Child Nutrition Department Dr. Yang Ying

90% of the parents who ask me if they should supplement their children with calcium, zinc, DHA, and vitamins actually find that their children are not lacking in any nutrients. What they are lacking is the habit of eating well and the parents’ mentality of not being anxious.

In the outpatient clinic last Wednesday afternoon, I had just sent away a little patient with a milk protein allergy. The mother came in with a 3-year-old boy in her arms, and the canvas bag in her hand was bulging. She took out a table of supplements: milk calcium purchased overseas from Australia, DHA recommended by a certain online celebrity blogger, calcium, iron and zinc oral liquid given to her by a supermarket promoter, and several boxes of children's health products with the slogan of "opening the spleen and strengthening the stomach". "Dr. Yang, look at my baby's hair, which is yellow, and he always runs away when eating. He has to chase for half an hour every time he is fed. Is he deficient in zinc? My friend said that he likes to eat more after taking zinc supplements. I have been taking it for half a month and it doesn't seem to have any effect."

I looked through the child's physical examination book. The height and weight were both in the 75th percentile, and the growth curve was steady. I asked about the child's diet in the last 24 hours: he drank 200ml of milk in the morning, ate a whole egg, half a bowl of rice, half a piece of braised pork ribs, and a few bites of stir-fried lettuce at noon. In the afternoon, he ate half a box of strawberries and drank a small box of non-additive yogurt. You see, there is enough milk, enough high-quality protein, and vegetables and fruits, so where does the zinc deficiency come from? After careful questioning, I found out that the old man in the family was always worried that the baby would not have enough to eat. He would follow him with a bowl to feed the baby every meal. The baby would eat while playing with building blocks. One meal would take an hour, and the food would be cold by the end of the meal. Of course, he could not eat much.

When it comes to supplements, there are actually different voices in the industry. Some experts in the field of public nutrition advocate complete dietary supplementation. As long as the dietary structure is reasonable, children do not need to take any additional supplements at all. Too much supplementation will increase the metabolic burden on the liver and kidneys. Some clinical pediatricians will also recommend that children with severe picky eaters, premature births, and low birth weight can supplement multivitamins or targeted nutrients in the short term to first fill the nutritional gap, and then slowly adjust their eating habits.

I have been doing clinical practice for so many years, and I actually prefer to "evaluate first and then make decisions". There is no standard that is universally applicable. For example, if your child only eats white rice every day and refuses to touch a bite of meat or dark green vegetables, and is found to be deficient in iron and zinc, he must supplement it first, otherwise it will affect his cognitive development and immunity. But if your child can eat everything during his daily meals, and his growth curve keeps on track steadily, then there is really no need to spend such unnecessary money.

Speaking of which, my child also had a "picky eating period" for half a year when he was a child. At that time, he would not touch the green leafy vegetables. He picked them out from the bowl and threw them on the table. My wife was also panicked at the time and asked if she should buy some imported children's vitamins to supplement her? I didn't agree, so I went back and tried different things. I chopped the spinach and mixed it with the minced meat to make meatballs. I chopped the broccoli and spread it on the homemade pizza. I even juiced the vegetables to make small green steamed buns. Within two months, the baby was willing to take the initiative to pick up the vegetables on the plate and eat them. Now every physical examination of trace elements and blood tests are normal, and he has not taken any additional supplements.

Don’t think that supplements are “all good”. Last month, I treated a 5-year-old baby who had nosebleeds for three days in a row. His coagulation function was checked and everything was fine. Finally, when I asked the parents, they read on the Internet that vitamin A supplements are good for the eyes. The imported supplements they bought for their children were originally supposed to take one pill a day, but the parents were afraid that the dose was not enough, so they gave him two pills a day for two months, which was too much. Don't you think this is unfair?

There are still many parents who like to talk about the results of trace element testing. I have to be honest about this. The industry has long since stopped recommending trace element testing in peripheral blood as the only standard for nutritional assessment. The dilution of tissue fluid during sampling and the child's recent diet will interfere with the results, and the accuracy is very limited. When we make clinical evaluations, the first thing we look at is the growth curve for six consecutive months, followed by the three-day dietary intake recorded by parents. The results of trace elements are just a reference at most. Don’t panic and place an order to buy supplements when you see a downward arrow on the test form.

To put it bluntly, I have been practicing as a clinician for so many years, and what I fear most is not that the child actually has nutritional problems, but that the parents’ anxiety first derails the rhythm of raising children.

In my clinic, I often tell parents that raising a baby really doesn’t need to be too meticulous. If you didn’t take so many kinds of supplements when you were a child, wouldn’t you be able to grow well? If you are really unsure whether your baby is deficient in nutrients, don't rush to watch live broadcasts to grab supplements. Use a small notebook to record everything your baby eats for three days, including the snacks you secretly stuffed and sugary drinks. Compare it with the children's dietary guidelines issued by the Maternal and Child Health Hospital. If you really don't understand, just call the nutrition department. We can calculate for you in ten minutes whether the intake is enough. It is better than buying a bunch of supplements and forcing your baby to eat, right?