Last weekend, I had an opportunity to talk to several parents of young children at a local cultural event. I did a short survey with them to learn more about their issues and concerns. One of the questions was designed to find out which sources of information they rely on for advice on child nutrition. I did a similar survey last year and I reported the results in this article. I have now added the new data for this update.

This data set now has  a total of 202 picks from 97 respondents from the blog, Global Toddlers and the recent cultural event.

Here is how the question was posed:

Where do you go for advice on toddler nutrition? Pick 3

1. Your pediatrician
2. Nutritionist or Registered Dietitian
3. Internet
4. Trusted friend/family
5. Books or Magazines
6. Networking group
7. Other

And here is chart showing the results:

Top 3 sources of child nutrition advice for most parents are Internet, Pediatrician and Books/Magazines.

I think that there is a tremendous opportunity for registered dietitians to connect with parents and offer them credible, science-based, actionable information. They get extensive training in all aspects of nutrition and many of them have graduate degrees. I believe they can bridge the gap between the pediatrician, who is unlikely to spend a lot of time addressing nutrition needs of a child, and the internet, where nutrition information tends to be largely fragmented across websites of dubious credibility. I have had a wonderful experience working with over 30 registered dietitians who have answered reader questions in my Ask the Expert column.

What do you think? Are you surprised by these results?

I would love to hear your opinion on the results of this poll. If you did not get a chance to vote in this survey, please feel free to leave a comment with your picks.

©2010 Littlestomaks.com

News of vitamin D deficiency in children are popular in the media these days. Like all concerned parents, I am sure you have paused to pay attention to these news and wondered if you should get a vitamin D supplement for your toddler. The only way you can be sure whether your child has a vitamin D deficiency is by getting a blood test which screens for a particular form of vitamin D called 25-hydroxyvitamin D. Unfortunately, there are no early warning symptoms which can help you determine if you should take a corrective action.

You don’t need to go rushing for a blood test right away though! By paying attention to your child’s general level of outdoor activity and eating patterns, you can get a few clues. Here are 5 questions you can ask to figure out if there might be a need to get a definitive answer on vitamin D deficiency in your specific situation. However, you should not jump to a conclusion too soon just by observing over a few days. Rather you should try to look for a general pattern over a period of time.

Does he get enough time to play in the sun?

Your child’s body (and yours) is programmed to make its own vitamin D simply by being out in the sun. Even 10-15 minutes of play with arms and legs exposed to the sun can be enough. And best of all, the body is able to self-regulate the amount of vitamin D by storing the excess in fat cells.

The problem is that you may not get enough sunshine during the day, especially during the fall and winter months simply because of where you live. Children with darker skins are also at a disadvantage because of the pigment in their skin which absorbs the UVB rays which would otherwise be used to make vitamin D.

The good news is that the effect of sun is cumulative - that is, it adds up over time. Take advantage of every sunny day, even in the middle of winter to let your child play outside. Getting fresh air and physical exercise is good not only from the point of vitamin D, but also for overall physical and emotional health.

Does she drink at least 4 cups of milk every day?

Milk, by far, is the best source of vitamin D because all milk in the US is now fortified with vitamin D. However you need at least 4 cups to reach the recommended level of daily vitamin D (400 IU for children).

The problem could be milk allergies and just a natural dislike of milk. Also 4 cups is a lot, and even adults don’t usually get to drink that much on a daily basis. Try to mix with vitamin D fortified cereals, most of them generally are these days. You can also get vitamin D fortified orange juice, but be sure to watch out for added sugar.

One good way of increasing milk consumption is to add it to a smoothie. This way you can also get your child to eat some fruits!

Does he eat fish as part of a balanced diet?

Eating fish such as salmon is almost like buying insurance as far as vitamin D is concerned. You don’t have to eat it everyday – even once a week can work its magic. One serving of 3.5 oz (about 100g) or the size of a deck of cards can provide as much 2 times or even higher than the daily recommended level of vitamin D. Other fishes like tuna, mackerel and sardines are also good sources of vitamin D. Mercury contamination is a risk but should not be too much of a concern if you eat them occasionally as part of a varied diet.

