Eating nutritious foods and being physically active are important for children and teens with blood and bleeding disorders. Making healthy eating and activity choices can support healthy bodies and joints. Children and teens need nutritious food with enough protein, carbs, fats, vitamins, minerals, and fiber to support their growing bodies. It is also important for children and teens to eat foods with other important nutrients like calcium and iron. Following nutrition and physical activity guidelines during childhood can support healthy eating and physical activity habits that will continue into adulthood. 

This section of Food Choices covers: 

The Importance of Healthy Eating and Healthy Bodies

What is Healthy Eating?

The Importance of Iron and Calcium During Puberty

Ways to Encourage Healthy Eating

Resources

The Importance of Healthy Eating and Healthy Bodies

Healthy eating and being physically active can be hard. By teaching children and teens how to make healthy food choices and the importance of being physically active, parents and caregivers can help their children and teens make good decisions as they become more independent. You can lead the way by modeling healthy eating and being physically active.

Eating nutritious foods will help keep your child and teen healthy and energized. Foods with the wrong kinds of fat, added sugar, and little nutrition can lead to bodies being unable to support healthy growth. Being at an unhealthy weight can be an issue for people with bleeding disorders. Being at a healthy weight supports less stress on joints and decreases the number of painful bleeds. Over time joint damage can lead to osteoarthritis. This is a form of arthritis where cartilage is lost. This can be common in the knees which are target joints for bleeds. Body weight also affects how much bleeding disorder medication you should take.

What is Healthy Eating?

Nutrition and food choices are not a one-size-fits-all solution. The best amount and types of food for one person may not work for another. For example, what is best for a 9-year-old may look different than a 15-year-old who has diabetes. Your child’s nutritional needs are based on factors like age, stage of life, bloodwork results, lifestyle, allergies, dietary restrictions, and health status including what type of illnesses you may have.

Models of basic nutritional needs, like My Plate, can be used as a guide but do not always apply to everyone equally. Also, the quality of food is just as important as the quantity of food. While nutritional needs may vary, there are some basic nutrition facts that are true no matter your age or stage of life. These may help guide you as you make decisions based on your child’s individual needs. Talk with a health care provider before making any changes to your child’s diet or if you have specific questions. 

food choice

Macro and Micronutrients
Macronutrients and micronutrients are needed for our bodies to work well. Macronutrients are carbohydrates, fats, and proteins. Micronutrients are vitamins and minerals. Healthy eating includes eating both macronutrients and micronutrients regularly. Below we will talk more about carbohydrates, fats, and proteins.1-5
Carbohydrates
All carbohydrates are not created equal. There are two types. There are simple carbohydrates and complex carbohydrates. Simple carbohydrates can be found in candy, cakes, processed foods, and soft drinks. Complex carbohydrates can be found in vegetables, whole grains, and legumes (chickpeas, lentils, beans, peas). Complex carbohydrates provide your child’s body with essential nutrients and usually take longer to digest. This keeps your child’s blood sugar more stable. Complex carbohydrates give us the energy we need to think, grow, and thrive.1-5
Fats

Different fats are also not created equal. There are several types of fat. There are naturally occurring fats, which include unsaturated fat and saturated fat. There is also manufactured fat, which is hydrogenated (or trans) fat. Examples of unsaturated fats are avocadoes, olives, olive oil, seafood, and some seeds and nuts. Examples of saturated fats are dairy fats, cocoa butter, and coconut oil. Examples of trans fats are Crisco, fast foods, certain crackers, and some processed foods.1-5

When thinking of fat, it is important to eat fat that is naturally occurring. These are the types of fat that provide benefits to your child’s body. Trans fats do not have a high nutritional value and they should be eaten in moderation. In your child’s body, fat helps build the brain, creates hormones, and makes healthy skin. Fat helps your child’s body use certain fat-soluble vitamins, protects organs, and provides energy.1-5

Proteins
Proteins are made up of amino acids, which are the building blocks of life. There are 20 amino acids. 11 amino acids are made by the body and are called non-essential. 9 amino acids must come from food because the body does not make them. These are called essential amino acids. Examples of protein sources include meat, fish, eggs, quinoa, beans, nuts and seeds, and dairy. Protein helps your metabolism, supports the repair of bones, muscles, tendons, and ligaments, stabilizes blood sugar, and boosts immunity.1-5

The Importance of Iron and Calcium During Puberty

During puberty, teens undergo dramatic physical growth and development. With increased growth teen bodies need more energy, protein, vitamins, and minerals. Their bones are getting longer as they get taller, and the muscles are growing to support those big bones. Two important nutrients for teens and preteens are calcium and iron.

Calcium
Bones grow rapidly during adolescence. Children ages 9 to 15 years need calcium to build strong bones, prevent tooth decay, and fight loss of bone density later in life. Many do not get the recommended daily amount of calcium. Preteens and teens need to eat calcium-rich foods every day. Calcium-rich foods include cheese, yogurt, and milk. Dairy-free foods, such as calcium-fortified juices and cereals, beans, and dark green, leafy vegetables (like spinach, broccoli, and bok choy) are also great sources of calcium. 
 
