There’s a decent amount of confusion when it comes to the decision to give our children vitamins and supplements. Store shelves (real or virtual) are filled with tinctures and gummies marketed towards children. And you’ve likely heard that, in general, pediatricians don’t recommend vitamins for children who eat a “normal” diet. There are exceptions to every rule (see below, especially as it pertains to vitamin D) but the bottom line is that supplemental multi-vitamins are not an essential part of a child’s diet. If your child eats a rainbow of foods, it’s unlikely they need pile of additional minerals and vitamins in pill form.
This month, the AAP published a clinical report representing the committee on nutrition, urging pediatricians and parents to work together to improve rates of iron deficiency in this country. The reason: iron deficiency is one of the more common problems among children but it frequently goes undetected. We can’t see it, smell it, or detect it easily on exam or with one simple blood study. Oddly enough, it’s complicated to determine an infant/child’s iron status.
New research finds that deficiency of iron, particularly at young ages (0-3 years)–when the brain is forming and growing rapidly–may have irreversible effects on cognitive and behavioral development. Although the majority of infants and children are not deficient in iron, between 5% to 15% of toddlers are deficient. There are no great studies (believe it or not) telling us exactly what percent of infants are truly deficient.
Don’t go nuts about this and don’t let this scare you. You only need to make changes now, not look back and worry. First of all, let me put this in perspective: iron deficiency used to be a bigger problem than it is now. Prior to the 1970’s (when iron was added to infant formula) rates of deficiency were around 30-40% of babies. Breast-fed infants are at higher risk (versus formula fed babes) of being iron deficient if there is delay in introducing solid foods. So when the pediatrician has mentioned waiting until 6 months for solids, we neglected to prioritize iron.
We care about iron deficiency because it can cause two major problems:
- Iron deficiency anemia (small, pale red blood cells)
- Slowed or depressed cognitive and behavioral development. The first 3 years of life are critical for brain development and there is new research that iron status, starting in infancy, is essential for later cognitive performance. Think of “cognitive performance” as seeing well, reasoning, remembering, and interacting with others. So this stuff matters.
My biggest hesitation when I read the report the first time was that we were sending yet another message to breast-feeding moms that their milk wasn’t enough (ie your baby may need a supplement of iron in addition to that vitamin D). Furthermore the recommendations are filled with testing, re-testing, and follow-up evaluations that may be confusing and scary for families. Yet after numerous conversations with other doctors who were initially skeptical, and about 4 personal reads of the report, I have come to the same conclusion as those with who I spoke: We need to protect infants from deficiency of iron and we need to do more comprehensive screening of those babies graduating into toddlerhood. So some facts and explanations: Read full post »
Every single day in clinic a parent asks me, “Do I need to give my child a multivitamin?
The short answer: No. The long answer is, of course, more complicated and evolving.
There is no research that finds young children, even the “pickiest” eaters out there, need a daily supplemental multivitamin. But there’s one sneaky little exception: Vitamin D. Over the past 5-10 years there is mounting evidence demonstrating that the majority of children in the US have low vitamin D levels. Children lack both the dietary intake of vitamin D and the exposure to UVB light from the sun they need. My blog posts explaining Vitamin D supplements in infants and children go into more detail.
All infants and children need 400 IU of Vitamin D every day but not a whole multivitamin. You can usually get 400 IU from a multivitamin (read the label), but also just as easily from an isolated vita D supplement.
So, you really may be able to bid Fred Flintstone farewell…
Vitamin D is clearly important. And like I said earlier this week, it is getting all sorts of attention. Two studies from this week have captured my attention.
I don’t think this vitamin D thing is a fad. The new (2008) recommendations for 400 International Units (IU) of daily Vitamin D in infants and children represent evolution in our understanding how we can protect and prevent illness in infants and children. It’s not that Vitamin D is more important than other vitamins, it’s just that Vitamin D is more likely to be absent in children than the others. New data this week suggests that delivering mothers (the ones with the big belly about to birth) who live in the city (are out in the great outdoors less) are more Vita D deficient that we thought. Another study finds that supplementing all infants, no matter what they eat, is essential in providing them the vitamin D they need. Vitamin D is synthesized in your body when you get some good sun (above) or from fortified foods in your diet including milk, cereal, formula or eggs and fatty fish. During the winter, getting those rays of sun is more difficult. And it’s more difficult all year long in infants who we say shouldn’t be in the sun whatsoever. So we have to ingest it. Take a look at this data and rationale for all of the D-detail.
Watch the video at the bottom of this post, too… Read full post »
F calls it our, “Seattle Vitamin.” In the upper left hand corner of the US (read: Seattle) we’re a little lacking in sunshine. It’s a product of not only our rainy weather, but our latitude on the globe. New data finds that taking supplemental vitamin D may be more important for we mamas, we city dwellers, and we little ones (infants) than we thought. Especially up here where the sunshine comes around about every fifth day.
Vitamins are so well engineered these days (gummy what?) my boys think they are a marvelous daily treat. So do I.
A study yesterday in Pediatrics finds that urban Boston moms (think Northern climate) who spent at least ½ of their pregnancy living in the city, were at far greater risk for having vitamin D deficiency than we thought. So were their babies! In this group of urban moms, up to 58% of newborns and 36% of the moms at the time of delivery were vitamin D deficient. Holy deluge of D deficiency! Say it with me…
A second study published yesterday found that we are doing a poor job getting babies the vitamin D they need. Less than 1/10 of all breast fed babies and less than 1/3 of formula fed babies are getting the vitamin D pediatricians recommend. Something has to change. Read full post »