The problem again could be allergies. Also your child may not like the taste or smell of fish. Trying new recipes and offering in small portions in combination with some of his other favorites can help you to build a taste for fish.

Does she seem overweight for her age?

Childhood obesity is on the rise and if your child is overweight or obese, you have a challenge in terms of vitamin D as well. That is because the body is not able to pull the vitamin D stored in the fat cells when needed.

Keep a close eye on her Body Mass Index by looking at the age specific growth charts. They are available on the CDC website or you can ask your pediatrician. Again, it is important to look at the trend and not a single point on these charts. If you see a trend creeping over the 85th percentile, you need to take action right away and improve the overall nutrition and eating habits of your child. Unless there is an underlying medical condition, nutrition and lifestyle changes can show good results.

Does he have special medical conditions?

In the most unfortunate situation, your child may have a medical condition such as Crohn’s disease, celiac disease or cystic fibrosis. These diseases cause poor absorption. Since vitamin D is a fat soluble vitamin, its availability is severely reduced in people suffering from these problems.

If this is the case, you are probably already talking to your pediatrician. Discuss the matter of vitamin D deficiency if you have not already done so.

After considering your specific situation, you can consult with your pediatrician about supplements. While I am not a fan of jumping on the vitamin supplements bandwagon, I think it is important to be informed about them. I plan to write about vitamin D supplements in future once I have had a chance to do some research on them.

What do you think? Are you concerned about your child’s vitamin D levels? Are you considering supplements? I would love to hear your comments.

Photo Source: Leo Reynolds on Flickr
©2009 Littlestomaks.com

Ask The Expert is a weekly column on Littlestomaks.com. The idea is to have a reader-submitted question answered by a nutrition expert or a pediatrician. Feel free to submit your question in the comments section below.

This week, Pediatrician Dr. Joanna Dolgoff explains how you can find out if your child is vitamin D deficient.

Joanna Dolgoff, M.D. BA Molecular Biology, Princeton, Graduated Cum Laude MD, NYU School of Medicine Pediatric internship and residency at Presbyterian Children’s Hospital of New York 5 years private practice in Pediatrics CBS News Online correspondent: childhood obesity expert Child & Adolescent obesity and weight management expert Website:Online Weight Management Program Twitter:@joannadolgoffmd LinkedIn Profile Contact: via email from website

Question: How do I know if my child has vitamin D deficiency?

Answer:

New studies are proving that vitamin D is an important nutrient that can help prevent many diseases such as cancer, depression, diabetes, hypertension, osteoporosis, chronic fatigue, autoimmune diseases and cardiovascular disease.

There are a few different ways to get vitamin D.  Vitamin D may come from foods or vitamin supplements; vitamin D can also be made by the skin when it is exposed to ultraviolet rays (UV light).

Vitamin D deficiency is often missed because there are no real symptoms associated with it.  Rickets and osteomalacia (softening of the bones) are the most common signs of vitamin D deficiency but there is no way for parents to tell if their child is suffering from these illnesses.  The only way to prove that your child is vitamin D deficient is by completing a blood test which screens for a particular form of vitamin D, called 25-hydroxyvitamin D (25(OH)D).

Think that name sounds complicated?  Unfortunately, many doctors do too.  In fact, doctors often order the wrong blood test when assessing vitamin D levels.  Be sure to ask for 25(OH) D blood test not 1, 25-dihydroxy-vitamin D (aka calcitriol).  With such complicated names, it is no wonder that such mistakes are made!

Vitamin D deficiency exists when 25(OH) D levels fall below 25 ng/mL.  Levels may vary depending on time of year, direct sunlight exposure, skin color and vitamin D consumption.  Levels should be between 50 – 80 ng/mL year-round for both children and adults.

As a doctor, I am finding more and more children with low levels of vitamin D, mainly because kids are spending less time in the sun.  These days, toddlers are more often inside watching TV than playing outside.  And if they are in the sun, they are lathered with sun block, which reflects the sun’s rays and decreases vitamin D formation.  Obviously, sunscreen is important and should not be avoided!  But it does lead to lower levels of vitamin D. Also, many toddlers do not get enough vitamin D to meet their needs since there are limited food sources of high vitamin D content.

