The ABC’s of Vitamins
Lots of questions pediatricians get asked are easy. We all agree about vaccinations (They're essential), toothbrushing (also yes), and bike helmets (absolutely). I am going to tell you about vitamins – what they do, where they come from, and when your child may need a supplement. So, vitamins aren't such a simple topic.
Vitamins are part of your body's system of helpers. They are needed in very small amounts, but without them we get into a lot of trouble, as we shall see. While vitamins are available in pill form, it is in fact possible to get all the vitamins you need from your diet. Of course, now we're relying on children eating everything we tell them to, so maybe we shouldn't forget about those Flintstones Chewables yet.
In alphabetical order Vitamin A is first. Orange and red vegetables have plenty of Vitamin A, but leafy green vegetables are also a good source. Since this vitamin is stored in the liver, liver is an excellent source of Vitamin A. In the past children were forced to take awful-tasting cod liver oil, but the dosing of Vitamin A was never precise and in fact taking cod liver oil could actually lead to an overdose of Vitamin A. Vitamin A is one of the few supplements that can be overdosed, so it's important to keep tasty chewable vitamins out of the reach of toddlers. When taken from food, children can't overdose, but they occasionally turn orange from the carotene in carrots, squash, and sweet potatoes. That isn't dangerous, but we are sometimes fooled into thinking the child has jaundice, which is a sign of liver disease. Vitamin A supports healthy vision, and also liver, kidney, heart, and immune function.
The B vitamins include thiamine, riboflavin, niacin, B6, and B12. These are water-soluble, which means that for most people the B vitamins in the supplements they take wind up in their urine without actually doing anything very useful. That's because it is very hard today to become deficient in these vitamins. The elderly, adults on reflux medications, and people who refuse to eat any fruit or vegetables are at risk. Also alcoholics can develop brain and nervous system disorders. For kids it's easy to get enough of the B vitamins by eating whole grains, fruit, and vegetables. The one exception is Vitamin B12, a deficiency of which leads to anemia (low red blood cells). Vitamin B12 is only found in animal products. Vegans and vegetarians have to take B12 supplements. There is no other way to avoid B12 deficiency! Fish, liver, and other animal products are good sources of B12.
Vitamin C is also known as ascorbic acid. It is found in citrus fruits like oranges and grapefruit. But lots of other foods have Vitamin C including berries, potatoes, tomatoes, peppers, cabbage, Brussel sprouts, broccoli, and spinach. There is no evidence that taking extra Vitamin C will help prevent or treat a cold, but it is an enduring myth. Taking high doses of Vitamin C has been known to cause kidney stones! Unless your child won't eat any of the foods mentioned above, there is no need for supplementation. The story of Vitamin C is truly fascinating. We know now that ascorbic acid is necessary for blood vessel, muscle, and wound maintenance. British sailors, away from home for long periods, found that old wounds started to open up again. When sailors realized that they recovered on shore leave when they could get citrus fruits, all the naval vessels were stocked with limes and oranges. The sailors were nicknamed Limeys because of their diet.
Vitamin D is a vitamin that humans can manufacture merely by absorbing ultraviolet light. This is much more complicated for us than our ancestors who lived on the plains of Africa. For one thing, they didn't spend any time indoors, and they didn't wear any clothes. Also, they didn't live very long so they didn't have to worry about getting skin cancer from too much exposure to the sun's rays. Today we know that more than 20 minutes of direct sunlight a day is unnecessary. We also realize that in Connecticut for most of the year we can't get enough sun to maintain healthy levels of Vitamin D. Since Vitamin D is very important for strong bones, we do recommend a supplement for almost everyone. We also encourage sunscreen to reduce the long-term risk of skin cancer.
A last word about iron, which is not a vitamin but is required for certain vitamin functions as well as the manufacture of red blood cells. Breast-fed infants get sufficient iron because the small amount of iron in breast milk is actually absorbed better than the iron in formula. Iron in formula does not cause constipation the way that most iron supplements can. In general we prefer to give children a variety of iron-rich foods rather than a supplement. Meat, chicken, and fish contain iron, but so do beans, sweet potatoes, fortified cereals, eggs, raisins and other dried fruits, and leafy green vegetables.
Remember that food should not be a reward or a punishment. All kids go through a picky eater stage, so don't panic. Continue to offer a healthy assortment, and fall back on something your child likes if he won't eat what you made. Try yogurt, peanut butter, chicken nuggets, or chick peas. Some kids spend months eating nothing but these 4 foods. Milk is already fortified with Vitamins A and D. Add in some Cheerios, and you can get by until he suddenly decides to eat broccoli. Good luck! If you feel stuck, talk to your pediatrician.
Robert B. Golenbock, MD