1. No category

Vitamin and Mineral Supplement Needs in Normal Children in the United States
Lewis A. Barness, Peter R. Dallman, Homer Anderson, Platon Jack Collipp, Buford L.
Nichols, Jr, Claude Roy, W. Allan Walker and Calvin W. Woodruff
Pediatrics 1980;66;1015
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PEDIATRICS is the official journal of the American Academy of Pediatrics. A monthly publication,
it has been published continuously since 1948. PEDIATRICS is owned, published, and trademarked
by the American Academy of Pediatrics, 141 Northwest Point Boulevard, Elk Grove Village,
Illinois, 60007. Copyright © 1980 by the American Academy of Pediatrics. All rights reserved. Print
ISSN: 0031-4005. Online ISSN: 1098-4275.
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AMERICAN
Committee
ACADEMY
OF
PEDIATRICS
on Nutrition
Vitamin
and Mineral
Supplement
in Normal
Children
in the United
The
creasing
last 50 yeas
understanding
tamins
and
trace
nutrition
has
also
have
minerals
and
intermediary
been
a growing
sometimes
dramatic
mineral
nutritional
needs
essential
vitamins
into
older
certain
mental
to be
used,
tively
tion;
inexpensive
therefore,
used
by
dietary
less
more
mineral
portion
are
in a wide
range
stone
for
good
health
array
of
ailments
from
are
or
Others,
mental
the
ency
conditions,
inborn
metabolism,
on
far
supple-
drugs.
require
Many
children
pharmacologic
should
be individually
those
of
nourished
errors
of vitamin
related
with
doses
or mineral
to the
these
of
prescribed
intake
disorders
vitamins,
by the
of
may
which
physician.
Currently
available
vitamin
and mineral
preparations
for infants
and children
in the United
States
are in accord
with
Food
and Drug
Administration
regulations89
in effect
until
early
1979. These
regulations,
designed
to minimize
misuse,
covered
the
specific
and
vitamins
maximum
New
regulations
probably
the
and
mineral
general
pub-
regulations
lowances
RDAs
by
the
tablished
sex, and
PEDIATRICS
are
may
be
use updated
(US
and
and/or
the
minimum
required
by
Academy
the RDA
in
the
based
on
Food
and
of
and the
dietary
66
No.
US
in
the
The
new
and
Daily
will
Al-
revised
Nutrition
1980
Board,
The
distinctions
RDA
are as follows:
allowances
for numerous
age
they are periodically
Vol.
preparation.
somewhat
different
US Recommended
RDAs),
developed
National
between
© 1980
minerals
allowed
women.
a wide
to
and
levels
multivitamin
and/or
multimineral
supplements
for
infants,
children,
adults,
and pregnant
or lactating
for
retardation
Copyright
and
inadequately
or deficiencies
recommended
PEDIATRICS
(ISSN
0031 4005).
American
Academy
of Pediatrics.
for
be reviewed.
This
statement
will not consider
special
requirements
of infants
and
children
overt
nutritional
deficiencies,
malabsorptive
other
chronic
diseases,
rae
vitamin
depend-
philosopher’s
treatment
common
cold.
As a result,
vitamin
supplements
are widely
abused
by the
lic, occasionally
to the point
of toxicity.
as
or imagined
to regard
as
The
is also
pressure
individ-
come
as
rela-
supplements
real
infants
are
need
children
in the
special
needs
of
the
low-birth-weight
mothers
usual
GOVERNMENT
REGULATIONS
AND
COMMERCIAL
PRACTICE
RELATING TO
VITAMIN AND MINERAL SUPPLEMENTS
prescripthey
are
corrected.
of doses
than
fortifica-
population.
that
have
ments
extent
without
that
mineral
will
the
with
and
will
contin-
extensive
of the
of ensuring
grounds,
of
to fortify
Supple-
of these
products
of advertising
adequacy.
Many
and/or
shortcomings
used
cereal.
supplements
consumption
a combination
about
dietary
rational
whose
aim
or tablets
and available
it is understandable
method
the
to a greater
the
vitamin
a reliable
were
also
as infant
drops
probably
a substantial
regard
with
and
infants
complete
food for infants;
to be lacking
in the diet of
mineral
of food.
