Joanne Roach (00:13)
Hello and welcome to the Food for Kids podcast. I'm Joanne from the Foodies. Today is the first of a two-parter about vitamins and supplements for children.
There's a lot of wellness information online for parents right now between ultra processed foods and gut microbiome information and allergies and deficiencies and picky eating advice. It's hard as a parent to know whether or not you're meeting your child's needs. And for sure, there is always someone trying to tell you something. And unless you have the time and skills to dig into the nutrition recommendation, you can be left thinking that maybe you're letting your child down if you don't investigate or try out some of the things you're being told you need for them.
So I wanted to ask an actual dietitian who has to work within proper evidence-based guidelines to untangle some of that noise for us. So I invited dietitian Sara Dawson to come and answer a load of the questions I see getting asked online about supplements.
Sara is a highly specialist allergy dietitian working for over a decade in two NHS allergy centres of excellence and also privately through her company YNRD Ltd. Because of these roles, she's had to work with lot of clients who've had complex nutritional gaps because of restrictions for allergy. She's also worked with lots of families on their general relationship with food and through CAMHS with adolescents with eating disorders, all of which means she's keen to ensure that families don't get sucked into supplements and treatments which are unnecessary, not evidence based and potentially can cause more harm than good. She has some great no nonsense reels on her Instagram about supplements, so I thought she'd be perfect for this Q &A.
In this first episode, we're going to talk through the guidelines for children in fairly average families. So where there are no particular medical needs or dietary restrictions that might need special consideration and during everyday life phases with nothing noteworthy going on.
And then in the second episode, Sara is going to talk through some more special circumstances, for example, times of life upheaval and families with allergy or ethical considerations.
Obviously in both episodes, her advice is for general information purposes only to give you some information about the UK guidelines and it does not replace the need to get personalised advice for your child from a GP or dietitian, especially if you've got any specific concerns, but hopefully it will give you a sensible starting point that cuts through some of that online noise. So let's get started with part one.
Joanne Roach (02:38)
Sarah, I know a lot of parents listening to this will at some point have either bought supplements for their child or they'll be wondering whether they should have. And a bit later on, I'm going to ask you advice about specific situations for people who are dealing with different issues. But firstly, for families listening who are eating a fairly average diet. So they've got some home cooked foods, maybe some convenience food mixed in, their kids are eating some fruit and veg, but they're not perfect, they're not eating a massive range, like a normal, “imperfect, but trying hard” kind of diet. Should those families be buying any supplements for their children?
Sara Dawson (03:09)
Yeah, that's a really good question actually because there's so much fear mongering around children's diets as a whole. And I know that you can just go into a pharmacy and there's whole rows of all different types of children's supplements. So I do understand how overwhelming it can be. So with this answer, obviously, I am going to be talking in general know, if you have your own medical team, then please, this doesn't kind of replace that advice. And if anyone listening does have any immediate concerns, then please speak with a health professional. The other thing that I would say is it does depend on where you are in the world, on what vitamins are recommended. So all my answers today will be based on the UK because obviously that's where I trained and that's where I work.
So the best place to look if you might consider yourself as a standard family, if you're managing to get some fruit and veg in there and some shop easy foods and some homemade, the best place to look is the government recommendations. Now the UK government recommends that all children from six months to five years, providing they're having less than 500 ml of formula have vitamins A, C and D daily within their diet as a supplement. Now again, if I saw a patient and I looked through their whole diet, I as a dietitian could then say, actually, I don't think you need this. But as a general rule of thumb, that is what is recommended. Interestingly, the SACN report, which is a 500 page report came out in 2023, the recommendations at the end were yes, vitamin A supplementation, yes, vitamin D supplementation, but they did see that actually most children were meeting their vitamin C requirements.
Joanne Roach (04:47)
Okay.
Sara Dawson (04:57)
However, with vitamin C being a water soluble vitamin, you can wee out excess of that and where a lot of the vitamins out there that contain A and D will also contain vitamin C. They said there's no harm in continuing to take that as well.
If your baby's under six months and you're breastfeeding, the recommendations are for vitamin D drops daily. And then if you're over five, all the way up into adulthood, as a general recommendation, vitamin D daily is recommended from the months around October to March. The reason being for this is because being in the UK we don't get a lot of sun during that time and our best source of vitamin D is from the sun. So it's the UVB rays. There are
groups of people who are higher risk of not being able to achieve that. So those who are indoors a lot, those who have darker skin tone, it's much easier if you have a lighter skin tone for you to absorb more from those UVB rays and turn it into vitamin D. And if you're someone who covers up a lot, what I would say though is if you're wearing sunscreen, that also blocks out the UVB rays as it should. So if you're wearing that all throughout the year, which really we are recommended to do so, then you're not going to be absorbing it from the sun. So actually quite a lot of the time, I do recommend vitamin D every day throughout the year. Obviously there'll be caveats depending on who you are.
Joanne Roach (06:14)
Okay so we're looking at vitamin D drops for the first six months when breastfeeding and then we're looking at A, C and D up to about school age and then school age onwards we're looking at vitamin D definitely in the winter and consider whether it should be all year round.
Sara Dawson (06:27)
Yeah, and just bear in mind that if your little one is taking formula, that will normally be supplemented with those vitamins. And that's where it's advised that if they're having more than 500 ml of that, you don't need to be supplementing with any vitamins.
