Lubbock hospitals have reported some measles patients showing signs of Vitamin A toxicity. Here is what you need to know about Vitamin A and measles.

What is Vitamin A?

We all have Vitamin A in our bodies. It helps with our vision, bone growth, cell development and immune system. This vitamin is naturally found in a lot of our food. Vitamin A deficiency is very rare. Most people have one to two years’ worth of Vitamin A stored in our livers!

Less than 1% of people in the United States have a Vitamin A deficiency.

Putting too much Vitamin A into our bodies at once, like with a supplement, can be harmful.

Taking Vitamin A supplements, especially at the dosages some people are recommending on social media, will likely cause Vitamin A toxicity.

A deeper look

Vitamin A is stored in the liver. The liver releases the right amount of Vitamin A into the rest of our bodies as needed. But when there’s too much Vitamin A, our bodies cannot process or store all of it. This can throw many of the body’s systems off. Too much Vitamin A flooding the body can cause vomiting, dizziness, blood clotting issues and liver damage.

For more detailed information about how this works, check out this article.

Toxic doses

Some social media posts recommend doses of Vitamin A that are dangerous.  Even a one-time high dose can be toxic. Our bodies can only handle so much Vitamin A at once.

Main takeaway: You and your child do not need to take Vitamin A, and taking it can cause harm.

Symptoms of Vitamin A toxicity

Acute toxicity happens when someone takes a toxic amount of Vitamin A.

• After 12 to 24 hours of toxic dose: headache, nausea, vomiting, lethargy, blurry vision, muscle and joint aches, dizziness.
• Chronic toxicity happens when someone takes too much Vitamin A over a period of time. These symptoms include:
• Skin lesions, skin lesions, dry and cracked lips, painful joints and muscles, fatigue, depression, anorexia, poor muscle control, alopecia (hair loss), visual impairment, blood clotting issues and liver damage

A deeper look

Where did this misinformation come from?

When someone has measles, their Vitamin A levels decrease. Because of this, people with the measles are sometimes given Vitamin A to make sure they do not develop deficiency.

But taking Vitamin A does not prevent measles. It should not be taken without a doctor’s recommendation.

Main takeaway:

Vitamin A supplements can cause toxicity in people, especially children. Some people urging people to take Vitamin A on social media are recommending doses that are far too high to be safe for children.

Vitamin A should only be taken at your doctor’s recommendation. The most effective and safest prevention against measles is the MMR vaccine. The MMR vaccine has helped keep us safe from measles for decades.

If you have questions about measles, the MMR vaccine or Vitamin A, talk to your doctor.

"What happens if my child eats all of my adult vitamins?"

We received this question recently. Let's discuss.

Just like any adult medication, vitamins should be locked away so that kids can't get to them. Vitamins are particularly risky because, while they may seem harmless, ingestion of multiple vitamins can be dangerous. In addition, vitamins are colorful and often made in forms that kids love to eat (chewables and gummies).

Vitamin toxicity can occur if a child is taking a few extra vitamins per day or if a child ingests a large amount of vitamins in one sitting.

The most dangerous vitamins ingested by kids are the fat soluble vitamins (A, D, E and K) and iron. Other vitamins and minerals can cause problems as well, but many are passed in the child’s urine without concern.

If you suspect your child has ingested a large amount of any vitamin, call Poison Control at 1-800-222-1222.

They can help you asses the amount that the child ingested and what the risk is.

Most commonly your child will have some stomach upset with or without vomiting. Severe toxicity can occur with Vitamin A and iron, which can lead to multiple problems and ultimately lead to death.

Hope this helps. Just remember to keep all medications locked away and out of reach of your kids. 

Doc Smitty

“They often times ask me if they should give their child a vitamin,” Dr. Mangham said. “Generally speaking, kids do not need to take a multivitamin or any supplements, for that matter.”

What is better than a multivitamin a day?

1. A good night’s sleep - every night.
2. A healthy, well-balanced diet.
3. Exercise and outside time
4. Good hand washing before meal time.

Dr. Mangham said going back to the basics with the above recommendations will boost your child’s immune system much more than any supplement could.

Recently, the New York Attorney General’s office cracked down on many major retailers, saying the herbal supplements they were selling didn’t live up to the promises on the label.

Joel Steelman, M.D., an endocrinologist at Cook Children’s said the quality testing program that stores such as GNC plan to put in place is a positive start, a lot of the herbal supplements have little hard science to really back up effectiveness.