Vitamin
and/or
uals
formulas
the
of the
deincor-
clearly
statement
and
and
were
This
preterm
states.
minerals
review
supplements
in normal
infants
United
States.
In addition,
There
of vitamin
more
and
considering
widespread
fostered
by
and concern
impact
and children
products,
such
and
in human
awareness
became
processed
vitamin
necessary
tion
public
an essentially
nutrients
likely
infants
food
role
in deficiency
As
providing
specific
their
metabolism.’7
clinical
fined,
ued
and
administration
porated
witnessed
a steadily
inof the biochemistry
of vi-
Needs
States
(RDAs)
groups
and
published
6 December
Downloaded from pediatrics.aappublications.org by guest on August 22, 2014
are
es-
according
to
by the Food
1980
1015
and
Nutrition
Board
Sciences,
of the
National
National
Research
Academy
Council.
RDAs
as a basis,
reference
figures
the
for
FDA established
US
the nutrition
labeling
and
supplements.
US
RDAs
three
groups:
infants,
are
children
the
RDAs
as
of foods
established
from
of
Using
for only
1 to 4 years
old,
and adults
and children
4 or more
years
scientific
basis for the types
of supplements
old. The
consid-
ered proper
for infants
substantially.
The
intention
of
changed
require
ments
to
tamins
and/or
and
children
the
FDA
multivitamin
and
contain
not
regulations
at levels
which
all
nutrients
and the
RDA.
instances,
were
upper
This
about
limits
type
previously
available
products
or multimineral
supplements
called
omitted
multivitamin
important
trients
many
preparations
of certain
nutrients,
to good
health.
contained
insignificant
and some
contained
nutrients
excessive
levels
of
harmful
The
if taken
products
dren
consist
mins
A, D, and
and
deemed
vitamin
mins
A, D,
A, D,
niacin,
B12,
and
acid
containing
reason.
C, with
or without
it
No
essential
are
attention
cause
to
is not
on
0.25,
liquid
riboflavin,
or without
omission,
0.5,
physicians
to
fluoride
supplements,
content,
or 1.0 mg
the
when
AND
also
fluoride
per
amount
fol-
in
guidelines
infants
K and
and
fluoride
to all newborn
against
infants
hemorrhagic
of
in a single,
intramuscular
dose
or an oral dose
of 1.0 to 2.0 mg.
the dose may have
to be repeated
to seven
of 0.5 to 1 mg
In rare
after
instances,
about
four
days.
Infants
further
discussion,
the
contain
vitamin
easily
particularly
small
with
respect
vitamins
in the breast-fed
human
breast
possible
milk
is in the
but
inap-
D (ie,
explanation
analogue,’5
A,
term
milk
of vitamin
amounts
One
sulfate
is that
form
of an
this needs to
be confirmed.
The antirachitic
properties
of breast
milk seem to be adequate
for the normal
term infant
of a well
nourished
mother.
However,
if the
are
ultraviolet
of
that
D in breast
absorbed
mother’s
vitamin
and if the infant
enable
SUPPLEMENT
or
was
be-
with
for vitamin
only.
a prophylaxis
Rickets
is uncommon
fant,
despite
the fact
con-
along
following
to the most
widely
used
supplements:
C, D, and E, iron and fluoride.
available
necessary,”
alone
the newborn.
This
1961 recommendastrongly
reaffirmed
in 1971’
to prevent
or minimize
the postnatal
decline
of the vitamin
Kdependent
coagulation
factors
(II, VII, IX, and X).
Vitamin
K, is considered
the vitamin
derivative
of
tionh3
22 lU/liter).
appropriate
MINERAL
disease
as
to
dose
either
in healthy
K administration
effective
about
products
K at birth
Infants
peas
Supplements
the
indications
in the text
for this
However,
these
summarizes
of supplements
the
residing
fluoridated.
prescription.
prescribe
VITAMIN
are
children
of vitamin
Ex-
disease
of the newborn
and
hemolytic
anemia
in small,
Iron
is the only
mineral
sup-
use
Vitamin
bears
supple-
available
this
are
indications.
