Vitamins for children (vitamin D, C, A)

Growing children sometimes don’t get enough vitamins A and C and it is difficult to get enough vitamin D through food alone.

The Department of Health recommends that all children aged six months to five years are given vitamin supplements containing vitamins A, C and D every day.

It’s also recommended that babies who are being breastfed are given a daily vitamin D supplement from birth.

Babies who are having more than 500ml (about a pint) of infant formula a day shouldn’t be given vitamin supplements because formula is fortified with certain nutrients and no other supplementation is required.

Vitamin D

Vitamin D is an essential nutrient that contributes to health, strong bones and has effects on many body organs.

Vitamin D is fat-soluble and is stored in fat tissue.  Vitamin D is made by the human skin but only in temperate climates in April to September – not enough UVB light.

Low levels of vitamin D is associated with a range of diseases including osteoporosis, cardiovascular disease, multiple sclerosis and mental health issues.

Although most of this evidence has been demonstrated in adults, these guidelines will focus on Vitamin D and role in bone health in school age children.

Vitamin D deficiency impairs the absorption of calcium and can lead to poor mineralisation of the bones.

Vitamin D occurs naturally in a few foods

• oily fish
• eggs
• added to some foods, such as margarines and cereals; and in some countries places also added to milk and other foods, especially in countries near the north pole.
• made in skin when exposed to sun – usually 10 minutes enough, avoid skin reddening, burning; useful advice about safe exposure to sun keep your child’s skin safe in the sun more about vitamin D and sunlight.

Note that doses are confusing as they are expressed as International Units (IU) or as micrograms of vitamin D – where 10 micrograms of vitamin D = 400 International Units.

Standard treatment dose for vitamin D deficiency with symptoms: –

• Up to age 12: 6000 units daily for between 4-8 weeks
• 12-18 years: 10,000 units daily for between 4-8 weeks

The Department of Health recommends that:

• Babies from birth to one year of age who are being breastfed need given a daily supplement containing 8.5 to 10mcg of vitamin D to make sure they get enough
• Babies fed infant formula need vitamin D supplement until they are having less than 500ml (about a pint) of infant formula a day, because infant formula is fortified with vitamin D
• Children aged 1 to 4 years old need daily supplement containing 10mcg of vitamin
• Exclusive breastfeeding until around six months will help you protect your baby from illness and infection. Babies who aren’t breastfed are more likely to get diarrhoea and vomiting and respiratory infections.
• For mothers, breastfeeding decreases the risk of breast cancer and it may also offer some protection against ovarian cancer.
• Breast milk should continue be given together with a varied diet once your baby is introduced to solid food Vitamin supplements containing vitamins A and C are recommended for infants aged six months to five years old, unless they are getting more than 500ml (about a pint) of infant formula a day.

Different forms of Vitamin D

There are two types of Vitamin D: Ergocalciferol (Vitamin D2) and Colecalciferol (Vitamin D3). For daily treatment, both D2 and D3 are equally effective (consensus statement 4). Vitamin D2 is a plant product and Vitamin D3 is obtained from fish or mammals.  Nevertheless many sources of Vitamin D3 are acceptable to vegetarians and those adhering to a Halal or Kosher diet as the main commercial source is lanolin. Lanolin is the oil of sheep’s wool and most religious authorities do not class it as a meat product.

Whether taken by mouth or made in the skin under the action of Ultraviolet light, Vitamin D is converted to 25(OH)Vitamin D in the liver. This is then converted in the kidney and other body tissues to 1,25-(OH)2VitaminD, which is also known as Calcitriol and is the form with metabolic effects.

Blood tests & x-rays

Blood levels of Vitamin D do not need measuring routinely.  It is advised that only children requiring blood levels are those with rare disorders such as rickets or unexplained symptoms including seizures and cardiomyopathy in infants, and poor growth in children and muscle weakness at any age.  If clinically indicated other test may be needed for calcium, parathyroid hormones, kidney, liver functions

X-rays are done to assess presence of skeletal changes with vitamin D deficiency

Where can you get baby vitamin drops?

Your health visitor can give you advice on vitamin drops and tell you where to get them. You’re entitled to free vitamin drops if you qualify for Healthy Start.

Some supplements are available over the counter in pharmacies contain other vitamins or ingredients.  Talk to your pharmacist about which supplement would be most suitable for your child.

Having too much of some vitamins can harm.  Keep to the recommended dose stated on the label, and be careful not to give your child two supplements at the same time, eg, do not give them cod liver oil and vitamin drops, as cod liver oil also has vitamins A and D. One supplement on is strong enough.

Treatment of relatives

If a patient is diagnosed with Vitamin D deficiency the family need to be screened or treated.  As a minimum, screening should take place by taking a history, and prevention advice given.

Investigation of other family members by blood testing is seldom indicated.

Overdose of Vitamin D

Adverse effects of Vitamin D overdose are rare but care required with multivitamin preparations as Vitamin A toxicity is a concern. Multivitamin preparations often contain a surprisingly low dose of Vitamin D.

Reference 

1. SACN Vitamin D and Health report
2. Scientific Opinion on the Tolerable Upper Intake Level of vitamin D
3. Vitamin D and Bone Health
4. British Paediatric and Adolescent Bone Group’s position statement on vitamin D deficiency
5. Global Consensus Recommendations on Prevention and Management of Nutritional Rickets

Vitamin A

Vitamin A is important for babies and young children.  It strengthens their immune system, can help their vision in dim light, and maintains healthy skin.

Good sources of vitamin A include:

• dairy products
• fortified fat spreads
• carrots, sweet potatoes, swede and mangoes
• dark green vegetables, such as spinach, cabbage and broccoli

Vitamin C

Vitamin C is important for your child’s general health and their immune system. It can also help their body absorb iron.

Good sources of vitamin C include:

• oranges
• kiwi fruit
• strawberries
• broccoli
• tomatoes
• peppers