FDA has issued a warning to parents about the risk of vitamin D overdose when using a liquid vitamin D supplement. It turns out that some products come with droppers that may allow an accidental overdose to infants. According to the FDA update:

…excessive amounts of vitamin D can cause nausea and vomiting, loss of appetite, excessive thirst, frequent urination, constipation, abdominal pain, muscle weakness, muscle and joint aches, confusion, and fatigue, as well as more serious consequences like kidney damage.

I think this is very a very confusing update! First of all, why does FDA allow such products with risky droppers in the marketplace? Secondly, what is excessive? Is there any standardization in dropper markings for infant vitamin D products? How can a parent tell if the dropper shipped inside the product packaging is the right dropper? What does the product labeling say about the safety and accuracy of the dropper?

So many questions are left unanswered in this update that I am surprised it was approved for publication!

Vitamin D is very important, especially for growing infants and children because it affects calcium absorption and bone growth. Now that there is so much news of vitamin D deficiency in infants and toddlers, parents are becoming ultra sensitive about it. When a warning like this comes from the FDA, it only adds to the anxiety. The FDA update does offer some recommendations, but I do not believe they offer enough guidance on safety or the level of risk.

The FDA supports the American Academy of Pediatrics recommendation of 400 IU of daily vitamin D supplementation for breastfed infants. It recommends parents to ensure that their infant does not receive more than 400 IU a day. The tolerable upper limit intake of vitamin D for infants birth through 12 months listed by the Office of Dietary Supplements of the NIH  is 1000 IU per day. That is 2.5 times more than what FDA is warning parents about. Further, adverse health effects are seen only after long term intakes above the tolerable upper limit.

What kind of a dropper is allowed to be packed inside a product which can dispense 2.5 times the recommended dose of any medication? I think that the FDA should also talk about what measures they are taking to ensure that unsafe droppers are not included in any product; not just infant vitamin D supplements. If the concern is so high, why not make sure that the maximum amount that can be dispensed from these droppers does not exceed 400 IU? Also, a list of potentially unsafe products should be made available to the public.

Parents – what do you think? If you are giving a vitamin D supplement to your infant or toddler, are you worried about this warning? What do you think the FDA should do?

Photo source: FDA’s warning update
©2010 Littlestomaks.com

According to the 2nd edition of the PDR for Nutritional Supplements -

The absorption efficiency of calcium varies throughout the life span. It is highest during infancy when it is about 60%. In prepubertal children, it is about 28%. During early puberty, at the time of the growth spurt, it increases to 34% and then drops to 25% two years later.

How you can use this information -

1. Get your kids to drink milk and eat yogurt at an early age. Dairy is the best source of calcium. Unless you have an allergy problem, this should be your first choice. Milk also has vitamin D which is necessary for calcium absorption.
2. Other sources of calcium and vitamin D – fortified orange juice, cereals, collard greens, broccoli, tofu, salmon, spinach. Offering a variety of food sources in addition to, or instead of dairy, is a good way to get calcium in your child’s growing bones early on.
3. Recommended daily value for children 1-3 years is 500 mg (about 2 cups of milk) and for children 4-8 years is 800 mg (2-3 cups of milk).
4. In addition to food sources, physical activity is also important. Both exercise and nutrition help bones to increase their strength.

Building a calcium reserve at an early age is almost like building a bank balance of good health for the rest of your child’s life.

What has worked well for you in providing adequate amount of calcium and vitamin D in your child’s diet?

©2009 Littlestomaks.com
Information provided in this post is not meant to be treated as medical advice

This is a guest post by Rima Mehta. She holds a Masters Degree in Business Management from Thunderbird University, and is a Holistic Nutrition Educator certified by the Southwest Institute of Healing Arts. In addition, she has completed an advanced training program in Wellness and Life Coaching.

Calcium for Kids

Calcium is the super nutrient that helps make strong bones and teeth. It’s most important during the growing years when bones are building. The best sources of calcium come from the cow.

