The American Academy of Pediatrics (AAP) is warning against the promotion of restrictive diets for children and adolescents with or at risk of diabetes. In addition to warning against other trends, the AAP urges caution toward pediatric use of the “low-carb” diet, which, in some cases, can severely limit a person’s intake of carbohydrates.

American Academy of Pediatrics. American Academy of Pediatrics Issues Policy on Low-Carbohydrate Diets for Children and Adolescents With or At Risk of Diabetes. September 18, 2023.

Some people use low-carb diets to lose weight or lower their blood sugar levels, two goals that,if achieved, can often help with diabetes management. This type of dieting can be supportive for some people, but not everyone. 

According to the AAP, children and teens fall into that not everyone category. The academy warns that restricting carb intake to lower-than-recommended levels could spur health problems like “growth deceleration, nutritional deficiencies, poor bone health and disordered eating behaviors.”

Neither the AAP, the American Diabetes Association, nor the International Society for Pediatric and Adolescent Diabetes endorse low carb diets for children with diabetes. Instead, they direct people to the United States Department of Agriculture's dietary recommendations for carbohydrate intake, which say to consume between 45% to 65% of daily calories from carbohydrates.

How can carb management support diabetes care?

While the content of specific foods varies, carbohydrates can be high in calories and sugar. When they aren’t paired with macronutrients like fats and proteins, or fiber, they can lead to blood sugar spikes and may not be sufficient for promoting satiety,  potentially leading to overeating and increasing risks for weight gain. Depending on the rest of a person’s diet, limiting carbohydrate intake can reduce sugar intake and calories consumed, thereby supporting weight loss or blood sugar management.

Furthermore, while overly restricting carbs is not recommended for children, dietitians say that being mindful of carb intake can support diabetes care.

Melanie Murphy Richter, MS, RDN, a registered dietitian nutritionist and Founder of Wholistic Ritual, a private nutrition practice in Los Angeles, explains that carbohydrates are high in sugar, which can influence blood sugar levels and thereby affect people with diabetes. 

To offset spikes, she advises encouraging children not to eat carbohydrates alone—for instance, they should eat an apple with nut butter rather than an apple on its own—and to not eat them on an empty stomach. If eating a full or meal with multiple macronutrients, the carb portion of the plate should be eaten last, she adds.

“This will slow the glucose spike and help to keep their blood glucose levels more stable,” Richter explains.

Counting carbohydrates is also a “fundamental component of managing diabetes” for adults and children, Richter says. This can be done, she explains, by looking at nutrition facts and subtracting the amount of dietary fiber from the amount of carbohydrates in a particular food and then dividing that number by 15. (There are 15 grams of carbohydrates per serving of carbohydrates, hence the divisor of 15.)

Children with diabetes

While the AAP clearly discourages cutting carbs, it does have advice for how to monitor carb intake to support health. Some of its tips include:

• Prioritizing intake of carbohydrates from fruits, vegetables, whole grains, legumes, and dairy products.

• Limiting intake of carbohydrates from nutrient-poor processed foods and sugary beverages.

• Encouraging healthy levels of protein and fat intake. Children aged 4 to 18 years  should get between 10% and 30% of their daily calories from protein and 25% to 35% of their daily calories from polyunsaturated and monounsaturated fatty acids.

• Striving for an hour of moderate to vigorous aerobic activity per day.

In addition to individual actions taken by families and children, pediatricians can help by advocating for government programs to support healthy food availability and affordability, particularly for socioeconomically disadvantaged families, the AAP suggests. Pediatricians can also encourage eligible patients and families to participate in nutrition programs, where they exist.