“In my opinion, herbal supplements don’t really have a place for use in children,” Dr. Steelman said. “I’ve done research in the past on behalf of families asking about alternative treatments to use along with their child’s diabetes care. Most of the research is very weak. I suspect that very weak describes most data on use in children, and there’s a variety of medical case reports on negative effects of supplements on children.”

Jessica Holy, a Cook Children’s dietitian in Neurology, is frequently asked what vitamins and/or supplements are worth taking. She said that answer differs for parents and their children.

“Most of us have heard that if we tend to eat a variety of foods, then we don’t need a vitamin/mineral supplement. There is truth in that,” Holy said. “If you usually eat several servings of fruit, vegetables, whole grains, calcium-rich dairy and quality protein sources daily, then you are likely meeting your need for most vitamin and minerals. But how many of us have diets like that? Even though I’m a dietitian, I freely admit that I do not have a perfect diet. The busy pace that most of us keep makes it difficult to plan healthy meals for ourselves and our family. We often find ourselves turning to grab-and-go options at the grocery store or fast food. If this resembles you, then taking a regular, adult multivitamin daily may be a good idea.”

In children, a multivitamin might be needed during times of fluctuating appetite and food jags (only eating a few specific foods). For instance, children who aren’t getting enough iron in their diet may need to take an iron supplement for a period of time, until they begin eating more protein.

For the most part, children are able to get their needed vitamins through what they eat. Infants get their necessary vitamins through breastmilk (including routinely fortified with supplemental vitamin D) and/or formula intake and toddler and school-aged children are often able to achieve their need for calcium and vitamin D by drinking milk.

But beware excessive milk intake (greater than 24 ounces daily).

“Milk has some good nutrients, but it is lacking in iron,” Holy said. “Children who drink large quantities of milk are not often hungry for regular meals that provide iron-rich foods.”

If your child is allergic to milk, talk to your pediatrician for alternatives.

Bones are 70 percent calcium, and it is minerals such as calcium which give bones their hardness for protection and support. What most people may not know is that bones also serve as the calcium bank of the body. There are daily deposits and withdrawals of calcium from bones. Calcium is vitally important in other organs in the body – mainly muscles. Without enough calcium, a person’s heart may beat out of rhythm or even stop! The release of calcium from bones prevents dangerously low calcium levels in the body.

Most people recognize strong relationship between calcium and vitamin D. The job of vitamin D is bringing calcium from foods eaten into the body for use. It also helps bone store calcium.

There are two prime time periods in a child’s life requiring enough calcium and vitamin D. Rapid growth happens in both of these periods which are infancy/early childhood and adolescences.

Rickets is the consequence of not enough calcium delivered into the body during infancy/early childhood. Bones are soft without enough calcium and can bow/deform or even break. Low calcium levels lead to muscle weakness and irritability.

The signs/symptoms of not enough calcium or vitamin are much harder to see in adolescence. Osteoporosis and easily breaking bones is possible in severe cases. However, most teens will have no symptoms. However, the worry is that teens without enough calcium in their bones risk osteoporosis or other bone problems occurring earlier in adulthood.

Bone health is even more important in medically complicated children such as those followed at Cook Children’s Bone Health clinic. Children such as those with childhood cancer, digestive disorders, rheumatoid arthritis, cerebral palsy, or osteogenesis imperfecta (brittle bone disease) are at high risk for bone breaks and daily bone pain. They often require other treatments in addition to supplemental calcium and vitamin.

The beginning of good bone health for otherwise healthy children begins with a good diet with enough calcium and vitamin D. It is sometimes hard, however, to know how much calcium or vitamin D is needed or if a child should take a supplement.

Recommended Intake

Dietary Reference Intakes – Recommended Dietary Allowances (meet needs of 98% of the population) IU= International Unit

Eat and drink low-fat or fat-free dairy (best source of calcium)

2-8 years: 2-3 servings per day 9-18 years: 3-4 servings per day

Sources of Calcium and Vitamin D in the diet

Calcium or Vitamin D supplementation?

Calcium supplements may be the best way for you to get enough calcium if you cannot meet the recommendations. Dairy sources of calcium are better absorbed than non-dairy sources so individuals with milk protein allergy or lactose intolerance may have trouble meeting their needs. When using supplements be careful of high intakes of calcium as it can lower absorption of other minerals like iron.

Due to low availability of Vitamin D from foods, supplementation may need to be considered even when a deficiency is not present.

