an abundant food supply, some children in this country can still be undernourished or deficient in some vitamins and minerals.
The dietary intake and eating patterns of children have changed considerably. In the last few decades, children have tended to over-consume fats and sweetened drinks and under-consume fruits and vegetables. In fact, only a fifth of children eat the recommended daily amount of fruits and vegetables ,which are important healthy dietary sources.
Consequently, many kids are not getting the ideal amount of vitamins and minerals and may fall prey to nutrient deficiencies.
What is nutrient deficiency in kids?
A child’s growing body requires various nutrients that play a critical role in optimal development and preventing nutritional diseases.
The body doesn’t produce these micronutrients, or vitamins and minerals naturally; therefore, kids need to get them from their diet.
A nutrient deficiency or micronutrient malnutrition in kids occurs when a child has an inadequate intake of the necessary amount of a specific nutrient intake. They can also occur when the body doesn’t absorb a specific nutrient properly.
These nutrient intake deficiencies can lead to numerous health problems including stunted growth, digestive issues, skin problems, and poor bone development.
Which nutrient deficiencies are most common in children?
The most common nutrient deficiencies in children include iron, calcium, vitamin D, zinc, vitamin B12, potassium, and fiber.
According to researchers, iron deficiency is the most common nutritional deficiency among children.
As a result of improved iron supplementation, the prevalence of iron deficiency has been on the decline during the first year of life. However, the rate of iron deficiency among toddlers and school aged children has remained constant for decades.
As your infant transitions into toddler-hood, food pickiness may take center stage. As a result, your child may be lacking in this essential nutrient.
Your child requires iron for numerous bodily functions. Iron is an important component of hemoglobin, the protein that carries oxygen from the lungs to the rest of the body.
How Much Iron Does My Child Need?
Breast fed infants typically get enough iron from their mothers until roughly 4-6 months of age. Around this time, iron-rich solid foods should be introduced.
Breastfed babies who don't get enough iron can be prescribed supplemental iron by their healthcare professional. Babies drinking iron-fortified formula do not need added iron.
Depending on their age, kids need different amounts of iron:
- Infants ages 7–12 months need 11 milligrams of iron per day
- Toddlers ages 1–3 years need 7 milligrams of iron per day
- Kids ages 4–8 years need 10 milligrams per day
- Kids ages 9–13 years need 8 milligrams per day
Vegetarian food sources of iron may include beans, peas, lentils, dark green leafy vegetables, dried fruits, iron-fortified cereals, breads, and pastas. Non-vegetarian food sources of iron include red meat, pork, poultry, and seafood.
Vitamin D Deficiency
Vitamin D is a fat-soluble vitamin that is essential for the absorption of a variety of nutrients including calcium, iron, magnesium, zinc, and phosphate.
Adequate vitamin D intake is necessary for optimal bone growth, a robust immune system, and heart health.
How Much Vitamin D Does My Child Need?
Babies younger than 1-year-old need 400 International Units (IU) of vitamin D per day.
Baby formula has 400 IU per liter, so babies who drink at least 32 ounces of formula every day will get enough vitamin D.
If your baby is exclusively breastfed, or only takes less than 32 ounces of formula each day, ask your health care provider about giving your baby a vitamin D supplement.
Kids older than 1 year need 600 IU or more of vitamin D per day.
Foods that contain vitamin D naturally are few and far between. These foods include fatty fish and fish oils; usually not the most popular foods for kids.
Thankfully, there are many foods that are fortified with vitamin D including milk, milk alternatives, yogurt, baby formulas, cereal, and juice.
Zinc is an important mineral needed for optimal growth, strong immunity, sex hormone development, cognitive functioning, and healthy digestion.
How Much Zinc Does My Child Need?
- Birth to 6 months: 2 mg
- Babies 7-12 months: 3 mg
- Children 1-3 years: 3 mg
- Children 4-8 years: 5 mg
- Children 9-13 years: 8 mg
Zinc can be found in a variety of animal foods including meats, poultry, dairy products, eggs, shellfish. Plant based zinc-rich foods include seeds, nuts, whole wheat breads, whole grain cereals, and beans for zinc supplementation in your child's diet.
Calcium is a mineral that supports your child’s bone growth, heart health, and nerve and muscle functioning.
The window to build strong bones is relatively short. A child who consumes adequate calcium in childhood will set the stage for developing strong bones well into adulthood.
