Do I need to give my child multivitamins? What about vitamin D?

In general, multivitamin supplements are not necessary for healthy children with balanced diets who are growing normally. Foods are the best source of nutrients and regular, balanced meals and snacks provide all the nutrients most children need.  A healthy, balanced diet means eating five portions of fruit and vegetables each day. Your child should also have some lean meat or fish, or pulses and beans, every day. A portion is roughly the size of your child’s fist. While many young children are picky eaters, that doesn’t necessarily mean that they have nutritional deficiencies. Many common foods — including breakfast cereals, milk and orange juice — are fortified with important vitamins, calcium and iron. So your child may be getting more vitamins and minerals than you think. Parents in Thailand should check carefully to see if the brands they buy have been fortified or not. Furthermore, keep in mind that taking multivitamins, particularly fat-soluble vitamins in high doses, aren’t without risks.

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One important exception to this is Vitamin D. Many recent studies in the US and other countries suggest that many children are not getting the Recommended Daily Allowance (RDA) of Vitamin D. The RDA is the average daily dietary intake level of a nutrient sufficient to meet the requirements of almost all (97.5%) healthy individuals in a specific life stage. This may be because Vitamin D is naturally present in very few foods (mainly fish, eggs, beef liver). The body also produces Vitamin D when ultraviolet rays from sunlight strike the skin and trigger vitamin D synthesis. Vitamin D obtained from sun exposure, food, and supplements is not biologically active and must undergo two chemical reactions, first in the liver and then in the kidneys, before it becomes a form usable by the body. Vitamin D promotes calcium absorption in the gut and maintains adequate serum calcium and phosphate concentrations to enable normal mineralization of bone and to prevent. It is also needed for bone growth and bone remodeling. Without sufficient vitamin D, bones can become thin, brittle, or misshapen. This is called rickets in children and osteoporosis in adults. Vitamin D is also very important for cell growth, neuromuscular and immune function, and reduction of inflammation.

 

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The American Academy of Pediatrics (AAP) and the US Institute of Medicine recommend a daily intake of 400 IU per day of vitamin D during the first year of life beginning in the first few days, and 600 IU for everyone over age 1. To make sure that happens, the AAP recommends that exclusively and partially breastfed infants receive supplements of 400 IU/day of vitamin D and continue to receive these supplements until they are weaned and consume at least 1 liter of vitamin D-fortified formula or whole milk. Similarly, all non-breastfed infants ingesting less than 1 liter per day of vitamin D-fortified formula or milk should receive a vitamin D supplement of 400 IU/day.  AAP also recommends that older children and adolescents who do not obtain 400 IU/day through vitamin D-fortified milk and foods should take a 400 IU vitamin D supplement daily.  It is important for parents in Thailand to double check to make sure the milk they buy has been fortified with Vitamin D as some major diaries do not do this. For more information visit: http://www.aap.org/en-us/about-the-aap/aap-press-room/pages/Kids-and-Vitamin-D-Deficiency.aspx#sthash.pWbM49Ry.dpuf

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Make an appointment with me if you’re concerned about whether your child is getting the recommended level of vitamins and minerals. A multivitamin, that will include Vitamin D, might be helpful for your child if he or she is not gaining weight as expected, has certain chronic diseases or food allergies, is on a strict vegan diet, or is a picky eater with a very restricted diet. When a supplement is necessary, it will be one that is designed for your child’s age group and doesn’t provide more than 100 percent of the RDA of vitamins and minerals. In addition, it is important to keep multivitamins out of your child’s reach and make it clear that they are not candy. Vitamins should never be used as a reward for good behavior. Finally, try to make sure your child spends at least 20 minutes per day playing outside, as this will help her body produce Vitamin D.

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