Getting enough vitamin A through diet (preferably) or supplements (carefully) is very important for growing children. In response to a reader comment to last week’s post 5 Things to Know About Vitamin A, I decided to write a follow up post on risks of vitamin A overdose and what you can do to protect yourself or your child.

Risks of vitamin A overdose

According to the 2nd edition of the PDR for Nutritional Supplements, overdose of vitamin A can be very serious in infants or children, and even adults:

• A single dose of 25000 IU per kilogram of body weight causes acute toxicity – vomiting, high pressure in the brain and death may occur (recommended daily dose for children less than 4 years old is 2500 IU)
• High amounts of vitamin A causes chronic toxicity – early signs are dry rough skin, cracked lips, sparse coarse hair and hair loss of the eyebrows. Late signs are irritability, headache, high level of liver enzyme in blood and liver disease.
• Supplemental daily doses of 10,000 IU or more taken by pregnant women have been reported to increase the risk of birth defects.
• Too much vitamin A can increase the risk of osteoporosis.

Clearly, you have to be careful not to exceed the recommended dosage and frequency if you are using a vitamin A supplement.

This is another reason why you should mainly rely on getting this nutrient from dietary sources such as carrots, sweet potato, cantaloupe, dairy products, eggs, green vegetables (spinach, collard greens), cod liver oil etc. Except cod liver oil, where it may be possible to get a lot of vitamin A at one time, all of these sources contain moderate amounts of provitamin A. There is no way you can get an overdose by consuming these sources.

Factors affecting vitamin A levels in the body

The amount of  vitamin A finally delivered into your body from provitamin A depends on the type of provitamin A (beta carotene, alpha carotene or beta-cryptoxanthin). Carrots, sweet potato, spinach and collard greens are good sources of beta-carotene, which is the more effective form of provitamin A. For example, 1 IU is equal to 0.6 micrograms of beta-carotene and 1.2 micrograms of other mixed provitamin A. Here is a nice table showing amount per serving of vitamin A from different foods. 5 servings of a variety of fruits and vegetables will provide about 3 – 6 mg of beta-carotene a day, enough for maintaining healthy levels of vitamin A in the long run.

Another factor affecting the vitamin A level is the amount absorbed in the small intestine after eating these foods. Efficiency of absorption can range from 9 – 22%. That is, out of the 3-6 mg daily beta-carotene, only about a tenth or a fifth will be absorbed. You can improve it by cooking the food and adding a little fat to the recipe. Absorption can be severely affected by certain medical conditions such as cystic fibrosis (pancreas), Whipple’s disease (small intestine), Crohn’s disease (intestines), ulcerative colitis (large intestine) and chronic liver disease.

Many processed  foods are fortified with vitamin A, that is they contain added vitamin A mostly in the form of retinyl palmitate and retinyl acetate. The efficiency of their absorption is much higher, typically around 60-90%.

A third factor that affects the amount of vitamin A levels is the amount stored in the body in the first place. Vitamin A is fat soluble and your body typically stores excess vitamin A in the liver. The half life of vitamin A is about six months, which means that it takes about 6 months for its level to fall down to half of the original levels. That is why it takes a long time of poor nutrition for vitamin A deficiency to show up.

5 actions you can take to be safe

Bottom line: vitamin A is vital for your child’s growth, but there are serious risks of accidental overdose or sustained high levels of vitamin A supplementation. Here are a few things you can do to be safe:

1. Rely on fruits, vegetables and dairy products to meet your growing child’s vitamin A needs. Check out these simple vitamin A rich recipes.
2. Reduce or limit processed foods, they are artificially fortified with vitamins (including vitamin A). While one serving of a particular food item may not have a lot of vitamin A, when you add all the processed food together, you can end up consuming a lot of them.
3. Check the nutrition facts label on your child’s multivitamin if you are using one. Vitamin gummy bears are very popular!
4. Talk to you doctor about a suitable vitamin A supplement if your child has a medical condition. Do not make this decision yourself and do not pick up any random over the counter supplement yourself.
5. Get an annual eye exam for both you and your child to catch early eye health problems

Are you using a vitamin supplement for your child? Have you checked the label? Share your thoughts and concerns in a comment below.