It is widespread knowledge that milk and milk products are rich in calcium, but there are many lesser known alternatives. These include calcium-fortified milk alternatives, dark leafy green vegetables, tofu, fish (salmon and sardines), nuts, seeds, white beans, chickpeas, and fortified cereals.
How Much Calcium Does My Child Need?
Babies younger than 6-11 months old need 200 mg to 260 mg of calcium per day which can be obtained through breast milk or formula.
As kids get older, they require more calcium to support their growing bones. Calcium requirements in children include are as follows:
- 1 to 3 years old: 700 mg of calcium per day
- 4 to 8 years old: 1,000 mg of calcium per day
- 9 to 18 years old: 1,300 mg of calcium per day
Vitamin B12 Deficiency
Vitamin B12 is an important nutrient needed for healthy red blood cells, cognitive development, enhanced immunity, and converting food into energy.
Vitamin B12 can be found in a variety of animal foods, including meat, dairy and egg products. Plant-based foods are poor sources unless they're fortified with B12.
A B12 deficiency is sometimes seen in children who are on plant-based diets with no extra supplementation of vitamin B12.
Additionally, children born to a mother who is B12-deficient or breast-feeding infants of mothers who are B12 deficient are also susceptible to B12 deficiency.
Disorders affecting the lining of the small intestine, like Crohn's disease or surgical removal of the end of the small intestine, can also lead to a B12 deficiency.
How Much Vitamin B12 Does My Child Need?
The average recommended amounts of vitamin B12 are measured in micrograms (mcg), and are as follows:
- Infants up to age 6 months: 0.4 mcg per day
- 7-12 months: 0.5 mcg per day
- 1-3 years: 0.9 mcg per day
- 4-8 years: 1.2 mcg per day
- 9-13 years: 1.8 mcg per day
Potassium is an important mineral that supports many of your child’s bodily functions and developmental needs. These include building muscle, supporting optimal growth, ensuring proper functioning of the nerve cells, and regulating body acid and water.
According to research from the National Health and Nutrition Examination Survey (NHANES), most infants (97%) get optimal levels of potassium through breast milk and/or formula.
However, according to the same research, only approximately 5% of children ages 1 to 3 years and less than 1% of children ages 4 to 5 years get the optimal levels of potassium.
How Much Potassium Does My Child Need?
- Ages 1-3: 3,000 mg per day
- Ages 4-8: 3,800 mg per day
- Ages 9-13: 4,500 mg per day
- 14 and older: 4,700 mg per day
The richest sources of potassium can be found in many fruits and vegetables. Other potassium-rich foods include white beans, black beans, and edamame.
Fiber is a type of indigestible carbohydrate necessary to prevent constipation, improve heart health, and enhance the good bacteria in the gut.
One study found that many children are falling short of the recommended guidelines for fiber intake. In the study researchers found that only roughly 6% of kids age 1-4 years old met the adequate intake for dietary fiber.
How Much Fiber Does My Child Need?
According to the American Academy of Pediatrics, an easy way to estimate how much fiber your child needs is to take your child's age and add 5 or 10 to it. For example:
A 5-year-old should get about 10–15 grams (g) of fiber per day.
A 10-year old should get 15–20 grams (g) of fiber per day.
A 15-year-old should get 20–25 grams (g) of fiber per day.
High-fiber foods include pears, apples, raspberries, green peas, broccoli, whole wheat breads, quinoa, oatmeal, beans, and lentils.
What are the common symptoms of nutrient deficiencies in children?
It may be tricky to decipher symptoms of nutrient deficiencies from other issues. The common symptoms of nutrient deficiencies in children are often very general. However, if you suspect your child is deficient in one or more nutrients, it is best to speak with your child’s healthcare professional to rule out anything more serious.
Symptoms of iron deficiency
Without enough iron, your child’s muscles can’t use oxygen as well and they may experience fatigue and foggy thinking. Other symptoms may include decreased appetite, pale skin, hair loss, brittle nails, and irritability
When left untreated, an iron deficiency can develop into anemia which can lead to extreme fatigue, delayed growth, learning problems, and impaired cognitive functioning.
Symptoms of vitamin D deficiency
If your child is complaining about bone pain or muscle cramping, this could be a symptom of a vitamin D deficiency. A vitamin D deficiency, when left untreated can result in impaired growth, osteomalacia (softening of the bones), and rickets (skeletal deformities).
