Micronutrients, as the name suggests, are required by our bodies in smaller amounts (<100 mg/day). Despite the low quantity, their role in the development of an individual, especially children, is crucial compared to their counterpart, macronutrients. Iron, calcium, iodine, zinc and vitamins (including vitamins A, B12, B9 and D) are the most common micronutrients that children need. “Micronutrient deficiencies among children can have a widespread effect on their growth [physical and psychological], immunity, productivity, performance and even cognitive functions,” explains Dr Preeti Galagali, pediatrician and adolescent health specialist, Bangalore Adolescent Care and Counselling Centre, Bangalore. Hence, it’s crucial for parents to ensure their children receive the necessary micronutrients in optimal amounts.
Micronutrient deficiency: Prevalence among children
A 17-year-long study conducted by the Global Micronutrient Deficiencies Research Group (from 2003–2019) published in The Lancet Global Health in 2022 found that more than half of preschool-aged children (6–59 months) and women of reproductive age worldwide have micronutrient deficiencies.
In India, vitamin D and B12 were second on the list (behind iron) among the most common deficiencies, as per a 2021 study. “When iron, an integral part of hemoglobin — the oxygen-carrying pigment in the blood — is inadequate, it can hamper growth, immunity and cognition in children,” describes Dr Galagali.
Signs and symptoms of micronutrient deficiency
Deficiencies can have physical or psychological manifestations. “For instance, when children are deficient in iron, they fail to perform well in academics, especially mathematics,” shares Dr Galagali.
Dr Tushar Maniar, HOD, centre for child health, Nanavati Max Super Speciality Hospital, Mumbai, lists the common symptoms of different micronutrient deficiencies:
- Iron: Developmental delays, concentration issues, psychological issues and social withdrawal
- Iodine: Stunted physical and intellectual growth and delayed sexual development
- Vitamin A: Dry eyes, improper vision in dim light and weakened immunity leading to frequent infections
- Vitamin D: Balance issues and weakening of bones and muscles causing pain
- Folate: Fatigue, concentration issues, headache, irritability, open sores on the tongue and inside the mouth and color changes in the skin, hair or fingernails
- Zinc: Frequent infections, loss of hair and appetite, slow growth, slow wound healing
- Vitamin B12: Fatigue, headache, tingling, numbness, pale skin, pain and inflammation in the mouth and tongue, concentration issues and depression (in rare cases)
- Calcium: Muscle cramping or a pin-and-needle sensation (in newborns), muscle weakness, fatigue and irritability
Overlapping symptoms
Sometimes, there can be overlapping symptoms from other conditions as well. Dr Maniar explains, “The common overlapping symptoms include stunted growth, developmental delays, anemia, fatigue and a weakened immune system.” These conditions can lead to skin rashes, poor wound healing, night blindness and dental problems. “A crucial overlapping symptom is depression. It can be an indicator of folate, iron or vitamin B12 deficiency,” shares Dr Galagali.
Processed foods are the culprit
In India, nutrition has taken a turn for the worse, owing to the large influx or availability of processed or ultra-processed foods, points out Dr Galagali. Such junk foods contain empty calories and are high in carbs, fats and sugar. “They stimulate the brain’s reward center, leaving children craving more. In addition, the high amount of sugar and fat provides a feeling of fullness. “This causes dietary insufficiencies in kids, as such food items limit their intake of healthy foods,” she adds. In addition, caffeinated drinks have replaced milk nowadays; this is increasing the risk of calcium deficiency in children. “They must refrain from having coffee, tea or sodas. These caffeine-rich beverages can interfere with iron absorption, increasing the risk of iron deficiency,” explains Dr Galagali.
Dr Maniar recalls, “Unlike the past, where an annual hemoglobin test was recommended to diagnose iron deficiency in children, clinical examination is the standard procedure today.” He adds that a complete blood count (CBC) is also recommended if needed, listing some measures that parents can take to look out for deficiencies in their children:
- Monitoring the child’s height and weight on a regular basis
- Addressing sudden weight loss at the earliest
- Keeping a close eye on the child’s developmental milestones
Micronutrient deficiency in children: How parents can help
While the symptoms vary for each micronutrient deficiency, parents must watch out for certain signs in their children, which include difficulty gaining height or weight, lack of appetite and insufficient eating, explains Dr Maniar.
In 2020, Soumya Bimal (34) from Bangalore suddenly started noticing that her 7-year-old daughter had small white patches on her right cheek. On consulting a doctor, she was diagnosed with vitamin B12 and iron deficiency, ruling out any skin issues. Before the diagnosis, Soumya’s daughter had repeated episodes of fever and a low immunity. Along with white patches, her skin was turning pale as well. Vitamin B12 plays an essential role in the production of red blood cells, while iron helps in the production of hemoglobin. Deficiencies in these nutrients can cause anemia if left unaddressed, say experts.
Ritu Kapoor, a nutritionist and wellness consultant from Bangalore, explains, “The required micronutrient amount for children depends on their age, gender and physical activity levels. Further, the quantity will also differ for children with specific deficiencies.”
Post-diagnosis, Soumya ensured her daughter ate foods rich in iron. She used cast iron vessels to cook and prepared the veggies on a low flame. The little girl was also recommended iron and vitamin B12 supplements. After about a year, the white patches disappeared, and her deficiency was in control too.
Dr Galagali provides a guideline for parents to ensure their children receive optimal amounts of micronutrients:
- Follow the GYOR (green, yellow, orange and red) rule while preparing food for children to ensure they get the required amount of micronutrients.
- Ensure that children play in the sun for 15–30 minutes every day to get a free dose of vitamin D.
- Add a dash of lemon (rich in vitamin C) to green leafy veggies, which aids in the better absorption of iron.
- Eating fiber-rich foods will help too.
- Ensure that children stay away from processed foods and caffeinated drinks.
Takeaways
Micronutrient deficiency in children can adversely affect their growth, immunity, productivity, performance and cognitive functions. According to experts, processed foods and caffeinated drinks are the primary reasons for the deficit, which interfere with or impair certain biological processes, increasing the risk of deficiency. Common symptoms of micronutrient deficiency can include fatigue, headaches, reduced concentration and developmental delays. Experts advise parents to look out for signs of deficiency in their children; they should keep junk food away from the kids and include brightly colored foods in their diet so that they can receive optimal amounts of micronutrients.