©2010 Littlestomaks.com

This post is part of the Attachment Parenting Month 2009 blog carnival, hosted by Attachment Parenting International. Learn more about how you can stay “Attached at the Heart Through the Years” by visiting API Speaks, the blog of Attachment Parenting International.

This also happens to be my 200th post on Littlestomaks. So I am doubly excited!!

I don’t characterize myself as an AP parent, but I do subscribe to their 8 principles of parenting. I read the API Speaks blog regularly. It is fun to read the experiences of Moms so passionate about the principles of attachment parenting. Not usual to find Dads writing or commenting on this blog, so I feel a little strange writing a post for the AP month 2009 blog carnival. Yet, just like my wife, the bond I feel with my twins is incredibly strong and it begins with the heart. Never before in my life, have I felt the kind of emotions I feel when I look into their eyes, enjoy their abundant smiles, feel the frustration of their tantrums. Incredible it may sound – or maybe not – this Dad is attached!

You see, Dad’s are funny creatures. Straddling the wide gulf of expectations of being tough on one side and being gentle and nurturing on the other, they try their best not to let their children and their spouse down. The heart doesn’t show itself too often in their actions, but it does beat the same way as a Mom’s and does melt at the sight of their children.

Anyway, I digress.

The theme of the AP month this year is to celebrate our growth as parents as we face the challenges of transitions in our children’s growth. Talking of transitions – our twins turned 3 this year, so we have gone through a lot in a very short period of time. So, I love this opportunity to share with you our experience and a few lessons we have learned along the way.

My son loves to go around the block with me on his tricycle. It was easy in the beginning – he would stay on the sidewalk and ride along the short circular loop around our house. Over the last few months he has grown more adventurous and curious about every small thing along the way. It is fun to watch him get off his tricycle to carefully examine the line of ants crossing the sidewalk. “Fireants! It will bite me” he shouts, remembering the time when a couple of them climbed through his sandals and bit him on the foot. He loves to climb on top of the cable boxes pretending to be on a train. Another favorite is stopping by the electrical utility boxes and trying hard to take a peek inside to see if the “electric monster” is awake! The warning label on the box shows a big electric arc in the shape of a monster hitting a child and throwing him to the ground. He knows to stay away and not climb on top of this one. “The monster will hit me and make me fall” is what he repeats to himself – not out of fear or panic, but in an attempt to register the dangers of electricity shown on the label. He is equally fascinated by the “shuttles” (airplanes) in the sky and dog poop (yikes!) on the ground! He imagines the monsters inside the wooded areas next to the sidewalk which he calls a jungle, and tries to get closer to the trees inch by inch each day.

Quite clearly, our walks around the block are not linear anymore. They are full of adventure, curiosity and story-telling. They are a stop-and-go most of the time unlike the slow, continuous riding of his early months. Sometimes he barely moves, and sometimes he pedals so fast I have to run along to stay by his side.

Although challenging, these walks have given me a chance to reflect upon a few simple parenting lessons:

Safety first – he loves to push the boundaries each day, but when it comes to safety, there is no compromise. My voice gets sharp and the tone high pitched as I command him to get back on the sidewalk when he tries to get on the road. Sometimes, I have to physically move him back on the sidewalk even if he kicks and screams. Staying calm, firm and decisive is key. Slowly he is learning that watching out for incoming cars is important, and so is getting away from the dogs even though their owners keep them on a leash!

Talk is cheap – which is why we do a lot of it on our walks! We talk constantly – he makes a statement, which I repeat in the same tone; he asks a question, which I answer not necessarily in a logical way; I ask a question which he answers definitely not in a logical way. If I were to record our conversation, it would seem at the edge of reason and bordering nonsense! He is crazy about trains, so everything boils down to engines, freight cars, signals, bridges and railroad crossings. I have been trying to talk him into writing a letter to Santa this year asking for a bag of a hundred train toys!

