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folate deficiency
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It’s National Folic Acid Awareness Week and we are going to look at the impacts of a folate deficiency in children.  Folate is also known by many as Folic acid. You heard about this nutrient a lot during your pregnancy.  “Increase folic acid intake through your prenatal vitamins to prevent birth defects.”  The importance of folic acid in the diet extends beyond pregnancy and impacts much more than preventing birth defects.

Folate helps in the production of DNA. DNA is responsible to the creation and functioning of all cells. The human body makes new cells every day and each of those cells need DNA. “Did you know that your body replaces cells in your small intestine about every 5 days? That’s about 17 billion (17,000,000,000) new cells your body makes every few days!” (1)

Folate and Play

Folate is also needed to create new red blood cells every day. Red blood cells carry oxygen throughout the body and are extremely important in providing children with the energy needed to play, run, ride bikes and play sports.  Playing and running helps to develop children’s gross motor skills.

Folate and Intellect, Executive Function and Motor Skills

An interesting publication in the Journal of the American Medical Association discussed research that “followed a cohort of 676 children born in 2000 and 2001, assessing various aspects of their intellectual, motor, and executive functioning.” The findings revealed, “The differences in intellectual and executive function tasks suggest that iron/folic acid, when provided during critical periods of development, may make an important difference in children’s ability to learn tasks that are related to their academic achievement.” (2)

Folate and Language Development

In another study published by the Journal of the American Medical Association, researchers followed over 38,000 children in Norway. The results of this study showed “severe language delay in 0.9% of children whose mothers took no dietary supplementation around the time of conception”. (3) A similar result was seen for children of mothers who took supplementation that did not contain folate.

Physical Signs of a Folate Deficiency

Physical presentation of a folate deficiency may reveal:

  • Darkening of the skin and mucous membranes.
  • Hyperpigmentation of the backs of fingers, toes, and creases of palms and soles.
  • Temperature elevation up to 102 degrees is common in the absence of infection.

To get to the bottom of a folate deficiency in children, physicians will look at potential issues with malabsorption, hemolytic anemia or medication usage.  Gastrointestinal symptoms such as nausea, vomiting, abdominal pain and diarrhea may be present too. Cognitive impairment and depression are neurological presentations of folate deficiency.

Causes of a Folate Deficiency

Poor Nutrition

In a nut shell, the child may not be consuming enough foods that are folate rich.  Another potential cause is anorexia or the restriction of foods that are rich in protein, potassium and phosphate.  A deficit of these nutrients in your child’s diet contributes to decreased folate intake.  Children with sensory isms tend to be extremely picky eaters and only consume a limited number of preferred foods, a risk of inadequate consumption.

Zinc deficiency also decreases folate absorption because zinc is required to activate mucosal conjugase.

Impaired Absorption

Absorption of folate occurs in the small intestine. If there are gastrointestinal issues such as Crohn’s or Celiac Disease, this will decrease the absorption of folate.  Bacterial overgrowth within the small intestine would also decrease folate absorption. If your child is experiencing gastrointestinal symptoms, it may be time to get your child evaluated by a physician.

Drug Interactions

Anti-convulsant drugs, such as Dilantin, will impair folate absorption.

Trimethoprim, used to treat urinary tract and ear infections, is a folate synthesis inhibitor.  In essence, it is an anti-metabolite.

Impaired Metabolism

When metabolism is impaired, it could lead to an inability to utilize any folate that was absorbed by the small intestine.


Hypothyroidism is noted to also be involved with the enzymes of folate metabolism.

Increased Requirement

Infancy is a period of rapid growth where you will see an increase in the metabolic rate thus increasing the folate requirement.  Infection is another time when there is an increased requirement.  Chronic hemolytic anemia is another cause of an increased requirement of folate.

Increased Excretion

If there is a vitamin B-12 deficiency, there will also be an increased excretion of folate in the urine.

Ensure Adequate Folate Intake

Before heading to the local drug store to get supplements for your child, consider all the foods that contain the natural form of Folate.  Folate rich foods include:

Leafy Greens

Dark green leafy vegetables like spinach and broccoli are rich in folate.  Children are known to dislike their vegetables.  Get creative and sneaky if you have to.  Explore some ideas to spur on your creativity >>

12 Kid Friendly Leafy Green Recipes

9 Sneaky Ways to Get Your Kids to Eat More Leafy Greens


Strawberries – Explore 6 strawberry recipes for kids

Orange Juice is rich in folate.  Go straight to the orange itself by using an orange sipper. The orange sipper is a great little tool that is stuck into an orange and then the child sucks the juice out of the orange.  Added bonus, this little gadget provides great ‘heavy work’ for lip and cheek muscles. (4)

The Magical Fruit

Beans, beans, the musical fruit, contains folate.  Consider navy, pinto and kidney beans.

Explore Eat Your Beans: Delicious Kid Friendly Recipes

Enriched Foods

Enriched grains like bread, pasta and rice contain folate.  Be sure to read the nutrition labels and compare which enriched grains offer the most bang for the buck.

Cereals containing 100% of the Daily Value of Folic Acid

Recommended Daily Allowances for Children

  • 1 to 3 years: 150 mcg/day
  • 4 to 8 years: 200 mcg/day
  • 9 to 13 years: 300 mcg/day

If you have concerns about your child not getting enough folate in his or her diet, discuss your concerns with your child’s pediatrician.  A deficiency can be assessed with a simple blood test.   If you have a picky eater and want to create change, learn from the experts in pediatric feeding.  If you have been in this situation and you have suggestions for other parents, please share your tips over on our Facebook page.



1) “Children and Teenagers.” Florida Folic Acid Coalition. N.p., n.d. Web. 02 Jan. 2017.

2) Christian P, Murray-Kolb LE, Khatry SK, Katz J, Schaefer BA, Cole PM, LeClerq SC, Tielsch JM. Prenatal Micronutrient Supplementation and Intellectual and Motor Function in Early School-aged Children in Nepal. JAMA. 2010;304(24):2716-2723. doi:10.1001/jama.2010.1861

3) Daniells, Stephen. “Folic Acid May Improve Kids’ Language Skills.” N.p., 11 Oct. 2011. Web. 12 Jan. 2017.

(4) Hacker, Bonnie, MHS, OTR/L. “8 Fun Oral Sensory Activities to Improve Your Child’s Regulation.” Special-ism. N.p., n.d. Web. 12 Jan. 2017.