When do kids need food supplements?

Dear Dr. Donya,

1. Up to what age should a normal child be given vitamin supplements? My elder daughter, 5, eats properly but I am not sure she gets enough vitamins.

2. How many calories does a five year-old need per day? Also, what is the maximum amount of carbohydrate, protein and fat that should be included in the daily menu?

3. My younger son, 3, eats well. But he's not gaining weight. Why? He is only 17kg. What is ideal height/weight for each particular age?

4. At what age is a child old enough to start swimming classes? When should children learn to skate?

5. My daughter often complains of pains in her leg and hand before going to sleep. Why is this? Can young kids get rheumatism? She is moderately active.

Thank you,

Vidya Soundar

Answer:

1. This is a common question that all parents want to know. Vitamins are substances that the body needs to function but the body cannot make. We get them from the variety of foods we eat, such as carrots (vitamin A), fish (B), orange (C), milk (D), spinach (E), cheese (K).

Vitamins are important because your body needs them to grow and develop strong teeth, healthy skin and hair and the more important functions such as vision and healing. As vitamins come from natural foods, it is not recommended to give supplements (taking extra vitamins in syrup or pill) for a healthy child who eats a variety of good foods.

However, children who do not eat a variety of good foods should take vitamin supplements.

2. A five-year-old girl needs 85-90 calories per kilogram weight per day. Protein should be 7 percent to 15 percent of caloric intake, fat should be 30 percent to 50 percent of caloric intake, and the remaining 50 percent to 60 percent of calories should come from carbohydrates.

Calorie is a measure of energy that is supplied by proteins, carbohydrates and fats. Each gram of protein or carbohydrate supplies 4 calories and each gram of fat provides 9 calories. So, if she weighs 20 kg, she should get 1,700-1,900 calories/day, lets say 1800 calories/day. So she should consume 126-270 calories/day (7 times 1800 divided by 100) which are proteins -- 31-67 grams/day (126 divided by 4); fats around 540 calories/day or 60 grams per day and carbohydrates 1,100 calories or 275 grams/day. This is a basic requirement for a normal healthy child; a child that is ill or involved in organized athletics will need more energy.

3. As children grow, they run, play and use a lot of energy and also their body shape changes over the years. That's why after 2 years of age, the average child gains 2 kg per year.

Growth charts are a good reference to check nutrition status, they comprise a series of curves called "percentiles" that illustrate growth of children. Serial measurement is the most accurate indication of physical growth. Your child is age 3 and weighs 17 kg. I think he is in good shape because by the growth chart 50 percent of 3-year-olds weigh 14 kg. The average 3-year- old's height is 95 cm.

4. Theoretically, children are not ready for formal swimming lessons until after their fourth birthday. My idea on what age to start swimming depends on where you live. If you live near a pond, there is no harm in starting swimming lessons at infancy or toddler age.

Infants and toddlers always love water, you can introduce young children to the joy and the risks of being in water but you have to closely supervise them as they are at high risk of drowning.

The right time to learn skating is when your child's motor and balance skills function well, usually around 6 years old. Prevent injury by using proper equipment (like helmet and padding) and do not learn to skate in the street or near water.

5. Yes, kids can get rheumatoid arthritis, which is called "juvenile rheumatoid arthritis"(JRA). It is an autoimmune disease, meaning the body fails to recognize normal cells and stimulates white blood cells to react and destroy normal cells.

The symptoms are swelling, redness, heat and painful joints, for example knee, wrist, fingers, or hips. The child usually has high fever and a rash.

I can't tell you why your daughter feels pain in her legs and hands before going to bed. One condition happens in normal children when their bones are growing, the bone will stretch muscles and tendons around it so pains may occur in limbs -- called "growing pains" and typically aggravated by exercise and relieved by rest.

If your daughter has any constant pain you should take her to see a doctor.