Be present – is probably the most important lesson. There is nothing between the two of us on these walks. No thoughts of work, meetings, deadlines; no thoughts of hanging out with friends to watch football while enjoying a beer; not even thinking about the topic of the next blog post. I do not carry my Blackberry with me; for an hour or so, there is nothing between the two of us.

Nothing is too small or ordinary – ants, dead bugs, mailboxes, cable boxes, sheriff’s parked car, sprinklers, speed bumps in the road, sound of traffic in the distance, dog poop along the road, planes in the sky and jet-skis parked in an open garage! Everything is extraordinary in my son’s imagination and he pauses for a moment to soak in the experience of everything big or small. All the senses are at their peak; being present in that moment is almost like meditation. I am learning to see the world from a child’s eye where everything is extraordinary!

Leash of love – is what keeps it all together. I know it makes you think of walking a dog, but I like to think of it as flying a kite. The line needs to have the right tension depending on the winds and how high you want it to fly. Too much tension and it will break and fly away; too little and it will sink to the ground. Love lets you get to the right tension in this invisible line. It comes by trial and error, but you will know.

Enjoy the joys of parenthood. Feel free to share your thoughts in your comments below.

©2009 Littlestomaks.com

Bonjour! So glad it’s Friday again! Last week was Safe Kids Week (Apr 26 – May 3). It is a good time to remind us of the very real risks of unintentional injuries to young children. Check out a short video on kids safety in this week’s Five for Fridays in addition to the usual nutrition-related stories. And of course, feel free to share your tips for safety especially in the kitchen.

Tips for kids safety

I was shocked to learn this scary statistic – there is one unintentional injury to a child every 12 minutes that is serious enough to require a visit to the ER. In recognition of this, Safe Kids USA along with its founding sponsor J&J is running an awareness campaign called Raising Safe Kids – One Stage at a Time focused on child development and injury risks to children 14 and under. Although their website has very useful information for various age groups, my interest was mainly in the 1-4 years old Stage (Little Kids). Here is a short video for this age group -

Burns in the kitchen or at the dinner table are among the 5 major risks identified by Safe Kids USA. Make sure the stove area is a “kid-free” zone. Use the back burners and turn the handles of pots and pans away from the front of the stove. When using the oven, be vigilant and do not allow children to get close because the oven door can get really hot. Use large bowls when serving hot foods like soup and allow it to cool down by stirring with a spoon before giving to your child. Cut meats and vegetables into small bite sized chunks – this will cool them down and also reduce the risk of choking. Knives and other sharp objects can also be dangerous and should be kept out of reach. Same goes for matches and lighters. The cabinet under the sink where you are most likely to keep dishwashing detergents and other cleaners should be locked. Consider getting a fire extinguisher and keep it in a safe, easy-to-reach place in your kitchen.

Here is an excellent report on kids safety which gives  a lot of handy tips.

Should junk food advertising aimed at children be banned?

Rising rates of childhood obesity in Australia have galvanized a few public health and consumer advocacy groups to kick-off the Burger Corp campaign against junk food advertising on TV during prime time. They want the Australian Communication and Media Authority (ACMA) to come out with tougher regulations this year once they complete their review. Ban the practice of giving out free toys with junk fast food; ban the use of popular cartoon or other promotional characters; regulate advertising beyond TV in print media and newspapers – in short ban! ban! ban! Although I certainly do not support excessive and misleading advertising aimed at kids, I am not a big fan of over-regulating our way out of this public health problem either.  There is also a role for parents, educators and community leaders to act as role models and to inform, influence and inspire young kids to make healthy choices, not just for food but for everything else that affects their health and growth. Removing ads from TV will not solve the problem of excessive TV watching. Banning free toys and promotional characters will not reduce the allure of inexpensive, great tasting junk food rich in salt, sugar and fat. Some regulations is needed; in my opinion it should be limited to restricting false and misleading claims. We should rather focus our resources on improving affordability of healthy options and increasing  awareness of the link between nutrition and long term health. What do you think?