The current recommendation is 400 IU per day in the form of of vitamin D3 (cholecalciferol).    New studies are showing that higher levels may be needed to prevent the diseases discussed above.  Many are now recommending 1,000 IU per day in the form of vitamin D3 (cholecalciferol).  If your child doesn’t get this amount of vitamin D in his diet, you may want to consider a multivitamin that contains vitamin D.

©2009 Littlestomaks.com. All Rights Reserved
Disclaimer – Information provided in Ask The Expert column on Littlestomaks.com is intended to give you general guidance on a question related to toddler nutrition. It is not meant to be treated as medical advice. You are welcome to contact this expert for a detailed consultation on your specific situation to determine what actions, if any, you should take regarding nutrition and health of your toddlers. We do not recommend you to take any action based solely on the information presented in this column. Experts have agreed to provide their professional opinion on toddler nutrition related questions on a voluntary basis and no compensation is offered to them by Littlestomaks.com.

Recently I posed this question on my blog because I have been interested in learning from toddler parents about their most preferred sources of information on nutrition. This is one of the questions in my weekly Global Toddlers survey, but I also wanted to open it up to everybody else. I collected a total of 147 picks from 51 voters on the blog and 18 Global Toddlers respondents.

Here is the original question:

Where do you go for advice on toddler nutrition? Pick 3

1. Your pediatrician
2. Nutritionist or Registered Dietitian
3. Internet
4. Trusted friend/family
5. Books or Magazines
6. Networking group
7. Other

And here is  chart showing the results:

These results may seem surprising – after all, it would be quite reasonable to expect that most parents would pick either the Pediatrician or Trusted friend/family since they would give the most credible advice. In fact, only 29 parents picked Pediatrician (42% of 69 parents who responded). The number for Trusted friend/family was even lower at just 20 out of a total of 69.

But if you give this question a little thought, these results are hardly a surprise. After all, you see your pediatrician usually when your child is sick or if you are going there for a routine exam. There isn’t much time during those visits to get all of your nutrition questions answered in detail. At least that’s what we have experienced. Things seem so rushed when visiting the doctor’s office. We seem to spend more time waiting than talking with the doctor!

And as far as trusted family and friends are concerned, sure they can provide sound, well-meaning advice based on their own experiences, but it is unlikely that they would truly understand your unique situation. We all live busy lives, and just like our doctors, it might not be possible to talk to them often enough to get nutrition related information. I also have a hunch that when you ask for their advice, there is a part of you which feels kind of “pressured” to act on it since you want to be able to “report” the results when you talk to them again. I would love to hear your feelings about this.

From this point of view, it is not surprising that a lot of toddler parents rely on indirect sources of information like the internet and books or magazines. There surely is a lot of nutrition information on the internet, but in my experience it is fragmented across many different websites, some of which may not be completely reliable. On top of that, the topic of toddler nutrition rarely is the main topic on these websites, and as such, does not receive the attention it deserves.

To address this gap, I recently launched a weekly column called Ask the Expert. It is my sincere hope that this column can provide highly credible nutrition information in a simple question-answer format to toddler parents. In the coming weeks, you will hear from several experts (pediatricians, registered dietitians). Please post your questions so I can continue to bring their professional advice to you through this blog.

I would love to hear your opinion on the results of this poll. If you did not get a chance to vote in this survey, please feel free to leave a comment with your picks.

©2009 Littlestomaks.com

I have asked this question on my Global Toddler survey, but I want to open this one up for everybody in a new poll on my blog. Please vote, and if you feel like it, leave a comment explaining your vote.

So where do you go for advice on toddler nutrition?

1. Your pediatrician
2. Nutritionist or Registered Dietitian
3. Internet
4. Trusted friend/family
5. Books or Magazines
6. Networking group
7. Other

Select up to 3 out of these 7 categories. I would love to hear your comments, especially if you choose the “other” category. Feel free to share your reasons for relying on your preferred sources.

©2009 Littlestomaks.com