Watch vitamin A in kiddos! No kidding!

Children ages 5 or less are a very special category of candidates for enriched vitamin A diet or supplementation intake. That’s because of three potential reasons: mother’s malnourishment during pregnancy, measles or pneumonia infection, or simple growth requirements for the age.Mother’s malnourishment during pregnancy is an issue mostly occurring in underdeveloped countries. Today, the World Health Organization keeps a close track on the incidence of vitamin A deficiency (VAD) for most of the countries in the world, particularly for the countries with past VAD reporting. If interested to find out whether the country you were born in or currently live in has reported VAD in pregnant women or young children, you could check this here. The second potential reason that would make a young kiddo a candidate for vitamin A supplementation is a serious ongoing infection, such as measles or pneumonia. It is well known that such infection events could suddenly deplete the circulating vitamin A in a young child’s body. Given the sudden short supply AND the young age, the child is at heightened risk for blindness. Thus, immediate vitamin A supplementation is mandatory. In fact, WHO recommends mega doses of vitamin A in children under the age of 5 who present with active measles infection and are coming from an underdeveloped country. That mega dose is 200,000 international units (IU)! However, please do not rush into taking that upon yourself and do not give your child such a dose yourself – never-ever!! Unless you are a trained healthcare provider and know very-very well what you are doing, giving such a mega dose to a kiddo is NOT under the incidence of your decision! In fact, depending on the age and size of the kid, this dose can be deadly if given to a child that is not the right candidate for it.  Protect kid
Unfortunately, many individuals disseminated distorted health information and today some people (wrongly) “know” that vitamin A supplementation is “highly recommended” during common colds. Some people go as far as saying that “nothing would stop a cold as vitamin A supplementation would”. In fact, nothing could be further from the truth! Measles or pneumonia versus common cold are entirely different animals with different vitamin A requirement at different ages. Yes, vitamin A blood level drops during an infection of any kind. NO, vitamin A does NOT need to be replaced in all individuals undergoing through a common cold or another kind of infection. Please note that the vitamin A level drop and the blindness concern only becomes an issue when measles or pneumonia occur in children younger than 5 AND born in an underdeveloped country. In other words, this translates as follows: if the kid is in full process of growth, was given birth by a likely malnourished mother (e.g. in an underdeveloped country where VAD is known to be a concern), AND acquires a life-threatening infection – such as measles or pneumonia – which will further drop the already low levels of vitamin A, THEN we are entitled to get freaked out and give a mega-dose of vitamin A. Who is entitled to get “freaked out” and take the mega-dose decision or suggest it as an option? ONLY a trained healthcare provider: physician, pharmacist, physician assistant or nurse. That’s it and no other one! Aunt? Nope! Neighbor? Nope! Cousin? Nope! MOTHER?! NOPE! What if the aunt, neighbor, cousin or mother are a physician, pharmacist, physician assistant or nurse? Even if you are, for the sake of the kid, please remember that you will be better off double-checking your idea with at least one other provider with similar training. Why? Because the kid can die, that’s why!Alexiphone

Would a 15 years old American teenager diagnosed with pneumonia for whatever reason qualify of a vitamin A mega-dose? NO!

How about a 10 years old? NO!

How about a teen that wears glasses? NO! Wearing glasses is not a justification for a vitamin A mega-dose! Not in teens, not in adults, just NO!

How about a 3 years old? If born in the US, then NO! If born abroad, in an underdeveloped country and delivered by a malnourished mother, MAYBE.

How about a pregnant American mother? Hell, NO! Enriched beta-carotene diet, absolutely! Vitamin A mega-dose? NO! What if the pregnant momma has recently immigrated from an underdeveloped country? Then she is not American. I don’t mean to discriminate, I mean to make a point that people born and raised in the United States have minimal chance (nearly zero!) to be malnourished to the extent of lacking vitamin A to require a mega-dose of supplementation. In fact, given the way vitamin A gets absorbed and deposited, chances are that no adult ever will need a mega-dose of vitamin A. An adult with xerophtalmia (VAD-driven dry eye), will require vitamin A, but never a mega-dose. With these said, do reflect at the fact that what we call a “mega-dose” here – 200,000IU of vitamin A – is really less than ten softgels of 25,000IU each. Vitamin A doesn’t wash off that easily. Taking 25,000IU daily for ten days and taking 200,000IU once is a very comparable amount. So, if the chances are that an adult will likely not need 200,000IU, then is equally unlikely to need ten times 25,000IU.

