Trip Answers

Question answered:17/06/08

In answering this question, we have assumed the children were of normal weight at birth and thus have excluded studies examining the effectiveness of vitamin supplementation in low birth weight infants.

 

We searched the NLH Specialist Library for Child Health and the TRIP and Medline databases but found little guidance on vitamin supplementation for very young children.

 

A consensus statement issued by the Medical Journal of Australian makes recommends on the prevention and treatment of infant and childhood vitamin D deficiency. In summary, it advises:

 

“Vitamin D deficiency has re-emerged as a significant paediatric health issue, with complications including hypocalcaemic seizures, rickets, limb pain and fracture. A major risk factor for infants is maternal vitamin D deficiency. For older infants and children, risk factors include dark skin colour, cultural practices, prolonged breastfeeding, restricted sun exposure and certain medical conditions. To prevent vitamin D deficiency in infants, pregnant women, especially those who are dark-skinned or veiled, should be screened and treated for vitamin D deficiency, and breastfed infants of dark-skinned or veiled women should be supplemented with vitamin D for the first 12 months of life. Regular sunlight exposure can prevent vitamin D deficiency, but the safe exposure time for children is unknown. To prevent vitamin D deficiency, at-risk children should receive 400 IU vitamin D daily; if compliance is poor, an annual dose of 150,000 IU may be considered…” [1]

 

The Food Standards Agency makes recommendations on the use of vitamin and iron drops in children and states:

 

“All children between six months and five years old could benefit from taking drops containing vitamins A, C and D. These will help to make sure that they get these important vitamins, particularly if they aren't eating a varied diet.

 

Vitamin drops are free for children under five years from families receiving Income Support or an income-based Job Seekers Allowance. They can also be bought cheaply from child health clinics.
Children who have a good appetite and eat a wide variety of foods, including fruit and veg, might not need vitamin drops.
As well as eating a healthy balanced diet, children also need sunlight to help them get enough vitamin D. (Remember to be careful not to let their skin burn.)
So, if a child doesn't spend much time outdoors, doesn't eat meat or oily fish, or if their skin doesn't get exposed to daylight because they always wear clothes that cover almost all of their skin when they are outdoors, you should give them drops to make sure they get enough vitamin D. If children don't get enough vitamin D, this can cause rickets, which can lead to permanent misshaping of their bones.

 

Iron is also essential for your children's health. But if they are eating some meat or fish every day, then they are probably getting enough iron and so they won't need iron drops or tablets. If your child doesn't eat any meat or fish, make sure they eat plenty of other foods that are rich in iron, such as:
• fortified breakfast cereals
• dark green vegetables
• bread
• beans and lentils
• tofu
• dried apricots, figs and prunes

 

It's also a good idea to give your child some food or drink that is high in vitamin C (such as fruit or fruit juice) at the same time as foods containing iron, because vitamin C helps our bodies absorb iron.
Talk to your health visitor or GP if you are concerned about your child's diet.” [2]

 

You may also be interested in an answer to a question we posted on vitamin D supplementation in dark children last year:

 

NLH Primary Care Q & A Service. Should all dark skinned children be started on Vitamin D supplementation indefinitely? August 2007. (http://www.clinicalanswers.nhs.uk/index.cfm?question=5832)

 

NHS Direct states:

 

“Children between the age of 6 months and 5 years may need vitamins A, C and D. Supplements may not be needed if your child is a good eater and has a varied diet. Ask your health visitor or GP for further advice.” [3]

 

A CKS patient information leaflet on introducing solid food refers to vitamin supplementation in young children:

 

“For the first 6 months, breast milk (and/or substitute milk) provides all the nutrients and fluids that your baby requires. The World Health Organisation (WHO) recommends that solid food should not be introduced before 6 months of age. Also, that after 6 months, you should continue breastfeeding and/or giving breast milk substitutes alongside solid food up to 2 years of age or beyond…

 

…Meat, fish, dairy products and pulses are all excellent sources of iron and protein, which are important to sustain the rapid rates of growth and development in a baby. Liquid drops containing vitamins A, C and D are recommended for infants over 6 months who are receiving breast milk as their main drink. They are available from your health visitor or baby clinic. Formula milk is fortified with these vitamins, so infants drinking formula do not require the supplement, unless they were born prematurely.” [4]

References
1. Munns C, Zacharin MR, Rodda CP et al. Prevention and treatment of infant and childhood vitamin D deficiency in Australia and New Zealand: a consensus statement. Med J Aust. 2006 Sep 4;185(5):268-72. (http://www.hubmed.org/display.cgi?uids=16948623)
2. Food Standards Agency. Children and babies. Does a one-year-old child need vitamin or iron drops? (http://www.eatwell.gov.uk/asksam/agesandstages/childrenandbabies)
3. NHS Direct. Do I need vitamin supplements? December 2005. (http://www.nhsdirect.nhs.uk/articles/article.aspx?ArticleId=1122).
4. CKS. When do I introduce solids? (http://www.cks.library.nhs.uk/information_for_patients/common_health_questions/question/when_do_i_introduce_solids)

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