Calcium is a mineral that is mostly present in your child’s bones. Having a diet with foods that are high in calcium to meet daily requirements is necessary for the development of strong bones. It is also an important way to prevent the development of osteoporosis in adults.

Recommended daily Calcium requirements:

Toddlers (age 1-3 years) require about 500mg of calcium each day (about 2 glasses of milk). Preschool and younger school age children (age 4-8 years) require about 800 mg of calcium each day (about 3 glasses of milk).

Older school age children and teens (age 9-18 years) require about 1300 mg of calcium each day. This higher level of calcium is especially important once they begin puberty (about 4 glasses of milk). Since milk has a lot of calcium in it, children who routinely drink milk each day usually easily meet their daily requirements of calcium. Children with milk allergies or who just don’t like milk are a little more of a challenge to meet these requirements, but it is still easy if you learn to read food labels.

Non-dairy sources of calcium:

Fortified orange juice is a good source of both calcium and vitamin D. Leafy green vegetables such as spinach and kale are also good sources. Here is a good link for a full list of non-dairy sources of calcium.

How Calcium Works

Calcium MUST have an acid environment in the stomach for absorption into the blood. Interestingly, the majority of Americans nowadays take antacids (prescription and over the counter). The antacids neutralize acid stomach and greatly inhibit calcium absorption.

If the calcium is absorbed from stomach to bloodstream, calcium must find its way to the bone, get into the bone and stay in the bone.

If one’s diet is high in animal protein or refined sugars, this creates blood acidity, which requires buffering. One of calcium’s best jobs is to buffer, so calcium will leave the bone to assist with this buffering. If one’s diet includes veggies, fruits, grains (and small portions of animal protein), the calcium has a chance to get to the bone, if it has a carrier molecule to assist it. Ninety percent of all calcium supplements on the market are “calcium carbonate. Another very important mineral, which most Americans are very deficient in, is magnesium. As a result, we see calcium leeching out of the bone, if it makes it into the bone to begin with, because magnesium’s biggest role is to keep calcium in the bone.

Calcium and Vitamin D

Vitamin D is also well known for its involvement with bone health. It is necessary to absorb calcium. Therefore, people with low vitamin D levels may be more likely to suffer from osteoporosis or joint pain. However, new research is showing that vitamin D has many more functions in the body than just helping our bones.

Vitamin D also effects the neuromuscular and immune systems and can reduce inflammation. Because of these functions, vitamin D deficiency has been related to a variety of disease states including: autoimmune disorders, cancer, diabetes, heart disease, hypertension, multiple sclerosis, osteoarthritis and osteoporosis.
We certainly do not lack for dairy sources of calcium in our country. In fact, most Americans imbibe it in milk and cheeses. However, milk is an animal protein and remember, intake of large amounts of animal proteins create acidity in the blood! Then to top it off food and beverages companies are typically looking to throw any old calcium into their products so they can add a ‘with added calcium’ label to the product but we are not interested in that.

So choose food products that are high in calcium to get your child the calcium he needs. In addition, compare food labels to choose brands or types of foods that have a higher percentage of the daily value of calcium.

©2009 Littlestomaks.com

One of my good blogger friends Annie from PhD in Parenting is running a Carnival of Play theme on her blog this month. What a fantastic idea! I decided to write this post as a part of her carnival to highlight the importance of both play and good nutrition on overall growth of toddlers.

Why play?

We have all heard about rising rates of childhood obesity. Kids today are eating more junk food, consuming more sugary drinks and spending  a lot of time in front of the TV or playing computer games. To some, this lifestyle might already fit the definition of “play” because it is so much fun  and kids don’t seem to complain about it. There are no immediate health problems and parents can find time to do their own thing if their kids are happy and busy with TV or computers. So what could be wrong? And as far as obesity is concerned, if the child is not really fat and his friends are about the same, who cares?