Don’t take a multivitamin supplement on an empty stomach

Even though there is considerable debate and uncertainty about the effectiveness of multivitamin supplements, they are quite popular and many people, including me, take them daily. That is why this question about when and how to take vitamins on the Fitness and Nutrition section of the New York Times caught my eye. According to the experts, the time of the day you take the vitamins is not important. What is important is that you take them consistently and that you take them with food. The water soluble vitamins B and C can absorb well on an empty stomach, but the fat soluble vitamins A, D, E and K need some fat from food to absorb in the body. Of course it does not mean that you need to eat fatty foods in order to take your vitamins. Simply eating some food right before taking the pill should do just fine.

Second hand smoke linked to iron deficiency and low antioxidant levels in children

Exposure to second hand smoke is getting a lot of attention in the 2009 annual meeting of the Pediatric Academic Societies this week in Baltimore. In two separate studies, data from the National Health and Nutrition Examination Surveys (NHANES) for children under 18 years of age was analyzed. One study from researchers at the New York University School of Medicine reported a link between second hand smoke (estimated by blood levels of cotinine, a metabolite of nicotine), obesity and iron deficiency. The other, from researchers at the University of Rochester Medical Center concluded that second hand smoke reduces the levels of anti-oxidants in children. Anti-oxidants work to protect the cells in our body from damage by free radicals which are produced as part of normal body functions. Vitamin C is a good antioxidant; although the researchers did not clearly make a recommendation about supplements to counter the effect of second hand smoke. Bottom line – second hand smoke is bad, not just for your lungs, but also for your nutritional health.

Good nutrition strongly linked to education

A new study published in the Journal of the American Dietetic Association concludes that highly educated and affluent people are more likely to have a low energy density diet (lean meat, fruits and vegetables) compared to those on the lower income and education levels. I was not able to read the original article; still I found this summary very interesting. I am not surprised by it because we have all heard enough about affordability of nutritious food. I think that more than education, awareness and basic understanding of nutrition are more critical in making this choice. I know of many highly educated people who have very poor eating habits. And this is even when they know that salty, fatty and sugary foods are no good for their health. So there is still another factor that is critical – and that is a genuine desire to take a long term view of health and nutrition. And while it is true that low energy density, nutrient rich foods cost more, there are many ways to still have a healthy diet. As I wrote in last week’s Five for Fridays, simply by cutting down on packaged foods and preparing your meals at home, you can save a lot of money and improve your nutrition. You don’t need to be a rocket scientist or a genius – just have a desire, some knowledge of nutrition and cooking and be able to find some time to cook. Go for it!

Enjoy your weekend! And do share your opinion or recent nutrition related news you found interesting.

©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

Daylight savings time is here! Summer cannot be that far away, right? Enjoy another set of noteworthy nutrition-related articles from this week.

Calories from sugary drinks add up to more than what’s on the label

Sugary drinks such as regular soda and concentrated fruit juices provide “empty” calories without much nutritional value. We all know that. Well, a new understanding is now emerging which suggests that when you consume a sugary drink, it does nothing to change your appetite and you don’t compensate it by eating less food. In another insightful analysis of several recent studies, Dr Ayala makes a point that soda drinkers end up consuming more calories since these drinks do not satisfy their hunger even if they might temporarily quench their thirst. Turns out, even candy eaters consume less food and calories compared to soda drinkers! It does not mean that you should let your kids eat candies the whole day; it just makes a point that solid foods are more effective at making you feel full. When it comes to snacking,  there is definitely a smarter way.

Taking your toddler grocery shopping? Watch that shopping cart

This report reminds us again of the many dangers of carrying toddlers in a shopping cart while shopping. Head injury is most common with kids falling out of carts head first on the floor, sidewalks or parking lots. Shopping carts in many stores are in very poor shape and, most importantly, several safety features are regularly missing. According to this report, 2 out of 5 carts were found unsafe at Toys ‘R Us and 13 out of 30 at WalMart and, surprisingly, none at Target! Not sure if this is true at other stores of these companies in different parts of the country.

