Boy, have times changed! When I think back to my early days as a pediatric dietitian – over 30 years ago – we focused on making sure kids got enough calories for proper growth, and the prevention of malnutrition.

Compared to 30 years ago, we know more now about the importance of nutrition in the first 1,000 days when the foundational blueprint of future health is laid. We also know much more about brain development, promoting healthy food preferences, nutrient needs and more.

Yet, we still have a lot to learn.

If you read this blog, you know I believe there’s a lot that goes into raising a healthy child, including food, feeding, and child development.

In this 2-part series, I want to take a deeper dive into the food and nutrient aspect.

A [Long] Look Back at Nutrient Recommendations

When my babies were born, I took my prenatal vitamin because my doctor told me to do so – I didn’t understand the intricate details of each nutrient and how they related to the health of my child. Yes, I thought about folate. And, since I was iron deficient throughout my whole first pregnancy, I constantly thought about iron during every subsequent pregnancy. But, there were also nutrients I wasn’t thinking about, like vitamin D and DHA.

I’ve spent some time on this blog discussing the importance of iron, DHA, healthy fats and other nutrients.

But, I haven’t shined the spotlight on choline yet.

Until today…

I’ve been learning more about choline, particularly its role in pregnancy and early nutrition, its influence on brain development and cognition throughout life, and what I might need to understand better to help parents like you.

All About Choline

Choline is an essential nutrient, which means it must be obtained from the diet. Although we produce a small amount of choline in our liver, we don’t make enough to meet our nutritional requirements.

Here are some other fun facts about choline:

• It provides special elements called methyl groups to make elements like phospholipids, which allow the cells in our body to maintain their shape.
• It helps make the neurotransmitter acetylcholine. Acetylcholine passes along signals from one part of the brain to another and is important for memory, mood, muscle control, and other brain and nervous system functions. 
• It is linked to brain development in the fetus and infant, promoting healthy brain growth, and offering protection against spinal cord defects. 
• It helps the brain process and store memories, which is important for learning and retaining knowledge.

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Choline During Pregnancy

During pregnancy, studies suggest higher intakes of choline are associated with a lower risk of spinal cord defects like spina bifida. In contrast, a deficiency of choline has been shown to prevent the development of the hippocampus, the area of the brain responsible for memory.

The hippocampus is also part of the limbic system, which regulates emotions. Supplementation of choline has been shown to stimulate development of the hippocampus.

Furthermore, consumption of choline during pregnancy has been found to have long-term positive effects on comprehension during childhood. For instance, data from Project Viva, a Harvard-based long-term study of women and children, showed that pregnant mothers who consumed choline within the Adequate Intake (AI) range during pregnancy had children with better memory function at seven years of age compared to children of mothers whose consumption was approximately half the AI.

According to a recent follow up NHANES analysis conducted by Dr. Taylor Wallace and Dr. Vic Fulgoni, less than 9% of pregnant women consume the recommended amount of choline (550 mg per day) in their diet.

Even if moms are taking their prenatal vitamin on a regular basis, they still might not be getting enough choline, as most prenatals only contain 10-55 mg choline (10% of the Recommended Daily Intake [RDI]).

In fact, the American Medical Association (AMA) recommends evidence-based amounts of choline be included in all prenatal vitamins given its role in promoting cognitive development and preventing neural tube defects among newborns. 

Choline for Babies and Toddlers

While choline is certainly important during pregnancy, it remains so in early infancy and beyond. Whether you nurse your baby or use an infant formula, choline should remain a priority nutrient for the continued development of your baby’s brain and its optimal function.

Breastmilk is a great source of choline, coming in at 160 mg/ liter of breastmilk, according to a 2012 study in Advances in Nutrition. Good news! Choline is prioritized in breastmilk for your baby. Bad news: your choline status may be compromised if your diet isn’t adequate in choline.

Most infant formulas contain choline. If your baby drinks infant formula, you can check the label to see the choline content. The amount your baby receives will depend upon the volume of formula he is drinking, as the nutrient quantity is expressed as an amount per liter or per 100 milliliters.

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How Much Choline Do Children Need?

In 1998, an Adequate Intake (AI) and a tolerable upper intake level (UL) of choline was established. The AI for infants reflects the observed intake from breastmilk; the upper limit was established from the lowest intake causing an adverse reaction (low blood pressure in an adult male).

Below are the current recommendations for choline intake in children, and their tolerable upper level of consumption, where established.

Age	Adequate Intake (mg/d)	Upper Level (mg/d)
0-6 months	125	Not established
7-12 months	150	Not established
1-3 years	200	1,000
4-8 years	250	1,000
9-13 years	375	2,000
14-18 years, boys	550	3,000
14-18 years, girls	400	3,000

About 90% of the U.S. population does not consume enough choline, according to a 2017 study published in Nutrients. As mentioned above, only about one out of ten pregnant women meet the Adequate Intake (AI) for choline. The only group meeting the AI level are young children aged 2 to 8 years. From age nine and on, consumption of choline falls behind AI.

How to Meet a Child’s Choline Requirements

In part 2 of this series, I will be digging into how you can meet your child’s choline requirements (and by default, yours) using food sources, including strategies for incorporating them into your child’s diet. If you have a child who won’t or who is unable to consume enough choline from food, I’ll have suggestions for what to do instead.

We are always learning new things about the power and promise behind food and nutrients.

Did you know about choline?

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Thanks to Balchem, a nutrition ingredient supplier who sponsored this 2-part series. As always, opinions are my own.