TO GIVE OR NOT TO GIVE
Do vitamin and mineral supplements affect child growth and development?
By Roger Badillo II, Contributing Writer
So much has been said about unhealthy lifestyles of adults. Unfortunately, children are easy to adopt these lifestyles themselves. Computer gaming and web-based recreation have replaced physical games and activities. Likewise, instant meals have become staple food, poorly prepared and hastily taken, at irregular times of the day, and are a woefully inadequate source of nourishment in today's households. Many mothers who work away from home find it increasingly difficult to look after their children's daily diet, not to mention problems with breast-feeding.
It is not surprising that most parents today are also looking to provide their children with dietary supplements. Parents are concerned that their children are not getting enough nutrition with their diet, especially since taking the next meal is not necessarily tops in a child's list of to-do priorities. Also, milk and dairy products are making up a smaller percentage of children's diet owing to a variety of reasons.
Physiologic anorexia
Providing nutritional supplements and vitamins for children seems justified these days, says Dr. Merle Sacdalan-Faustino, consulting pediatrician at the Dr. Fe Del Mundo Medical Center. But there are various factors to be considered before giving dietary supplements to a child. "It depends on the age. [Those] usually at high risk are below six years of age. Incidence of malnutrition for that age is very high, so that's the reason we ought to give supplements-because the food itself is not going to be complete. Plus the fact that physiologic anorexia comes in, at six months to two years of age,
talagang ayaw nilang kumain so definitely you have to give something. During preschool, usually because of the increase in activity, and also due to school pressure, they cannot eat properly. So there is really a need to give supplementation."
Whether or not children need nutritional supplements and extra vitamins is best determined by the child's pediatrician. Parents are not to assume that just because a vitamin supplement is effective for the adult it will necessarily work for the child. Children have different metabolic and nutritional needs. More important, vitamins should not be treated as a cure-all for every condition and every disease. There is no single vitamin pill or dietary supplement that protects against every other disease or provides optimal health per se. More importantly, vitamin supplements cannot, and should not, be made to make up for a child's poor diet. Proper nutrition has always been the cornerstone of health and well-being for children and adults alike. Supplements may provide a much-needed health boost among malnourished individuals, but they are not intended to replace a healthy and well-rounded diet.
Unmet requirements
As far as babies are concerned, breast-feeding is ideal, as recommended by the World Health Organization. Sacdalan-Faustino explains the reason for some obvious difficulties: "The ideal setup should be breast-feeding. Usually
hanggang six months lang naman talaga pwede ang breast-feeding. After that you have to give your complementary feeding and supplementary feeding. So you add up your solids. And then from the solids [not all vitamin requirements would be met] because each child should be receiving [vegetables twice a day and fruits thrice a day] and thrice a day of fruits.
Kaya bang kainin 'yun ng isang bata, e tayo ngang adults minsan ayaw kumain din, how much more
ang mga bata?"
In addition, there are also working mothers who have to leave home every day and are unable to continuously breast-feed their infants. "This is also one aspect, which is the reason infant-food preparations are being fortified with vitamins. That is the latest recommendation from the WHO and DOH (Department of Health)-to fortify these foods," adds Sacdalan-Faustino.
The lactating mother's state of nutrition and course of pregnancy also warrant consideration in the overall feeding picture. "You presume that the mother is also properly nourished. If the mother is not nourished, then what kind of milk is she going to produce? At the same time, in the intrauterine life, infant nutrition is already affected if the mother is not properly nourished. So nutrition starts in the intrauterine period,
hindi lang sa paglabas ng bata."
There are many available multivitamin and nutritional supplements for children under the right circumstances. More important, however, is a better understanding and awareness of some concerns associated with the use of such products. One of the bigger concerns is to know the actual content of the vitamin supplement being given to the child, including quantity and quality, which can vary among brands. It is important to have supplements with only the highest-quality ingredients to ensure safety and efficacy.
Efficacy and tolerability are the subject of controlled trials for some of these supplements. "There are already controlled trials that [prove] vitamins are really very important, especially in children with measles, providing vitamin A for epithelialization and the eyes to prevent blindness," says Sacdalan-Faustino. Iron supplementation is also important because of the prevalence of anemia among preschool children and the high incidence of worm infestation, which is one of the causes of anemia in children, she adds.
Vitamin A
Deficiency in vitamin A affects some 190 million children all over the world, putting them at risk for blindness and stunting. A study on mice at the United States Salk Institute for Biological Sciences showed that vitamin A is essential for proper development of the nervous system in a developing embryo, underscoring its importance with learning and memory throughout life. The evidence suggests that while increased amounts of vitamin A in the diet do not necessarily improve one's learning ability, complete absence of the vitamin may be detrimental to brain function altogether.
Brain foods
The brain is primarily made up of fat by dry weight (60 percent). As such, proper brain growth and development should emphasize the need to provide adequate amounts of fatty acids in the child's diet. The omega-3 long- chain fatty acid, docosahexaenoic acid (DHA), forms the building blocks of the brain and the eye's retina, and is the most abundant essential fatty acid in the brain.
In a 21-year study at the University of Queensland in Australia, researchers found that breast-fed children with optimal levels of DHA had an "intellectual advantage" (IQ points) over babies fed formula without DHA. With the finding that DHA is critical to brain development, the WHO has recommended that DHA be included in infant formulas at levels comparable to that of breast milk.
"Omega-3 is the one that comes from salmon and other fishes. It is already proven to be helpful [in child development],
merong studies na, even among children, particularly … those with some mental retardation. They cope better because it [aids] in myelinization of the nerves," says Sacdalan-Faustino.
Acetylcholine is a neurotransmitter found in the brain and the peripheral nervous system that is also critical for brain development. Choline is its major precursor, and is responsible for maintaining adequate acetycholine levels. "Choline is also good for eye development, and even more for neurologic development. Another one is iodine. In endemic areas with low dietary iodine like mountainous areas, iodine should be given for better brain development."
Sacdalan-Faustino notes that milk companies try to emphasize components in their products to entice consumers, like the short-chain fatty acid, oleic acid, which is also essential for brain development; bifidus, which acts as an antidiarrheal; and DHA.
"These are all different ways of trying to simulate the real contents of breast milk, since all of these [micronutrients] are contained in breast milk; others, such as taurine, chlorella growth factor, or glycine for appetite stimulation," she explains. Another vital micronutrient is zinc, which is important for cellular metabolism. "Children with pneumonia and chronic diarrhea are supposed to receive zinc for better epithelialization and faster healing."
According to Sacdalan-Faustino, there is now testimonial evidence that children benefit from supplements, "so there's no harm if you try. There are even friendly pathogens or nonpathogenic bacilli to help prevent diarrhea in children."
So, do children need vitamins?
"In my practice I do give, because of the various growth patterns," replies Sacdalan-Faustino. "Vitamins augment whatever is missed from the regular diet, but do not take the place of a good diet. [Giving vitamins to children] has to be under the prescription and supervision of the pediatrician. It is not just about the vitamins, it is about proper nutrition. That is the bottom line, which is the foundation."
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