For more information on finding the right supplement visit www.FDA.gov or www.usp.org.

But, here goes …

Our intestines are full of bacteria that help us to break down food products and whose function has an effect on immunity and possibly allergies. These bacteria can be called “probiotic” organisms.

1.What are probiotic/prebiotic supplements?

Probiotic bacteria can be given as a supplement which can be mixed in with foods, beverages or given as a supplement (similar to a vitamin).

Prebiotics are substances which, when ingested, help to increase the number of probiotic bacteria in the colon. Prebiotics are typically small chains of sugars that humans cannot digest or use. They can be ingested in beverages or nutritional supplements and are even added to some formulas.

2.Are they safe?

Studies suggest that the use of probiotics is safe in healthy infants and children. However, some patients might be at risk:

Children who have abnormal immune systems such as ill preterm babies or children with implanted catheters (or other medical devices) should consult with their doctor because infections have occurred as a result of giving probiotics in these groups. Studies have also shown that adding prebiotics to infant formula is safe.

3.What conditions do they work for?

Infectious diarrhea (stomach bugs)

Some evidence suggests taking probiotics might prevent cases of infectious diarrhea, particularly in day care centers, but the effect is very small. It would take about seven kids taking the probiotic daily to prevent just one case of diarrhea, thus I don’t recommend use of probiotics to prevent diarrhea.

Once diarrhea has started, there’s pretty good evidence that starting probiotics may decrease the time of a child having diarrhea by as much as 40 hours. So it would seem good to provide probiotics at the first sign of infectious diarrhea. The effect was greatest with a probiotic known as Lactobacillus rhamosus GG (LGG).

Antibiotic associated diarrhea

Diarrhea is a common side effect with children who are taking antibiotics. Studies have shown that taking may decrease the child’s risk of developing diarrhea. Once again, the effect is small as it takes seven kids taking the probiotic to prevent one episode of antibiotic associated diarrhea. However, because it only requires the child to take the probiotic during the course of the antibiotic, this seems like a reasonable approach. Treating antibiotic associated diarrhea once it has already started does not appear to be helpful.

4.What conditions might they work for?

Eczema and allergies

Studies have been mixed on the use of probiotics for both prevention of and treatment for allergic diseases (including eczema). One of the major problems is that these diseases often are difficult to study because they are difficult to define and assessment for improvement is often subjective.

Colic

Some early data suggested that probiotics might be helpful for infants with colic. This is also very difficult to study as definitions for colic are wide and varied. It’s hard to even know if colic is a real, definable illness or just a baby that cries a lot. Further information and studies would be necessary in order to fully recommend probiotic use.

5.What’s next?

As we learn more about the normal bacteria that live in our intestines and how variation of the amount and type might contribute to disease, I’m hopeful that we’ll continue to see conditions for which probiotics are safe and effective.

That's one of the most common questions I get while doing my AMAs on our Willow Park Pediatrics Facebook page. 

The answer I give, most of the time, is - nothing.

Here's a few points about vitamins. Short and simple.

1. If your kiddo eats a well-rounded, healthy diet, they don't need a daily vitamin. This means meats, milk, veggies, fruits, and whole grains daily.
2. If your kiddo has a "bad day" - a.k.a. a chicken-nugget, mac-and-cheese kinda day, offer a simple chewable children's multivitamin that day.
3. Limit your child's milk intake to 20-24 ounces or less per day. While we love the calcium and Vitamin D in milk, it hinders the absorption of other vitamins, like iron, and fills kids up so they don't eat the other foods they are supposed to eat.
4. Large doses of certain vitamins can actually be harmful. Be careful of natural websites/naturopaths who claim "megadoses" of vitamins can cure ailments. Be especially careful with kids, as there is lacking research about this and some bad side effects can happen.
5. If your child is a vegan or a vegetarian, or allergic to milk, they need a daily vitamin. Talk to your pediatrician about this.
6. Certain medical conditions require vitamin supplementation. Think food allergies, GI tract disorders like celiac and Crohn's, and endocrinologic (hormone) problems. Talk to your doc.
7. Vitamins can have SIDE EFFECTS! Yes! Vitamins! For example, B vitamins are associated with night terrors and nightmares. Other vitamins can cause nausea, dizziness, vomiting, headaches. They're similar to medications, folks - yet not as strictly regulated by the FDA - and you have to be careful with them.

Cook Children's published a good article about vitamins a few years ago. Check it out!

Hugs,

Dr. Diane

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