Developmental Delays in Toddlers May Be Due to a Lack of Fat

The most common side-effect of a diet too low in fat is diarrhea. If you’re toddler or preschool child suffers from chronic loose stools, then lack of fat may be the reason [5].

Eisenberg, Murkoff and Hathaway believe,

“If your toddler is under two years old, most of the dairy products he or she consumes should be full-fat; toddlers older than two should be switched to skim milk and mostly low fat (not non-fat) dairy products. But remember that a very low-fat diet is not appropriate for any child” [6].

So how much fat is in your child’s sippy cup of milk? If it is whole milk, there are approximately 6.5g of fat; if it is 2% there are 4.4g, but if you are giving your toddler skim milk there is only 0.4 g of fat [7]. Studies have not yet proven that infant and toddler diets too high in fat lead to future metabolic health problems. For this reason the American Academy of Pediatrics recommends not restricting the fat in diets of infants or children under the age of two [8].

Low-fat dieting affects more than toddler body weight. It can also have detrimental developmental consequences. Fat provides both energy density and adequate amounts of essential fatty acids; it acts as a carrier for necessary fat-soluble vitamins, and is necessary to assist in proper toddler growth and development. Fatty acids are each involved in specific metabolic functions. For example,

“short-chain fatty acids are local growth factors in the colon; medium- and long-chain saturated fatty acids are good energy sources; long-chain polyunsaturated fatty adds participate in metabolic regulation; and very-long-chain fatty acids are structural components in membranes”[9].

A possible side effect of long-term inadequate animal-source fat intake is the development of a vitamin B12 deficiency. The Center for Disease Control featured a report outlining two extreme cases of B12 deficiency. In the report two young toddlers were eating vegan diets and suffering from failure to thrive syndrome. This study outlines the worst-case scenario of malnutrition from a low-fat low-cholesterol diet [10]:

Breastfed by a vegan mother until 9 months of age, the boy in the study was not thriving. When the boy was 9 months old, the health-care provider and his parents became concerned about the child’s growth and development and so they supplemented his diet with fruit and dry cereals to improve growth. He was taking a multigrain formula because he could not tolerate cow’s milk based formula or soy-based formula. He exhibited poor motor and speech development at age 11 months, and was evaluated by a developmental pediatrician, who ordered genetic and metabolic studies and prescribed speech, occupational, and physical therapies.

After diagnosis of a B12 deficiency, the pediatrician began nutrient therapy. The boy continued to have delays in speech, but he experienced catch-up development in motor skills. Six months after treatment had begun, the child still had slight speech and fine motor skill delays but had age-appropriate gross motor skills.

“The amount of vitamin B12 actually needed by the body is very small, probably only about 2 micrograms or 2 millionth of a gram/day. Unfortunately, vitamin B12 is not absorbed very well so much larger amounts need to be supplied through the diet or supplementation. The richest dietary sources of vitamin B12 are liver, especially lamb’s liver, and kidneys. Eggs, cheese and some species of fish also supply small amounts, but vegetables and fruits are very poor sources” [www.yourhealthbase.com].

Parents concerned about their infant or toddler’s fat-intake should first answer Anderson and Zlotkin’s five key questions before implementing any type of dietary changes:

1. Does modification of diets in childhood prevent chronic disease? If so, which disease or diseases?
2. Will dietary change affect growth and development?
3. Can children meet energy requirements on energy-dilute diets? If so, at what age?
4. Will nutrient intakes be compromised?
5. Is there a monitoring system in place to evaluate dietary change?” [1].

Eisenberg, Murkoff, and Hathaway suggest we feed our 1-3 year old toddlers between five to eight servings of high-fat foods every day, each serving about 7 grams of fat.

“Try to vary the sources of fat in your toddler’s diet. Though some of it should come from animal sources (whole milk, cheese, meat), especially in the second year, more of it should come from vegetable oils (especially in the third year and beyond)” [5].

Below is a guideline offered by the Harvard School of Public Health outlining fat types and sources.

Full text article can be found at harvard.edu.

In summary, it is important for parents to watch not only what they serve, but also what their child actually eats. A child that exhibits delayed development and chronic diarrhea may just be suffering from a lack of fat.

References:

1. Anderson, G. Harvey; Stanley H. Zlotkin. “Developing and implementing food-based dietary guidance for fat in the diets of children.” Am. J Clin Nutr. 2000:72, 1408S.
2. Allen, Lindsay; Joanne Graham. “Beef as a Source of Vitamin B12, Iron and Zince to Improve Development of Infants Fed Low Amounts of Animal Products” GL-CRSP Annual Report, 2005.
3. Pollan, Michael. In Defense of Food: An Eater’s Manifesto. The Penguin Press. New York (2008) 49.
4. Lutter, Chessa K.; and Juan A. Rivera. “Nutritional Status of Infants and Young Children and Characteristics of their Diets.” Journal of Nutrition, 2003: 133, 2941S-2949S.
5. Cohen S.A.; K. M. Hendricks; E. J. Eastham; R.K. Mathis; W.A. Walker. “Chronic nonspecific diarrhea: A complication of dietary fat restriction.” American Journal of Diseases of Children. 1979:133,490–492.
6. Eisenberg, Arlene; Heidi E. Murkoff, Sandee E. Hathaway. What to Expect the Toddler Years. Workman Publishing. New York (1994) 506-507.
7. USDA Nutrient Laboratory
8. American Academy of Pediatrics. Statement on cholesterol. Pediatrics 1992: 903, 469-71.
9. Giovannini M; C. Agostoni, P.C. Salari .”The role of lipids in nutrition during the first months of life.” J Int Med Res 1991:19, 351-362.
10. R Muhammad, MD, P Fernhoff, MD, Dept of Pediatrics, Emory Univ, Atlanta, Georgia. S Rasmussen, MD, Div of Birth Defects and Developmental Disabilities; B Bowman, PhD, Div of Diabetes Translation; K Scanlon, PhD, L Grummer-Strawn, PhD, L Kettel Khan, PhD, Div of Nutrition and Physical Activity, National Center for Chronic Disease Prevention and Health Promotion; M Jefferds, PhD, EIS Officer, “Neurologic Impairment in Children Associated with Maternal Dietary Deficiency of Cobalamin.” CDC, 2003, Jan 31; 52:04, 61-64.