There is enough evidence from scientific research and surveys that the overall health of our children today is in a state of decline. Childhood obesity is real;  BMI’s are rising; attention spans are shortening and immune systems are weakening. What I find most worrisome is that there are now reports of increasing rates of Type II diabetes in children as young as 8 years old. Diseases like this don’t happen overnight; they slowly creep up on you. On a day-to-day basis, a lifestyle of poor nutrition and no physical play may seem ok, but it can lead to serious health problems in the long run.

Benefits of play

Bone growth

This is very important especially in the early years of life. Most of the current debate is focused on calcium and vitamin D deficiency when it comes to healthy bone growth. But physical play has an important role in growing strong bones. The Iowa Bone Development Study concluded that various forms of physical activity, particularly vigorous physical activity, plays a critical role in early childhood bone development well ahead of reaching peak bone mass.

Muscle and joint development

Physical activity involving running, jumping and climbing builds strength in the muscles and joints as they try to support the body weight. It does not have to be a power workout for the strength to build; the good thing about physical activity is that even a small amount adds to itself. In fact it is better to go slow and watch your child carefully as she attempts increasingly difficult tasks in the playground. Over the long run you will notice a clear increase in upper body strength and legs.

Hand-eye coordination, balancing and making sense of physical forces

By engaging in physical activity, children begin to develop an intuitive sense of how the physical forces work. The begin to understand and feel how their bodies respond to gravity (jumping), friction (sliding), rotation (swinging), motion of all kinds and action-reaction of push-pull. It helps them to make sense of the physical world so they can anticipate the reaction to their actions.

Cardiovascular health

Just like adults, children also benefit from the benefits of elevated heart rates during sustained physical activity. The heart is also a big muscle, which gets stronger when it is forced to pump blood through the body at a faster rate during physical play. Lungs are also hard at work which increases their capacity of providing oxygen to the blood at faster rates. The entire circulation system benefits from physical work. The American Heart Association has some great tips for raising heart-healthy active children.

Creativity and mental growth

Although it may not seem so at first, physical activity also builds mental agility and creative thinking. As I watch my twins play in the park, I am constantly amazed by the games they invent around the simple equipment (slides, swings, tunnels, monkey bars etc). Sometimes we play “train” and run around under the big slide making all kinds of train noises. At home we play the “tunnel” in which I stand with my feet apart and they come running through the space pretending to be a truck or a train. It is a lot of fun, and the good thing is that it does not require any fancy toys. Just pure imagination and a willingness to indulge them in whatever gives them a good “workout”.

Risk taking, team work, leadership

As children grow and engage in team sports, they begin to develop a sense of teamwork and leadership. These two qualities are critical for their future success in life. They have to learn the rules of the game and figure out what is acceptable and not acceptable. It promotes a drive to achieve success, builds confidence and increase their self worth if they finish a task successfully. No wonder, sports are a big part of our popular culture.

They also develop a sense of risk and an ability to decide their action which will keep them safe. I have been amazed to watch my son pause at the top of a tall slide before coming down. I don’t see fear in his eyes; but clearly his mind is doing a quick calculation to figure out if he should really take the plunge or not. He feels comforted when he can see me waiting for him at the bottom and lets himself go!

Nutritional needs of an active child

Physical activity burns calories. It is important to make sure your child is well fed before taking him to the park. Also pack a healthy, nutritious snack after he is done. Handing out a no-sugar added fruit juice is ok if not overdone during the rest of the day. One of our favorites snacks is from Earth’s Best, which goes very well after a visit to the park. We also give organic milk and string cheese sometimes. Overall, active children need more calories during the day according to the following data from MyPyramid.gov:

Play is good for Mom and Dad too

Sometimes it may seem overwhelming to run after energetic toddlers all the time. Usually we are pretty tired when we return home from work, but playing with my twins is a lot of fun. It gives me a chance to unwind and not think about deadlines at work or the all-too-important meeting the next day. We simply run around, get silly and make up all sorts of games! Even if it is for a short period of time, it is a great bonding experience for otherwise busy parents.

