Nutrition is a vital sign

Richa Agnihotri, MD FRCPC; CPS Community Paediatrics Committee

Nutrition impacts children’s health and development in profound ways. Currently, Canadian children are consuming an excess of sodium, sugar, and saturated fat, and too little fibre, calcium, and vitamin D. So where do parents learn about nutrition? In the context of widespread TikTok-style oversimplification and even misinformation, community paediatricians can stand out as a voice of reason. But to do this, we first need to ensure that nutrition is incorporated into training for paediatrics and family medicine.

Nutrition education is a critical area that does not get enough attention in medical schools. In practice, paediatricians often need to focus on emergent medical concerns at the expense of nutrition guidance, but the preventative visit is still a rich opportunity to provide anticipatory guidance for families and prevent chronic health conditions from developing.

A healthy curriculum

Trainees already recognize the importance of nutrition in disease prevention and treatment, but many feel unprepared to effectively counsel families on foods and eating. A better integration of nutrition education into medical curriculums—through longitudinal, applied learning, for example—could give paediatricians a deeper understanding of how nutrition influences key aspects of child health, such as bone, muscle, and cognitive development. Trainee doctors need to start practice with a real appreciation of how social determinants drive the food choices people make and how hard these decisions become as food insecurity grows. Learning techniques like motivational interviewing can help empower parents to make sustainable, healthful choices for families. Graduating physicians would be better able to offer evidence-based recommendations, tailored to parental values, goals, and the barriers they face. They could address misinformation and make appropriate referrals to specialists like dietitians, contributing to a more comprehensive approach to healthcare.

But how can nutrition be woven through medical training in a way that transforms our approach to every patient encounter? We can start by recognizing that nutrition is often implicated in presenting complaints. The current approach emphasizes nutrient deficiencies, with clinical vignettes focused on the clinical presentation of generally severe or prolonged deficiencies. This ignores how malnutrition (both deficiency and excess) can impact myriad common presenting complaints. For instance, iron-deficiency anemia can contribute to symptoms like inattention, hyperactivity, and sleep disturbance. Similarly, excessive consumption of ultra-processed foods—high in sodium, sugar, and saturated fats—has been linked to lower IQ and cognitive dysfunction. There is growing evidence that poor nutrition is a contributing factor to conditions like hypertension, dyslipidemia, and type 2 diabetes, which are increasingly common in Canadian children and adolescents. We need to recognize the increasing evidence of the effects nutrition has on a broad array of physical and mental health issues, so that counselling on nutrition becomes a default part of the non-pharmaceutical management of many more conditions. We can utilize great evidence-based resources such as Canada’s Food Guide, Dieticians of Canada and the Joannah & Brian Lawson Centre for Child Nutrition (University of Toronto) in our counselling and recommendations, which include practical tips on the food environment, food preparation, reading nutrition labels, grocery shopping, and meal planning.

Nutrition counselling at well-child visits

It is equally important to emphasize the role of nutrition in routine well-child care, and the updated Rourke Baby Record includes proactive nutrition counselling at well-child visits. Addressing nutrition early and often can help prevent many issues from becoming more pronounced. The timing of such counselling matters—it can evoke different emotional responses from parents, which, in turn, can impact the therapeutic alliance between the parent and paediatrician as well as adherence to the management plan. When addressed proactively, during routine visits and as a way to enhance well-being, the focus shifts from pathology to lifelong healthy habits. Take, for example, a parent who receives counselling on healthy food choices during a routine well-child visit, as opposed to when they are managing a childhood condition that may have been impacted by diet.

An integral part of routine well-child follow-ups—growth charts—provide valuable information about a child's development. However, it is important to recognize that a normal growth chart can hide important information about the quality of a child’s diet. A child with a "normal" growth trajectory may still have a too high intake of dairy or ultra-processed foods that could also be contributing to nutritional deficiencies and behavioural issues. In these cases, addressing diet quality—regardless of growth—is critical for promoting long-term health. The quality of food matters.

Improving nutrition is not always easy and, although some barriers are individual, many are systemic. Low food literacy can be addressed through doctor-to-patient education during well-child visits, but to make even greater change we need systems-level solutions through public health departments and community initiatives. Systemic barriers, such as poverty and other sources of food insecurity, cannot be fixed in a clinical encounter. Knocking these down requires political advocacy, such as ensuring that a national school food program provides healthy food to our children.

Know your community

Even with systemic barriers, there are often community resources that can help. In my community, for instance, GROW Food Literacy Centre is a non-profit that helps people make better food choices by providing both education and access to low-cost, healthful foods. Paediatricians need to be familiar with local community resources that can help parents and families overcome the systemic barriers they face.

Cultural safety & Environmental sustainability

In addition to recognizing the widespread effects of nutrition on physical and mental health, reinforcing its importance within routine well-child visits, and empowering families to make positive changes, there is one other piece that we must address: cultural safety. All the above factors must be discussed in the context of our patients’ individual values, beliefs, and experiences. Some people choose plant-forward or vegan diets for ethical, climate-related, or religious reasons. For others, the annual deer harvest is an important part of reclaiming a nearly extinguished cultural identity. We must be humble, self-reflective, curious, and respectful when discussing the role of certain food choices in enabling and maintaining healthful lives, or we risk breaking the trust we seek to build.

As paediatricians, we can help families understand how diet affects health and encourage them to make sustainable changes that align with their values, goals, and resources. These discussions should be frequent and proactive, starting early in childhood and continuing through adolescence. We need a medical curriculum that trains physicians to support parents and children to make healthy food choices a lifelong habit.

---

Copyright

The Canadian Paediatric Society holds copyright on all information we publish on this blog. For complete details, read our Copyright Policy.

Disclaimer

The information on this blog should not be used as a substitute for medical care and advice. The views of blog writers do not necessarily represent the views of the Canadian Paediatric Society.

la-nutrition-est-un-signe-vital