By: Tamara S. Hannon, MD, MS, FAAP
A child's diet is important because it helps them grow, stay healthy and have the energy to play, learn, and do the things they love. If you're the parent or caregiver of a child with
diabetes—or one who faces risks for the disease—you may feel especially concerned about what your child should and shouldn't eat.
Do the low-carbohydrate diets sometimes touted as solutions really make sense for children and teens? Or are they a potential recipe for other health struggles? An American Academy of Pediatrics (AAP) report explores these questions and others, offering useful guidance for parents other concerned adults.
How diabetes threatens our kids' health
Diabetes is an urgent health issue for children and teens in the U.S. From 2001 to 2017, the number of kids aged 20 and under with type 1 diabetes
rose 45%, while cases of type 2 diabetes shot up an alarming 95%. (For more on the differences between type 1 and type 2 diabetes, check out this
Concerns about diabetes in children go beyond the condition itself, since people with diabetes can suffer long-term health consequences, including heart disease, kidney disease, vision problems, and life-threatening complications.
There is no cure for diabetes at present, and we can't prevent all kids from getting it, especially those who face family risks for type 1 diabetes. But we can keep many kids and adults from getting type 2 diabetes, which often can be prevented through healthy
lifestyle habits. We can also give kids with type 1 diabetes the best possible chance to manage their blood sugar well and live active, healthy lives.
Good nutrition is essential in this fight to protect our kids' health. The difficulty comes in defining exactly what "good nutrition" means, especially for growing bodies.
Do low-carbohydrate & keto diets make sense for kids at risk of diabetes?
In recent years, some health care providers have suggested that low-carbohydrate diets—specifically, the
ketogenic diet—can help children and teens who live with diabetes (or face serious risks of developing it). Many point to the diet's effectiveness in helping some people achieve a
healthy weight. But others aren't sure that keto's severe restrictions are the best solution, even for kids already living with diabetes.
Children in the U.S. get about 50% of their calories from carbohydrates, which tracks with accepted nutrition
guidelines set by the U.S. Department of Agriculture (USDA). The trouble is, most of the carbs our kids consume are from
added sugars and starches in highly processed foods.
Sugary cereals, chips, snacks, sodas, cookies and candy are all examples of foods linked with higher blood sugar levels, weight gain and higher type 2 diabetes risks. Unlike nutrient-rich carbs like fruits, vegetables and whole grains, these foods don't help kids feel full and satisfied. In fact, there is
strong evidence that the flavors and textures of processed foods make us crave more of them, causing us to overeat (and suffer the health consequences).
Even so, the idea of cutting nearly all carbs from a child's diet may not be a wise strategy because:
Growing bodies need the healthy nutrients found in fruits, veggies and whole grains. In fact, a child's growth may slow down when carbs are restricted, and bone health may suffer too.
Kids need the energy that carbohydrates supply to thrive in school and in life. Both the body and brain depend on carbs as healthy fuel for sports, play, study, social activities and more.
High protein diets can be hard on the kidneys as the kidneys need to get rid of all that extra protein that the body doesn't need.
Labeling carbs as "bad" foods may set kids up for
disordered eating, fueling the patterns that can lead to anorexia, bulimia, binge eating and other health threats.
Restrictive diets can make family and social situations more stressful. Limited food choices may make kids feel out of step with their siblings and friends. Planning and preparing keto-friendly meals means significant work for parents and caregivers, often creating tension and worry that can affect a child's wellbeing (and the family's emotional equilibrium).
A more balanced approach to low-carb & keto diets for kids: 3 key steps
Good nutrition is essential for all children and teens, especially those living with diabetes or prediabetes. The AAP agrees with leading dietitians and other health experts who recommend a balanced approach to prevention and treatment. Specifically, the AAP advises:
Healthier carbohydrate choices: Help kids choose nutrient-rich carbs in place of sweet, starchy processed foods that can elevate diabetes risks.
Skip sugary beverages: Eliminate sugar-sweetened drinks altogether.
Get moving: For kids with diabetes or prediabetes, a
balanced diet paired with 60 minutes per day of moderate to vigorous exercise to regulate blood sugar and support healthy body weight.
The AAP also confirms that children and teens with diabetes should be followed by a focused, multidisciplinary medical team that includes their pediatrician or family doctor. Due to the risks of disordered eating and other health issues, the AAP does not recommend keto or other ultra-low-carb diets for kids with diabetes, except under the close supervision of a diabetes care team that focuses on safety protocols to protect the child's overall wellbeing.
What about keto diets for kids with epilepsy?
For the estimated 470,000 children under 17 in the U.S. who live with epilepsy, the keto diet may
provide answers when standard treatments do not. No one knows why this high-fat, high-protein regimen is helpful in controlling seizures, but for many children and teens, it has proven more effective than even the newest medications, often improving alertness and behavior.
Although the AAP does not recommend keto for children with diabetes unless they are closely supervised by a diabetes-focused medical team, we do recognize the diet's potential value for young people with epilepsy.
Advocacy for good nutrition & prevention in all communities
Healthy eating can be difficult sometimes. This can be especially true for families who may not be able to afford fresh, nutritious foods or those who live in
food deserts where healthy choices can be hard to find. The AAP encourages pediatricians and other health professionals to advocate for stronger federal nutrition programs that can help families gain access to the healthy foods that are part of diabetes prevention and treatment.
Questions? Talk with your pediatrician
Making sense of the conflicting advice you may have heard about childhood nutrition can be challenging. Whenever you have questions or concerns about diabetes, prediabetes and your child's health, get in touch with their doctor. Pediatricians have a strong stake in helping children and teens navigate health risks and embrace the habits that can lead to a healthy future. Rely on your pediatrician for guidance that follows your child's unique needs—and the needs of your family, too.
About Dr. Hannon
Tamara S. Hannon, MD, MS, FAAP, is a board-certified pediatric endocrinologist who serves as Director of the Pediatric Diabetes Program at Riley Hospital for Children in Indianapolis, Indiana. Dr. Hannon studied Nutrition Science at Purdue University and has a long-standing interest in the impact of diet on health. A member of the AAP’s Committee on Nutrition, Dr. Hannon is a co-author of the AAP Clinical Report, "Low-Carbohydrate Diets in Children and Adolescents With or at Risk for Diabetes."