Don’t ignore safety

Slips, trips and falls are the major hazards of physical activity. Even for adults, these 3 risks are responsible for a large number of injuries each year. Keeping a watchful eye on children without making them fearful while playing is very important. Expect the unexpected and stay close. Make sure children have comfortable clothing and good shoes on. And no cell phones or Blackberrys!

Summing it all up

For long-term healthy growth of your child, think PNR – Play, Nutrition and Rest. There is nothing wrong with watching TV and playing computer games -  both of them can stimulate the mind by entertaining and educating at the same time. It becomes a problem when they take over and there is no time left for play involving physical activity on a daily basis. Like everything else, balance is key, and although there is no fixed formula, common sense can help you figure out how to provide appropriate PNR for your child each day. Good luck, enjoy each day and feel free to share your ideas and opinions on how you are managing them for your child.

Top Photo Source:  OliverAlex on Flickr
©2009 Littlestomaks.com

If you are giving your toddler a couple of cups of milk, vitamin D fortified orange juice, yogurt and cereal, and you take him out to play in the sun for 5 – 30 minutes each day, then there is no reason to worry. And if he has a taste for salmon and tuna, you are in really good shape. There is absolutely no need to grab that fancy multivitamin nutritional supplement on your next shopping trip. Balanced diet and an active, healthy lifestyle works like a charm!

There has been a recent buzz in the media about vitamin D deficiency among infants and toddlers. “Kids Aren’t Getting Enough Vitamin D” screams one headline, while “Vitamin D Deficiency Puts 40% of U.S. Infants and Toddlers at Risk” cries another. It is quite natural to be alarmed by such news; even I paid attention to it and started researching the topic to figure out if our twins were getting enough vitamin D each day.

It is worthwhile to get a little better understanding of why vitamin D deficiency is such a big deal. It is known to cause rickets (softening and twisting of bones in children). Vitamin D is important of absorption of calcium and phosphorus in bones to maintain their strength and proper development. Recent research is also showing that vitamin D plays an important role in prevention of diabetes, multiple sclerosis and certain cancers. It can also cause weakness in muscles if deficient. It seems to influence over 200 genes, including those that regulate cellular proliferation of both normal and cancer cells.

As I read more, I found myself fascinated by the incredible biochemistry that goes on in the body while processing vitamin D from various sources. Sunlight converts cholesterol from skin into vitamin D₃, which is converted inside the liver into another form (25-hydroxyvitamin D) and released into the circulating blood stream. Vitamin D fortified foods can contain D₃ and another form D₂, both of which end up in the liver for conversion to 25-hydroxyvitamin D. By the way, it is the level of this 25-hydroxyvitamin D that tells you if you have a vitamin D deficiency. If this level is between 30 – 60 ng/mL, you have no reason to worry! 25-hydroxyvitamin D now finds its way to the kidneys, where it is converted to the active form 1,25-dihydroxyvitamin D under the influence of hormones from the parathyroid gland. This active form of vitamin D increases calcium absorption in the small intestine. Calcium and phosphorus absorbed in the small intestine are released in the blood, from where they are picked up by the bone cells for bone growth. 1,25-dihydroxyvitamin also regulates the growth and maturity of bone cells, which in turn release back the calcium and phosphorus in the blood to maintain their levels in the circulation system. The whole system works in harmony, promoting controlled bone growth!

You can continue to be vigilant by paying attention to what you buy. Remember that unless the label says Vitamin D fortified, orange juice, yogurt, cheese and cereals do not contain this vitamin. If you have a choice, go for Vitamin D₃ because it is three times more effective than Vitamin D₂ in conversion to 25-hydroxyvitamin D. If the label simply says Vitamin D, then most likely it is Vitamin D₂.

Here are some of the products we use regularly. Looking at them, and how much our twins are getting overall each day, I am not worried about Vitamin D deficiency.

Are you still worried?

If so, discuss with your pediatrician. Depending upon your specific case, you may be able to get advice about a nutritional supplement.

Here are some links for more information:

1. A very technical article in the New England Journal of Medicine
2. Dietary supplement fact sheet on Vitamin D from NIH