Fussy eaters and nutrient deficiencies

According to guidelines from Royal Children's Hospital Melbourne, several key micronutrient deficiencies are commonly seen in paediatric practice.

Iron deficiency alone remains the most common preventable nutritional deficiency worldwide, particularly in children who have high nutrient needs but often limited diets.

Autism, ADHD & nutrient deficiencies

Children with autism and ADHD are at a higher risk of deficiencies, especially when they experience picky eating, sensory sensitivities and rigidities.

Research highlights the following in children with developmental differences:

• ADHD
• Higher rates of vitamin D deficiency
• Increased risk of iron deficiency
• Greater likelihood of multiple nutrient deficiencies
• Autism 
• Lower intake of calcium, vitamin D, B12, and protein
• Increased likelihood of food aversion and restrictive eating
• Up to 5x higher risk of feeding difficulties leading to nutritional gaps
• Neurologically diverse children
• 15-50% may experience deficiencies in nutrients like iron, zinc, selenium, and vitamins C, D, and E

The tricky part: you might not see symptoms

One of the biggest challenges? Micronutrient deficiencies are often silent.

Clinical signs like fatigue, poor concentration, behavioural changes, or slow growth tend to appear late. That's why nutritional risk should be identified through dietary history rather than waiting until signs or symptoms develop. 

Red flags in fussy eaters

If your child is a picky eater, these factors increase risk of nutritional deficiencies:

• Very limited food variety
• Avoidance of entire food groups (e.g. vegetables, protein)
• High milk intake replacing meals
• Sensory sensitivities to textures, colours, or smells
• Diets lacking fresh fruits and vegetables

Common deficiencies & subtle signs

When deficiencies do show up, they may look like:

• Iron → fatigue, irritability, poor focus, pallor
• Vitamin D → bone pain, delayed development, fatigue
• Vitamin C → easy bleeding, bruising
• vitamin A --> vision changes at night, dry eyes, dry skin 

What parents can do

• Focus on whole foods and variety as much as possible
• Keep offering a range of foods without pressure
• Speak with a health professional if intake is very limited
• Consider support strategies when diet alone isn’t meeting needs

Nutrient deficiencies are often invisible. A proactive, history based approach is key to consider possible nutrient deficiencies (alongside clinical exam, height, weight and consideration of blood testing).

If you think your child may be at risk of nutritional deficiencies talk to your health professional to consider potential nutrient gaps and practical approaches to supporting nutritional intake during periods of fussy eating.

 

Dr Claire

Paediatrician and Founder, Base Kids