I think these types of risks to small children exist everywhere, not just while shopping. As a parent, it is very challenging to keep a close eye on your little ones, especially when you are in a hurry or distracted. There are several very good suggestions in this report for child safety while shopping. Check it out, and if you have any tips of your own, feel free to share a comment!

Feed with love and respect; respond with sensitivity

I really enjoyed reading this post from a Mom of a 2 year old as she tried to figure out why her toddler threw a fit when offered a fish meal at dinner. Being a vegetarian herself, she was already hesitant to introduce any meat, but the idea of nutritious omega acids was compelling enough for her to try. It didn’t turn out as planned and the child refused to eat anything as long as even a small bit of fish was on his plate. Eventually, she decided not to force her child and wait for another time before trying again.

This is a great example of feeding with love and respect and really “listening” to your child. In her guest post Attachment Parenting and Toddler Nutrition, Annie introduced us to this idea. We have been trying it with our twins for quite sometime now and it seems to be working well since they are beginning to develop a taste for different types of foods. And we don’t have to battle with them at mealtimes. The situation is not perfect by any means, but we are are happy so far.

Does it mean that you should let your child eat whatever he wants whenever he wants? Clearly no, but there is no use getting into a power struggle in the moment. You can correct undesirable habits (candy, junk foods etc) slowly by setting an example yourself and then by positive reinforcement when he makes more desirable choices.

First lady on a mission to promote healthful eating for the masses

In her public appearances, Mrs. Obama is emphasizing the need for fresh, nutritious food “not just for the wealthy, but for the ordinary and struggling families” all across our nation. Her message could not be more timely – the waistline of our nation is getting wider and childhood obesity, especially among the underpreviliged segments of our society, is on the rise. I came across this article in the New York Times, and was immediately impressed by Mrs Obama’s walking-the-talk approach to healthful nutrition. And she is very pragmatic – there is no harm in an occasional indulgence in fast food. It becomes a problem if it happens to be the only source of daily nutrition. Will this attitude reflect into policy? Only time will tell.

1 in 7 teens is vitamin D deficient

A new study by researchers in the Cornell Medical College finds “alramingly” high rates of vitamin D deficiency among teens, particularly among the African-American population. Girls had more than twice the rates of deficiency compared to boys. Overweight teens also had nearly double the rates of their normal weight counterparts. The researchers used a “revised” criteria for vitamin deficiency, which raised the minimum level from 11 to 20 ng/ml in a blood test.

To me, this is not news anymore! We keep hearing of vitamin D deficiency in various reports which raise the alarm bells about the risk of rickets in children and a host of other diseases in adults. I do not understand the purpose behind these reports,  which do not really propose anything new about how to solve this problem. Everyone knows that you need a balanced diet and sun exposure to build the vitamin D reserves. It is also commonly know that most kids today are growing up with not-so-healthy eating habits and child obesity is on the rise. So what should we be doing? Should there be a policy change? Should the pediatricians start recommending a daily dose of nutritional supplements? There is always that magic line in these reports: “more research is needed”! I say, stop this charade and come out with some new ideas!

As for the risk of rickets, I am yet to find any evidence of a rise in the number of reported cases nationwide. From what I understand, bone growth is quite complex and vitamin D is only one piece of the puzzle. Just because we measure low levels of vitamin D in blood tests (compared to pretty arbitrary standard anyway), we should not ring the alarm bells about rickets!

I have nothing against vitamin D. In fact, I have tackled this subject in this post about rising rates of vitamin D deficiency in kids. I am also not against supplements since I have written about reasons when you might consider a daily multivitamin for your kids. What I have a problem with is report after report of “scientific” studies saying the same thing without leading to any substantial progress in finding a solution. I am so much waiting to read a different kind of a report in future.

Enjoy your weekend!

Image source: orangeacid on Flickr
©2009 Littlestomaks.com