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Parental influence: A look at restrictive diets in children

Parents of young children are the principal providers and influencers of their diet. However, we are unsure to what extent popular dietary trends influence parents to modify what their children eat.

Diets including raw, clean, gluten-free and vegan feature widely in popular media, but we are unaware how these dietary patterns are changing the eating patterns of families, and whether this could have any adverse effects on the nutrition intake of children.

The potential implications of some of the more prevalent restrictive diets to young children are considered in this article.

Suspected food allergies/intolerances

Research indicates that self-diagnosis of allergies, and the use of inappropriate commercially available tests is common. Parental fears about increasing food allergies and intolerances can result in eliminating major food groups from the diets of their children.

Children with suspected food allergies/intolerances should be properly diagnosed and guided appropriately by health professionals to ensure their diets provide the nutrients they require. The importance of professional support is illustrated in medical case studies.

For example, Dr Lee Noimark, a paediatric allergy specialist, has reported on a 10 month old with cow’s milk allergy admitted with hypocalcaemic seizures, clinical rickets and iron deficiency resulting from a restricted diet of breast milk and a limited number of fruits and vegetables as a consequence of maternal fears to progress the infant diet.

Another of his case studies includes a malnourished five-year-old who was unnecessarily avoiding multiple foods based on the results of alternative (electrodermal) testing.

Gluten free diets

Enabling children with coeliac disease (affecting around one per cent of the population) to maintain a gluten-free diet is essential for their health and preventing long-term complications. However, for children who do not have coeliac disease or a wheat allergy, there is no evidence that restricting gluten, simply because parents may think it’s a healthy option, has any clinical benefit.

It is also important for parents to be aware that some gluten-free packaged foods contain more fat and sugar than their gluten-containing counterparts.

Vegan diets

Appropriately planned vegetarian diets, including vegan diets can be nutritionally adequate across the lifecourse. General studies have suggested a vegan diet can provide a higher intake of certain nutrients eg fibre, vitamins C and E and folate but lower intakes of others (such as vitamin B12, calcium, vitamin D, zinc, and long-chain n-3 fatty acids) compared with diets containing meat/fish.

There have been a number of published case studies with regards vitamin B12 deficiency in restricted vegan diets. For example, vitamin B12 deficiency was described in a BMJ case study of a 7-year-old boy hospitalised for acute ataxia and failure to thrive after subscribing to a strict vegan diet with no inclusion of fortified foods.

As children have greater nutrition requirements for their body weight than adults, they will be more susceptible to the risk of nutrition deficiency from restricted diets. Such diets can also make children feel more socially isolated.

Furthermore, it is imperative that parents are aware of misconceptions which may lead to unwarranted restrictions. For example, parents may well be aware of the need to reduce added sugars in their child’s diet, but may mistakenly restrict fruits and dairy foods (eg plain milk, yogurt and cheese) because of misplaced concern over their natural sugars content.

Fruit and dairy contain a range of beneficial nutrients and play an important role in a healthy balanced diet. There is no evidence that the sugars naturally present in them are harmful to health.

Parents should be aware that strict dietary restrictions can have serious consequences. Children are not small adults, and consideration must be taken before placing parental dietary restrictions on them.

If parents do eliminate certain foods - such as meat or dairy or gluten-containing grains - they should talk to a health professional about how to best replace these.