Issue 127 vitamin and mineral supplements are they needed for children

PUBLIC HEALTH

VITAMIN AND MINERAL SUPPLEMENTS: ARE THEY NEEDED FOR CHILDREN? Priya Tew Freelance Dietitian and Specialist in Eating Disorders

Priya runs Dietitian UK, a freelance dietetic service that specialises in social media and media work, consultancy for food companies, eating disorder support, IBS and Chronic Fatigue. She works with NHS services, The Priory Hospital group and private clinics as well as providing Skype support to clients nationwide.

For full article references please email info@ networkhealth group.co.uk

Supplements are increasingly popular with adults and now in my practice I am seeing this trend in children too. So the question is, how much should we be promoting a food first approach and is there a need for supplements in children? Are parents aware of the potential need for supplements for children? Is there a tendency to rely on supplements to top up nutritionally rather than using a food first approach?

Ideally, of course, we would want all children to be achieving a balanced intake of nutrients from the food they eat: plenty of colourful fruit and vegetables, a spectrum of protein foods, a mix of grains and wholegrain carbohydrates, plus healthy fats and full fat dairy. The reality is that many families struggle to cook nutritious dinners and rely on quick convenience foods. This could be due to lack of time, lack of cooking skills, or general ease. Cooking for several children who all have different likes and dislikes, whilst they all also need your attention, can put a lot of pressure on parents.

Whilst some convenience foods can be absolutely fine to eat on a regular basis, many are often beige foods lacking in the range of nutrients the body needs. On top of this, children go through fussier stages where they can refuse to eat vegetables and limit themselves to a smaller range of bland foods, making it harder to achieve a balanced intake.1 This is a great area in which we, as dietitians, can give simple tips, healthy meal ideas and encourage variety in family meals. Reminding parents that just because a child says they don’t like a food on one day does not mean that they do not like it all of the time! From personal experience, I routinely have a child who refuses to eat a certain vegetable, but this changes throughout the year.

Offering foods in different forms and being inventive can be tiring for the meal preparer, but it also helps.

So, it would seem that although children can meet all their nutritional

needs through diet, there can be a role for supplements. A multivitamin/mineral with vitamin D in it, is a good option, rather than taking individual preparations of nutrients. Dietitians and nutritional professionals have the opportunity to educate parents and caregivers on the importance of a balanced diet, but also on how a supplement can be useful as a top up.

WHAT ARE THE RECOMMENDATIONS?

Vitamin D It is currently recommended that babies being breastfed are given a daily vitamin D supplement from birth, but, for some reason, this information does not seem to be filtering down. Having had three babies recently, I was not made aware of it in hospital, or by my midwife/health visitor, so I think that this is an area where we can improve on the health messages.

New mums are frantically adapting to having a baby to look after, so preparing them as much as possible before they give birth about supplements, weaning and feeding children is key.

Due to vitamin D only being present in a few foods and it not being sensible to have children out in the hot sun for too long, it is easy to see how they could become deficient. The Department of health recommends that breastfed babies 0-1 year are given a daily 8.510mcg vitamin D supplement.2 Formula milk is already fortified with vitamin D, so no extra supplement is required.

Children aged one to four years in the UK are recommended to take a

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Table 1: The recommended supplement amounts for vitamins A, C and D4 Vitamins D C A

0-1 year breastfed baby 8.5-10mcg 40mg

1-5 years 10mcg 15mg 200mcg

Table 2: Iron requirements in children and infants Age of child/infant 0-6 months 6-12 months 1-3 years

10mcg a day vitamin D supplement. However, it may be that this figure is too low. Some recent research in Sweden found that the amount of vitamin D needed varied on skin tone. Darker skinned children needed higher intakes of up to 28mcg/day of vitamin D in order to maintain sufficient plasma levels.3 In the summer months, if your child is outside without sunscreen for some of the day, they may be able to make all their vitamin D and not need a supplement. However, this can be hard to regulate and as vitamin D is not stored in the body, it is easier for most people to take a supplement all year round. There are of course foods that contain vitamin D (wild oily fish, free range meat, fortified breakfast cereals, egg yolks, some mushrooms, fortified margarine), but in reality, in the UK, it is not easy to achieve your vitamin D intake from these foods and sunlight.

Vitamins A and C From six months it is recommended that all babies take vitamins A and C as well. For breastfed babies that also means they need to continue with the vitamin D too. Then these same recommendations continue until the child is around five years of age.2 From this point, there are no set recommendations, but your child should be able to meet their micronutrient needs from a well-balanced diet.

Formula-fed babies do not need the vitamin drops until they are taking less than 500mls of formula milk a day. At this point (potentially at six months when weaning starts), it is recommended to take vitamin A, C and D. Good food sources of vitamin A include dairy foods, fortified margarines, carrots, sweet potatoes, swede, mangoes and dark green

Iron requirements 0.27mg/day 11mg/day 7mg/day

vegetables, so a focus on these foods will also help. Supplements should provide at least 200mcg/day (see Table 1).

Iron Iron stores are depleted from around six months of age. Due to the rapid growth that occurs, their risk of iron deficiency increases from six to 12 months. It remains a high risk from 12 to 24 months due to the toddler tending to eat less iron at this stage. It can be a fussier eating stage and toddlers start to exert taste preferences and opinions over what they eat. Iron deficiency at this stage can have an irreversible impact on cognitive and psychomotor development.5 Although iron is known to be a mineral that young children may be deficient in, they should be able to meet their needs through diet. There is also a risk of death by poisoning in this age group.6 So, more of a focus needs to be made on iron rich foods rather than taking large amounts of supplements. A caution with vitamin and mineral supplements in general needs to be taken, as they are attractive and often tasty to children. Keeping them out of reach so that overdosing doesn’t occur is important; this message is a good one to pass onto parents.

TYPES OF VITAMINS AVAILABLE

The health visitor may be able to direct mums to free Healthy Start vitamins. These are often available through Sure Start centres if mums are in receipt of benefits. The same healthy start vitamins can also be bought at some pharmacies, supermarkets and at Superdrug.

Other alternatives include Abidec and Dalivit.

Pharmacies may also sell their own brands; it is a good idea to check the dosage of these. www.NHDmag.com August/September 2017 - Issue 127

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