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What Do Healthcare Providers Get Wrong About Nutrition?

a girl lying on the grass eating a carrot

Common Nutrition Mistakes Healthcare Providers Make

If you’re anything like us, you’ve asked your kid’s healthcare provider for advice about pretty much everything under the sun—including diet, nutrition and the like. But we’ll be honest—paediatricians, general practitioners, nurse practitioners and other experts who haven’t specialized in nutrition aren’t always the best to ask when you have specific questions or concerns about what your kids are eating. That’s why we asked Adrianna Smallwood, a registered dietitian, the founder of Newfound Balance and a clinical dietitian with Eastern Health in Newfoundland and Labrador, for her advice on a bunch of diet-related questions. Read on for her take on common questions. 

ParentsCanada: Parents typically speak to their kids’ paediatrician, family doctor or nurse practitioner when they have a question about their kids’ nutrition and diet, but sometimes these professionals aren’t necessarily well-versed when it comes to this topic. What do healthcare providers (who aren’t registered dietitians or nutritionists) tend to get incorrect when it comes to nutrition and diet? 

Adrianna Smallwood: First, we need to consider that most doctors don’t get an overwhelming amount of nutrition education during medical school, and that’s okay. Some specialists might even make recommendations that aren’t always accurate when related to food and nutrition. I will preface this by saying that their information isn’t always incorrect, but it could be outdated. All health professionals must keep up to date with their continuing education, and nutrition isn’t at the top of a doctor’s list with so many other topics they need to cover. I think the most important thing is for them to refer patients to a dietitian. Not doing so and taking on the role of providing education regarding nutrition isn’t the best idea.

ParentsCanada: So many parents are concerned about sugar. Some healthcare providers say kids can easily become addicted to sugar and it makes them hyperactive. Yes, too much sugar is problematic, but does this ring true to you? 

AS: There isn’t overwhelming research to prove increased sugar consumption in children can cause them to be hyperactive. I think it’s related to the environment they’re consuming the sugar in. For example, most children consume more sugar than they normally would at birthday parties, but at the birthday party, they’re also excited and amped up because of all the children, food, activities, decorations and the presents. A balanced diet that also includes sugar is not toxic. However, consuming high-sugar foods routinely can displace room in our kids’ tummies for important nutrients they need to grow and thrive. For example, if we give our kids a big glass of pop, juice or something with a lot of calories with their meal, their tummies might get full from the calories in the drink and they won’t have room for their meal, so they haven’t consumed as many nutrients even though they may have consumed a lot of calories. 

ParentsCanada: What kinds of advice have you heard healthcare providers offer when kids are overweight? Some say kids should be put on strict diets, cut carbs, etc., but these suggestions could be an issue, especially when it comes to promoting healthy body image and ensuring kids don’t develop eating disorders. What are your suggestions to parents when their kids are perhaps overweight for their height, age, body type, etc.? 

AS: I think it’s important to note there is a lot of misinformation about how to approach the health of children who are overweight, those who have high cholesterol or high blood sugar, and the way some healthcare professionals dole out incorrect information that can be harmful to our child’s relationship with food. Parents are often told weight loss is the only helpful outcome and they should cut their kids’ intake of high-fat or sugary foods. They’re not usually given practical tips that can help.

I always like to explain the different nutrients in food and why they’re important in our child’s growth and maintenance. It’s a conversation I have a lot with my young school-ager. And I feel like when I talk to him about why he needs a variety of foods and not just three chocolate bars a day, he gets it. We talk about how calcium is good for our bones and teeth, and how protein helps our muscles grow and helps our bones work. We talk about how vegetables are good for our eyes and immune systems, and how drinking water is necessary because our bodies are made up of so much water. Sugar is in carbohydrate foods, which our bodies need for energy, but like everything else, it needs to be consumed with a balance and variety of foods. If your child tends to like foods high in sugar and fat, this is the approach I would take. 

If they need to be more active, you could also seek out a kinesiologist, physiotherapist or occupational therapist—these professionals are specialized in the areas of how our bodies move, which is super important, and not just because it helps us lose weight. In fact, we don’t want to talk about “weight” with young kids—we want to talk about how exercise makes our hearts and lungs strong, and keeps our bones and muscles strong, too. At the end of the day, weight is an arbitrary number. It doesn’t tell us everything and it isn’t the only factor that determines our health.

ParentsCanada: Healthcare providers typically recommend the BRAT (bananas, rice, apple sauce, toast) diet when kids have stomach bugs/diarrhea. Some dietitians say this advice is akin to an old wives’ tale, and kids should be eating a variety of healthy foods when they’re not well. What’s your take? 

AS: I always suggest fluids and plain foods when kids have a stomach bug. In fact, I usually only encourage sips of water and not much else while they’re vomiting because it can trigger them to vomit more if they drink too quickly or put too much food in their bellies. Once the vomiting subsides, I encourage plain foods because too much sugar or spices can affect how quickly food moves through our digestive systems, which are super sensitive after a bug. The BRAT diet is still followed in hospital settings because these foods are plain and contain a little fibre, which can help bulk up our stool to help with diarrhea.

ParentsCanada: We know there are plenty of types of milk on the market these days—soy, oat, almond, cow’s milk, etc. Some healthcare providers are quick to discount varieties other than cow’s milk because of the calcium and other nutrients we derive from it. What is the value in giving children milk that doesn’t come from cows? 

AS: Some plant-based milks are just glorified sugar water, but others can be a good substitute for individuals who can’t drink cow’s or goat’s milk due to allergies or intolerances. It’s important to look for the right things, though. For children, we usually suggest soy milk because it has just as much protein as cow’s milk—of course, milk is an important source of protein. I will not discount oat, cashew, rice or any other kind of milk, but I will say there is no point in drinking it as a milk replacement unless it is fortified with calcium and vitamin D. Drinking plant-based milks that aren’t fortified might mean your child isn’t getting their daily allowance of calcium and vitamin D, which can lead to improper growth or issues with bones and teeth in their later years. 

Originally published in September 2023. Updated in March 2024.