Joanne Roach (06:40)
Okay cool. And thinking about winter bugs and immune system you mentioned vitamin C. Should we be giving vitamin C when they're not sick but there's bugs around to help fight bugs off?
Sara Dawson (06:50)
So this has been something that's been going on for years. Not that I've done loads and loads of research in this area, but certainly back in the 1930s, they thought vitamin C might help respiratory conditions. And then in the 1970s, they concluded that vitamin C is a preventative for colds. So that's where this idea of vitamin C, if you've got a cold, oh take some vitamin C. Now about two dozen studies have been done since then. Unfortunately, they don't show that taking vitamin C when you have a cold has any kind positive impact unless of course you're C deficient, which is very, very rare in the UK. And that's a whole host of other symptoms. But as we're talking about children here, a good number of studies have shown that if a child is supplementing with vitamin C before they get the cold, it can reduce amount of time that they have the cold and the symptoms by about 14%.
Joanne Roach (07:39)
Okay.
Sara Dawson (07:40)
So if they have a cold for 10 days, if they've been supplementing beforehand, it'll maybe be about a day and a half less. There have also been studies to show that the severity of the symptoms can be reduced as well. The recommendations aren't necessarily to take vitamin C, but if you feel that you or your children are typically always getting colds in the winter, it probably won't be doing any harm to be supplementing with C as you go into those months where more colds around. But it's not a massive impact.
Joanne Roach (08:07)
If you wanted to do that, that would be just around the recommended daily amount, not the sort of crazy high amounts.
Sara Dawson (08:14)
So the studies that were done was about 200 milligrams of vitamin C up, but of course don't be supplementing with really high levels of anything with children certainly. But the nice thing about vitamin C is it is water soluble. So a lot of it you can wee out, but it doesn't mean that you can't get toxic levels if you're going a bit too crazy with it. But yeah, unfortunately it won't stop a cold.
Joanne Roach (08:39)
And on iron, people worry a lot about iron especially if their children are being a bit fussy about different foods, they worry they're not getting enough iron. How common is it for children to need extra iron and can can you figure that out by looking at what they've got in their diet? Do we need to look at symptoms or do they need tests before you put a supplement in?
Sara Dawson (08:55)
So obviously, yes, a big part of my job is looking at children's diets, seeing if they've got adequate amount of iron in their diet. But people who are going to be listening are not trained like I am to be able to do that. So I think what's really important is looking at how common iron deficiency anaemia is in the UK. And it's pretty low. So it's about 1% to 4% children. Obviously, if your child is particularly fussy, then actually I'd really recommend that you're not just kind of buying to try and sort their diet out and actually seeking some professional guidance on that.
Also do speak with your GP as well because you can get blood tests.
So the symptoms to look out for with iron deficiency anaemia is if your child is abnormally fatigued, so not they've had a bad night's sleep or they've been unwell and they're tired.
And also just pallor as well, they can be abnormally pale you can get dark under eyes. it can actually impact appetite which is a really mean symptom because if you're low in iron what you want to be doing is probably eating more iron and if your appetite is reduced that's going to make it a lot harder. So yeah, always speak with a health professional if you're concerned about that.
Obviously there are going to be people who are higher risk than others, children or babies who get to six months and then weaning is delayed for one reason or another, that can impact on whether they're getting enough iron, especially as the more milk they have that can affect the absorption of iron and also because they're having more milk they might not be eating enough and therefore that will affect the intake of the iron. There are certain cultures where they focus a lot more on carbohydrates which might be kind of rice and potato and therefore they're not going to be getting a lot of iron that way.
And also, and as with a lot of nutrition, it can also depend on socio-economical status, you know, food deserts, things like that, where you're potentially having to rely on more processed, less nutrient-dense foods, which can impact on your iron and your child's iron intake as well.
Joanne Roach (10:53)
So basically if you're noticing a change in tiredness, inability to concentrate, that's different for that child. If they may be bit paler than they normally are and maybe if their appetites have dropped then go and see your GP, see if you can get a blood test. Don't look at supplementing until you've checked out with somebody whether or not that might be the cause of the problem because it's likely to be quite rare.
Sara Dawson (11:14)
Yeah, exactly. And also you don't want to be assuming that it's iron when there might be something else that's going on. And also supplementing with iron, if you have too much iron, can be toxic. there's lots of ways of getting iron in your diet via food. So you don't have to necessarily supplement.
Joanne Roach (11:33)
So that's part one of the two-parter and covering the basic UK guidelines for babies and children on vitamins A, C and D and some things to look out for on vitamin C and iron.
And as always, your child and your family are individuals, so the guidelines are there to give you an evidence-based starting point. But if you have any concerns about your child, you should always go and see your GP or a properly qualified children's food professional like Sara. I will link to Sara's Instagram and website in the show notes and I'll also link to the Find a Dietitian page on the British Dietetic Association website if you want to find an in-person appointment locally. But hopefully these recommended guidelines will have been some help.
In next episode we'll have part two of this chat and Sara will talk to us about things like times of upheaval or fussy eating when we worry our children aren't getting everything they need in their diet, allergy families and plant-based diets, and also some of the supplements being pitched as support for behaviour and wellbeing like magnesium and vitamin B12. So I hope to see you on that episode and in the meantime, happy eating.
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