Do young children need iron and vitamin supplements?
Dear Dr Donya,
I read that fluoride should not be taken with milk and that it must be taken hours after milk has been consumed. Is that true?
My daughter is six and a half months old. When I visited my pediatrician he said vitamins and iron supplements were not necessary. But I have read elsewhere that iron supplements are very important after six months. Can you buy iron supplements without a prescription? If so, which brand is best?
And what are the best brands of vitamins for children?
-- Pauline
Dear Pauline,
Oral fluoride may be dropped directly into the mouth or mixed with cereal, fruit juice or other food. I have never heard that it should not be given with milk.
Regarding iron supplements, both breast-fed and formula-fed infants need a supplement from about four months to six months. Children aged six months to three years should receive a total of six milligrams a day, which includes the amount they acquire from food, vitamins or mineral supplements. An iron-fortified formula is sufficient. The best dietary source of iron is lean red meat. Chicken, turkey, and fish are also sources of iron, but they contain less iron than red meat. Iron is best absorbed when taken on an empty stomach, with water or fruit juice, about one hour before meals or two hours after, though it can sometimes irritate the stomach when given with meals or after one.
Liquid forms of iron supplement tend to stain the teeth. To prevent, reduce or remove these stains:
* Mix each dose with water, fruit juice or tomato juice. You may use a drinking tube or straw to help keep the iron supplement from touching the teeth.
* When doses of liquid iron supplement are applied with a dropper, the dose should be placed well back on the tongue, and followed with water or juice. Iron stains on teeth can usually be removed by brushing with baking soda.
These foods should not be taken with iron: cheese and yogurt, eggs, milk, wholegrain breads and cereals, bran and spinach.
Regarding vitamin supplements, breast milk has little vitamin K, vitamin D and iron. I always say that if the baby has a varied and nutritious diet it will not need supplements. I would recommend only using vitamin supplements as required because all necessary vitamins can be obtained from food. Problems can arise if a child consumes too large a quantity of vitamins.
The main concern is the right amount of the vitamin:
Vitamin A. An infant needs 1,500 international units (IU) per day. Sources of vitamin A are vegetables such as morning glory and carrots, yellow fruits such as papaya, mango, pumpkin, egg yolk and liver. Do not give more than 50,000 IU per day because it can be toxic, especially if the child is more than six months old.
Vitamin D. Infants can produce their own vitamin D if they receive enough sunshine, at least two hours per week. The American Academy of Pediatrics suggests supplementing vitamin D for those infants who are exclusively breast-fed from as early as birth to two months, with a dose of 200-400 IU per day.
Vitamin C. May be lacking in breast-fed babies whose mother does not consume enough citrus fruits. A supplement of around 35 milligrams per day is recommended.
I advise you to look at the amount of vitamin and minerals contained in supplements before you buy.
-- Dr. Donya
Dear Dr. Donya,
My daughter, Shirley, aged seven and a half months and weighing eight kilograms, has the heart problem VSD, but never appears blue. The doctor said she should be operated upon, but it can wait until she is one year old. Do you think it will affect her lungs? I would prefer that she is not operated on. I have attached two pages of information on her condition.
-- Siska
Dear Siska,
Shirley has Tetralogy of Fallot (TOF), which is a combination of four defects; a hole in the ventricular septum, (VSD); a narrowing passage between the right ventricle and pulmonary artery (pulmonary stenosis); a shift in the connection of the aorta to the heart (overriding of aorta); thickened muscle in the right ventricle (Right Ventricular Hypertrophy or RVH).
Most of these patients display symptoms such as blue "cyanosis", difficulty breathing during exertion, squatting or hypoxic spells. If the patient does not display any blue appearance, called "acyanosis", then they do not usually have any of the symptoms above but will gradually develop cyanosis between the age of one year and three years.
As I wrote before, this condition needs surgical correction, and early surgical repair protects the right ventricle function and has the best outcome.
The right time to operate depends on the infant's condition. If there is severe cyanosis, a surgeon will conduct a palliative (partial correction) to increase blood flow to the lungs and can operate as early as a newborn or a baby of three months.
If asymptomatic, the operation is more likely to involve a "total correction", which can be done on an infant as early as six months depending on the facilities and the surgeon's experience.
Normally, it will be performed when the child weighs between 10 kilograms and 15 kilograms or after the child is one year old. The procedure will involve a total repair of the defects, which includes patch closure of the VSD and the widening of the stenosis by cutting the narrowing tissue and replacing it with a fabric patch. There is no hurry for the operation but the earlier would be better in terms of preventing complications such as a brain abscess or thrombosis in the brain.
For the lungs, Shirley's condition causes less blood flow to the lungs, which in most cases causes symptoms such as a blue appearance and hypoxia. After the operation her lungs will receive more blood.
-- Dr. Donya
Questions? Contact Donya Betancourt at drdonya@hotmail.com or features@thejakartapost.com.