For older children, a lack of vitamin D can lead to an increase in bone fractures.
Symptoms of a zinc deficiency
If your child is constantly sick with a cold or the flu, this could indicate that they are suffering from a zinc deficiency.
A zinc deficiency in children has also been linked to impaired growth, slow wound healing, impaired memory, learning disabilities, and poor attention span.
Symptoms of a calcium deficiency
There are generally no symptoms associated with a calcium deficiency however, when present, symptoms can include dry skin, dry hair, brittle nails, and muscle cramps.
If left untreated, a calcium deficiency in children can lead to rickets, impaired growth, weakened tooth enamel, and seizures.
Symptoms of a B12 deficiency
According to researchers, vitamin B12 deficiency in children often has non-specific symptoms including developmental delays, irritability, weakness, poor appetite, and poor growth.
Initial symptoms of a B12 deficiency may include fatigue, weakness, redness in the lining of the mouth called stomatitis, decreased appetite, weight loss and sometimes gastrointestinal issues.
If left untreated, children can develop a specific type of anemia called megaloblastic anemia, in which the red blood cells are larger than average.
Symptoms of a potassium deficiency
Symptoms of dietary potassium deficiency are rare. However, if your child has vomiting and diarrhea and/or a fever this can impact their electrolyte imbalance and lead to symptoms of a potassium deficiency.
These symptoms include muscle weakness, constipation, and fatigue. A severe potassium deficiency may include polyuria (excessive urine), difficulty breathing, muscular paralysis, and cardiac arrhythmias.
Symptoms of a fiber deficiency
A lack of fiber in your child’s diet can lead to uncomfortable gastrointestinal symptoms. Most commonly, a fiber deficiency contributes to constipation.
Fiber supports your child’s regular bowel movements by bulking up stool and increasing motility of the digestive tract.
Surprisingly, a lack of fiber can also lead to diarrhea. This is because a low fiber diet may reduce the diversity and amount of helpful bacteria in your child’s gut which may make them more susceptible to GI infections.
Can nutrient deficiencies lead to nutritional diseases in children?
The lack of ideal amounts of crucial vitamins and minerals can affect a child’s growth and their long term health status.
According to researchers, many diseases have been linked to nutritional deficiencies. These include developmental defects, such as physical and cognitive developmental delays, increased risk of infectious diseases, and increased risk of poor health in adulthood.
Additionally, nutrient deficiencies in childhood can lead to chronic long-term health problems. These chronic health issues may include rickets, iron deficiency anemia, obesity, coronary heart disease, type 2 diabetes, stroke, cancer and osteoporosis.
Can vitamin deficiency cause behavior problems?
It may be a surprising connection, but there is a link between vitamin deficiencies and behavior problems among children.
Years ago, research on infants showed an association between iron deficiency and decreased alertness, ability to self-soothe, and decreased self-regulation.
New research is emerging showing that a decrease in several micronutrients may play a role in behavior problems in older children.
One study in school-aged children found that a vitamin D deficiency in grades 6th through 8th was associated with higher aggression and an increase in rule-breaking behaviors. The study also found that lower levels of vitamin D within this age group was linked to symptoms of anxiety and depression.
Another study examining children ages 5-12 found that iron deficiency, anemia, and a vitamin B12 deficiency in boys at around age 8 was associated with 10% higher oppositional behavioral scores.
Iron deficiency was also associated with higher reporting of anxiety and depressive disorders.
How do you test for nutrient deficiencies?
Testing for nutrient deficiencies is done to evaluate the levels of specific vitamins and minerals in the body and typically involves a blood test or a series of blood tests.
The test results can be compared to reference ranges of normal values to help your healthcare professional diagnose nutritional deficiencies to prevent the development of nutritional diseases in children.
Prior to testing, your child’s healthcare provider will ask about your child’s health history and current symptoms.
If you or your child’s healthcare provider suspects that your child has a vitamin deficiency, a vitamin panel test can be ordered.
A vitamin panel blood test will check the levels of various vitamins (vitamin D, vitamin B12, vitamin A, folate, among others) to identify any deficiencies like vitamin B12 deficiency or Folate deficiency, and determine if a change is needed.
A mineral panel blood test will check your child’s levels of key minerals including calcium, iron, magnesium, and zinc.