Some foods and drinks, including sodas and caffeinated drinks, can affect the body’s ability to absorb and use calcium. If your child is on a vegetarian or vegan diet, talk with your health care provider, nutritionist, or dietician about how to make sure your child is getting the right amount of nutrients to keep your child healthy and strong. 
Iron

Iron builds up blood cells, which may be especially helpful after a bleed or injury. Iron also helps blood carry oxygen to the body's muscles. During a bleed, a small amount of iron is lost. Your child can maintain adequate iron levels by eating naturally iron-rich foods, such as liver, lean red meat, and poultry. Other sources of iron include leafy green vegetables, broccoli, dried beans, grains, and raisins.  

Combining iron-rich foods with good sources of vitamin C (such as orange juice) can help the body absorb iron. Certain foods can also block iron absorption. These foods include coffee, tea, egg yolks, milk, fiber, and soy protein. It is best to avoid eating these and iron-rich foods at the same time.  

Women, girls, and those with the potential to menstruate need more iron because people who menstruate lose iron with each menstrual period. People who have heavy periods are at risk of losing too much iron and developing iron-deficiency anemia. Heavy menstrual bleeding (called menorrhagia) is the most common cause of anemia in people who menstruate. 

Here are some common signs of anemia: 

  • Tiredness 

  • Weakness 

  • Tingling and numbness in fingers or toes 

  • Sensitivity to cold 

Talk to your Hemophilia Treatment Center (HTC) or health care provider about ways to fight iron loss and include iron-rich foods or supplements in your child’s diet. 

If you want more information about vitamins and minerals, please go to Vitamins and Minerals. 

Ways to Encourage Healthy Eating

For 9–15-year-old kids with busy schedules, eating is often on the run. Frequently, this means eating at fast-food restaurants and grabbing vending machine snacks. Eating also becomes more of a social activity as preteens and teens eat away from the family or home, such as at a friend’s house or a restaurant. The result can be poor food choices. This may lead to eating the wrong type of fats, sugar, or not eating enough nutritious food. It is important to encourage your child or teen to make healthy food choices when you are not around.4

Tips for Healthy Eating

  • The quality of the food you choose is important. When shopping, look at the ingredients of items like peanut butter, cereal, and crackers. Usually, the fewer ingredients the better. 

  • Everything in moderation. Unless you are allergic or have dietary restrictions there is no such thing as ‘bad’ food. You can eat a lot of foods like fruits and vegetables. Other foods like cookies should be eaten in moderation. 

  • Eat a variety of foods. The more colorful the plate, the better! 

  • Eat protein, fats, and carbs at every meal to stabilize blood sugar and allow for good digestion. 

  • Listen to your body. What foods make you feel good? Are there foods that do not make you feel good? Which ones? Even if they are considered ‘healthy,’ think about what works for your body. 

  • Think about how you choose and cook your food. If possible, choose baked, broiled, or grilled meats, poultry, and fish over fried ones. 

  • Giving kids a ‘choice’ between two healthy options can help them feel like they have a voice while also giving kids important nutrients. 

  • Food preferences are developed early in life. You can influence your child's food choices by offering a variety of nutritious foods. This is the best way to give the body the energy, protein, vitamins, and fiber needed for good health. 

  • Remember, before taking any vitamins or supplements, talk with your Hemophilia Treatment Center (HTC) or health care provider. 

Resources

Below you will find a list of resources to help you and your family to plan healthy meals and provide you with additional information.

References
  1.     Carreiro, A. L., Dhillon, J., Gordon, S., Higgins, K. A., Jacobs, A. G., McArthur, B. M., … Mattes, R. D. (2016). The macronutrients, appetite, and energy intake. Annual Review of Nutrition, 36, 73–103. doi:10.1146/annurev-nutr-121415-112624  
  2.    Chen, Y., Michalak, M., & Agellon, L. B. (2018). Importance of nutrients and nutrient metabolism on human health. The Yale Journal of Biology and Medicine, 91(2), 95–103. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/29955217  
  3.     Morris AL, Mohiuddin SS. (2022). Biochemistry, Nutrients. StatPearls [Internet].  Treasure Island (FL): StatPearls Publishing. Retrieved from:  https://www.ncbi.nlm.nih.gov/books/NBK554545/  
  4.    Sears, W., M.D., Sears, M., R.N., Sears, J., M.D., & Sears, R., M.D. (2006). The healthiest kid in the neighborhood: Ten ways to get your family on the right nutritional track. New York, NY: Little, Brown Spark.  
  5.    Venn, B. J. (2020a). Macronutrients and human health for the 21st century. Nutrients, 12(8), 2363. doi:10.3390/nu12082363