The renewed
emphasis
on human
milk as an ideal
food
has
raised
the
question
whether
breast-fed
infants
require
any vitamin
or mineral
supplements
prior to the introduction
of solid foods.
This subject
(a) vita(b) vitamins
dietary
commercially
fluoride
available
taming
iron;
specific
administration
Table
Breast-fed
iron.
children
folic acid,
B12, with
combinations
infants
and
water
of their
vita-
is required
on the label
immedithe list of vitamins
(and
minerals)
“This
product
does not contain
the
folic
acid.”
The
foregoing
with
fluoride
for
where
infants
(a)
for
FOR SUPPLEMENTATION
children.
The
are discussed
choice
is relatively
unstable
in liquid
liquid
multivitamin
supplements
call
vitamin
areas
possibly
iron; (b) vitamins
niacin,
vitamin
young
from
folate
To
In
chil-
or without
for
lowing
statement
ately
following
in the product:
1016
with
tablets
is omitted
ments
because
preparations.
only
or without
riboflavin,
and E, and C, thiamin,
vitamin
B, and vitamin
iron.
Folic
nu-
of time.
infants
and
for
the
hemorrhagic
E to prevent
infants.’2
the
is
of:
preparations
C, with
E, thiamin,
2. Chewable
some
and
over a long period
on the market
for
drop
A, D, C, and
B,
conducive
primarily
Liquid
1.
The
Newborn
US RDA,
of the US
because
considered
except
GUIDELINES
25%
were
of regulation
are
to prevent
vitamin
premature
for
to 50% of the
100% to 150%
infants,
amples
from
is useful
addition,
amounts
for
sufficient
to minimize
risk
limits
(estimated
to fully
without
undue
excess).
In
the lower
limits
for individual
lower
limits
(considered
of deficiency)
to upper
meet
nutritional
needs
almost
used
for
to
suppleof viranged
or vitamins
and iron recommended
child
and age group.
of individual
vitamins
rarely
vitamins
plement
commonly
used
in infants,
in combination
with vitamins.
was
multimineral
combinations
appropriate
minerals
has
the
a particular
Supplements
light
D nutrition
does
not
(due
exposure
to light)’6
tamin
D daily
may
Vitamin
infants.
to dark
supplements
be indicated.
A deficiency
Historically,
has
benefit
rarely
vitamin
NEEDS
Downloaded from pediatrics.aappublications.org by guest on August 22, 2014
skin
been
inadequate
from
adequate
color
and/or
of 400
occurs
IU
little
of
in breast-fed
A supplementation
vi-
TABLE.
Guidelines
for Use of Supplements
Child
in Healthy
MultivitaminMultimineral
Term infants
Breast-fed
Formula-fed
Preterm
and
Children*
Vitamins
0
0
Minerals
D
E
±
0
0
±t
0
0
0
0
Folate
Iron
infants
Breast-fed
Formula-fed
Older infants
(after
+
+
±
±
+
+
+
±
±
+
0
0
0
0
±t
6 mo)
Normal
0
High-risk
+
0
0
Children
Normal
±
0
0
0
0
0
+
0
0
0
0
Normal
±
0
0
±
+
High-riskj
+
0
0
+
+
High-risk
Pregnant
teenager
Symbols
*
Infants
indicate:
sometimes
fluoride
in areas
that
+,
indicated;
0, that
where
a supplement
is usually
usually
is insufficient
indicated.
Vitamin
K for newborn
infants
and
fluoride
in the water supply
are not shown.
it is not
there
indicated;
that
±,
it is possibly
or
t
Iron-fortified
formula
and/or
infant
cereal
is a more
convenient
and reliable
source
of
iron than
a supplement.
:j: Multivitamin
supplement
(plus added folate)
is needed
primarily
when calorie
intake
is
below approximately
300 kcal/day
or when
the infant
weighs 2.5 kg; vitamin
D should
be
supplied
at least
until
6 months
of age in breast-fed
infants.