What is worse than this is the fact that some people choose to give children 25,000IU of vitamin A daily and that is TERRIBLY wrong! The kids need vitamin A because their little bodies require essential resources for development. Yes, vitamin A is such an essential resource involved in cellular and tissue growth and is an integral part of the bone and skin development. BUT, if the kid is little enough to undergo such a growth process, then is also way to young and way too little to receive 25,000IU daily – that is enormous for a young kid! It could kill the kid! If you are concerned about the kiddo’s proper growth and eye development and you are his/her mother or the person in charge with his/her health, look first at the mother’s diet, at the kid’s diet and determine how much retinol (also called “preformed vitamin A”) or beta-carotene the kid already receives. If the mother was well nourished during pregnancy, then the appropriate diet will do it for the kid too. Take a map and look at where in the world you are and whether that place in the world was EVER a concern for VAD. If it wasn’t, then chances are that neither you nor the kid is at risk (by this I mean blindness- or growth-risk). Many developed countries chosen to supplement essential foods – such as milk, butter etc – with vitamin A. Poultry, for example, by the fact of their own enriched diet, do provide vitamin A (especially skin, liver or the eggs). For more gimmicks about foods in the U.S. and vitamin A content, check out this older post of mine. Also, be curious enough and read about my other posts on beta-carotene and vitamin A. If you are not in the U.S., make a habit from reading the labels AND knowing what foods are naturally reach in beta-carotene. That should give you a very good idea of how much vitamin A the mother had, the kid currently has and whether or not you should feel ok with what you already eat. Of course, read my other vitamin A posts, too – you may save a kid’s life one day!

Long story short: at what age would I CONSIDER sole vitamin A supplementation – like softgel or liquid or else – in a kid? NEVER without a strong reason. My only strong reasons are: malnourished mother, measles or pneumonia. These reasons only apply if the kid is younger than 5 and only for supervised very short course of vitamin A supplementation. Without these reasons I will NOT give a vitamin A pill/liquid to a kid. How about cod liver oil? For the vitamin D benefit, I love cod liver oil. For the vitamin A intoxication risk – I hate it! Of all, however, the cod liver oil is less risky. First, because kids don’t appreciate it what-so-ever. Second, it is also a great source of vitamin D. For this reason, at least one of the main concerns of vitamin A overdose – lowering of vitamin D – is at least taken care of. However, a teaspoon of cod liver oil contains 4,500IU of vitamin A. Given its “oily” nature, over 90% of this amount will be absorbed and be in the circulation in NO TIME. A big part of it will have to be stored since it is unlikely to be utilized in a day. At the same time, a teaspoon of cod liver oil only provides about 800IU of vitamin D, amount certainly sufficient to prevent rickets in kids, but not sufficient to prevent the imbalance of vitamin D caused by the excess of vitamin A in older kids or adults. Let’s put it this way: the higher requirements of vitamin A will prevent lowering of the vitamin D levels in young kids, but if we keep giving cod liver oil too often, the action may be defeating the purpose beyond a certain point in the kid’s growth. Would I take myself cod liver oil on a regular basis? No. Although I do need vitamin D, I know that the vitamin A it contains may be toxic for me, particularly given my past history (not malnourished mother) and eating habits (love eating liver of any kind – not bear or seal liver, nope!).IMG_6150
Does a kid need a daily multivitamin? Yes. Such will not exceed the vitamin A requirements. Whether the multivitamin is sufficient for the supply of other vitamins, that is an entirely different story and we’ll talk about it in another post. Does a kid need beta-carotene-rich foods? Hell, YEAH!!!! What are you waiting for, mom?! Do you risk overdosing the kid with beta-carotene rich foods? Nope, not at all! Do you risk overdosing the kid with vitamin A-enriched foods? Possibly. Read the label, mom! Do you risk overdosing the kid by feeding him/her beef or chicken liver? This is not entirely out of the realm of possibilities, BUT luckily the food preference of both kids and parents makes this quite unlikely. One teaspoon of chicken liver though would ensure retinol for kiddo’s growth for quite a bit of time!

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Dr. Alice

I teach people how drugs work, when they are needed, and why. My expertise as a pharmacist and researcher allows me to determine whether taking or not taking a drug will pose any risk given all current circumstances that apply at this moment. Many times we don't know unless we try, but other many times walking the extra mile pays off giving in return more wonderful moments and more to give to others.

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