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Chapter 1 Index
A. General Information
about the well child examination B. Nutrition Issues
--Breastfeeding – Advantages and Disadvantages
--Breastfeeding: Resources and Frequently Asked Questions
--Formulas – Which
Gets Used When?
--Nipples, Bottles, Feeding
--Solid Food Introduction – Questions Parents Might Ask |
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The Confusing World of Vitamins
Introduction: Millions of children take unnecessary
supplemental vitamins in the US; 54% children take supplemental vitamins.
Should pediatricians make a point of advising people that they don’t need to
give their children these vitamins? As practitioners, we find this a
difficult task to achieve, because there are a number of vitamins that are
critically important to maintain children’s health:
| Vitamin |
Indicated Reason to use |
| A |
Measles treatment: increases
survival by 50%; no benefit for RSV, anemia, growth. Does prevent
reaction to measles vaccine, xerophthalmia, possibly BPD; too much:
pseudotumor, diarrhea. |
| B1 |
Prevent Beriberi, Wernicke’s
encephalopathy |
| B6 |
Seizures, infantile spasms;
prevents growth failure in breastfed |
| B12 |
Pernicious Anemia |
| C |
Reduces common cold in 23%;
no effect: asthma or allergy |
| D |
Rickets prevention and
treatment |
| E |
Treats dry skin; prevents:
retinopathy, peripheral neuropathy; some cardiologists recommend extra
Vitamin E for “heart-healthy” behavior (antioxidant) |
| K |
Liver disease treatment;
prevents hemorrhagic disease of newborn |
| Folate |
Prevents neural tube defects
(prevents 72% of the recurrences)
Given in sickle cell anemia
Reduces level of homocysteine (elevated in premature heart disease,
stroke) |
Problems:
- Vitamins are said to do much more than listed above: implicated in
illness prevention and treatment of 67 conditions ranging from acne to
vitiligo:
www.greatearth.com/consumer/ailments With the growth of herbal
medications, the pediatrician’s job is to try and maintain a balance
between what we know and what the proven effects are of both vitamins and
herbs.For example, at
www.realtime.net/anr/vitamins, the information is terrifying and
implies that if you don’t take supplemental vitamins, you will go blind,
tremble, itch and burn, have poor circulation, have low energy, hair loss,
and yes even constipation.
- Many of the above effects of vitamins were not know until recently.
For example, the benefits of taking folate for prevention of neural tube
defects have only relatively recently been recognized. What other
beneficial effects of vitamins do we not know about?
- There is merging of the effects of supplemental vitamins and
alternative (herbal) medications. They need to be considered separately.
What do we tell parents? Supplemental vitamins are not needed for
children with poor appetites, who don’t eat vegetables. However, there are
situations such as those listed above for which we do need to give them;
also, this list is in constant flux.
Written 10/2001
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