Electrolytes are a category of minerals. An electrolyte panel blood test will test your child’s levels of sodium, chloride, potassium and bicarbonate.
Blood tests are also used to screen for and diagnose anemia in children. Testing the levels of hemoglobin and hematocrit is often the first screening test for anemia in children. This test measures the amount of hemoglobin and red blood cells in the blood.
A complete blood count, or CBC may also be ordered to test your child for anemia. A complete blood count checks the red blood cells, white blood cells, blood clotting cells (platelets), and young red blood cells (reticulocytes).
Speak to your healthcare provider to determine if your child needs a blood test for vitamin deficiencies.
How can we prevent nutritional deficiencies?
A well-balanced diet is usually all it takes to ensure your child is getting the necessary nutrients they need to prevent a nutritional deficiency. While this seems simple, many factors may prevent kids from eating a well-balanced diet.
Some challenges parents may face include:
- Picky eating
- Gastrointestinal issues that prevent the proper absorption of nutrients
- Children with medical conditions that impact nutritional status, such as cystic fibrosis
- Food allergies
- Genetic disorders
The USDA recommends that parents use ChooseMyPlate.gov for their children as a guideline for how much of certain foods kids need for a healthy diet.
Some healthy eating tips for kids include:
- Choose a variety of foods for your kids to try. An ideal meal should incorporate items from each different food group-grains, protein, dairy, and fruits and vegetables.
- Try filling half of your child’s plate with vegetables and fruit. Depending on your child’s age, aim for 1–3 cups per day of vegetables per day. For fruit, kids should try to get 1-2 cups every day.
- To meet a child’s calcium requirements, kids need 2-3 cups of milk or milk-alternatives with calcium. Try to serve lower-fat milks and avoid milk-alternatives that contain a lot of sugar.
- Depending on their age, kids need 1.5 to 4 ounces of whole grains each day. Try to offer whole wheat bread, oatmeal, and brown rice.
- Kids need 2-6.5 ounces of protein every day, depending on their age. Rich protein sources include chicken, turkey, fish, beef, eggs, tofu, beans, nuts, Else nutrition products, and lentils.
When should my child take a supplement?
Most children can get the nutrients they need from diet alone. However, there are cases in which a dietary supplement may be considered to prevent a nutrient deficiency from becoming a nutritional disease.
If you are concerned about your child’s nutritional status, and you suspect they may have a nutritional deficiency, it’s best to speak with a healthcare provider first. A healthcare provider can order the necessary blood tests and monitor vitamin and mineral levels accordingly.
Specific vitamin and mineral supplements may be beneficial for kids at risk for deficiencies which include:
Kids following a vegetarian or vegan diet may need a vitamin B12 supplement as this nutrient is generally only found in animal foods. Kids following a strict plant-based diet may also need supplemental calcium, iron, zinc, and vitamin D.
It is important to note that children who are following a plant based diet may not need a nutritional supplement. This may be true if they’re eating enough plant foods that naturally contain or are fortified with critical vitamins and minerals.
Children who have a medical condition that affects the absorption of certain nutrients may need a nutritional supplement. These children may benefit from iron, zinc, and vitamin D supplementation. This is because these diseases can damage the areas of the gut that absorb these specific micronutrients.
It is important to discuss micronutrient supplementation with a healthcare provider before giving them to your child. It is also imperative to choose supplements that are specifically designed for kids to ensure that they don’t get dangerous megadoses of certain nutrients.
When choosing a supplement for your child, look for quality brands that have been third party tested. These third party testing labels may include NSF International, United States Pharmacopeia (USP), ConsumerLab.com, Informed-Choice, or the Banned Substances Control Group (BSCG).
Optimal nutrition in childhood is the cornerstone of lifelong health.
Despite your best efforts, your child may not always get all the vitamins and minerals they need. Offering a variety of healthy foods is the best way to prevent common nutrient deficiencies in childhood.
In some cases, supplementation may be necessary to prevent nutrient deficiencies that may lead to nutritional diseases in children. Else Nutrition products can help increase nutrition for picky eaters and plant-based kids.
Additionally, emerging research is making the link between vitamin deficiencies in childhood and behavioral problems. This newfound connection makes the case for providing optimal nutrition that much stronger for kids.
Providing the best nutrition for your child will set the stage for your child’s health and happiness allowing them to reach their best potential.