Iron should
be started
by 2
months
of age (see text).
§
Vitamin
E should
be in a form that is well absorbed
by small, premature
infants.
If this
form
of vitamin
E is approved
for use in formulas,
it need not be given separately
to
formula-fed
infants.
Infants
fed breast
milk are less susceptible
to vitamin
E deficiency.
II
Multivitamin-multimineral
preparation
preparation
alone.
#{182}
Multivitamin-multimineral
iron
was
coupled
cause
both
there
ments;
vitamin
vitamin
is little
there
vitamin
is
or iron
alone
with
were
vitamin
by cod
to provide
there
would
be
A from
supplements
D for infants
who
no evidence
E is needed
folate
D supplementation
provided
reason
thus,
and
(including
(including
natal
be-
oil. Currently
vitamin
no
are
that
for the
liver
A supple-
ham
in
designed
breast-fed.
to
provide
Similarly
may
contain
B12
infants
deficiency
of strict
is relatively
report
with
rare
in North
of a 6-month-old
severe
megaloblastic
reminder
that
the concentration
in breast
:u18
in breast-fed
but this
developing
breast-fed
the
has
been
vegetarian
required
Thiamin
should
The
diet strongly
water-soluble
deficiency
can
of thiamin-deficient
situation
is virtually
countries.
In the
infants
of mothers
malnourished
America.
in
but
receive
of
age
rarely
in
breast-fed
infants
because
4
to
neo-
more
than
the
in
not
However,
are
being
quently,
AMERICAN
to the
from
of
term
iron-fortified
is desirable
supplementation
to
in
the
This
is underof evidence
that
in the first
six months
of
of dental
caries
in the
In
addition,
milk,
may
even
extra
view
that
during
the
ACADEMY
in
fluoride
first
in
fluoride
OF
level
where
a teleologic
knowledge
supplemental
low
areas
fluoride
the
mineralized
the
in
provide
supplying
by
liter,’9
breast-fed
diet
probably
fluoride
breast
the
per
iron
of iron.2’
prevalence
is fluoridated,
of
milk
is controversial.22
of the dearth
dentition.
unnecessary
6
of age
amounts
of
portion
breast
in contrast
is assimilated
the
supplementation
alters
fluoride
for
0.3 mg
In normal,
to
6 months
infant
because
major
helps
to delay
the depletion
but other
sources
of iron are
addition
benefit
secondary
supple-
before
little
breast-fed
standable
life
restricted
to infants
in
United
States,
the rae
who are themselves
develops
Although
adequate
tempered
deficiency
the
period.
after
supply
fluoride
ments.
Iron
supply
this
in midinfancy.
The
influences
vitamins
also occur
mothers,
multivitamin
can
the
cereal
recent
infant
of a vegan
mother
anemia
and coma’7
is a
maternal
of certain
infants
reported
mothers,
stores
during
half of this iron is absorbed
smaller
proportion
that
infants,
Vitamin
breast-fed
months
needs
to use of iron alone.
is preferred
to use of
other
foods.#{176}This iron
of neonatal
iron stores,
with
term
infant.
this
iron
iron
about
much
omitting
supplementation
normal,
breast-fed
iron) is preferred
iron and folate)
argument
early
infancy.
supplementation
six months
of life
that
unerupted
teeth
early
infancy;
conse-
would
PEDIATRICS
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of
water
be
expected
1017
is
is
to
a beneficial
have
weighing
these
cently
favored
shortly
after
that
at
cated,
in
water
infants,
In
re-
available
alone
be
and
with
vitamins,
with
or without
or vitamin
D supplements
are
to include
supply
contains
0.25
less
mg
than
in
iron.
indi-
fluoride
if
ppm
of
0.3
fluoride.22
Formula-Fed
Term
Infants
cow’s
the
recommendations
need
milk
and
six months
ments
the
to
with
solid
formula
be
sources
use
supplements.2’
formula
used
is
first
year
appropriate
only
if the
0.3 ppm
formulas
are
and
now manufactured
recommendations
corn-
of age,
cereal
community
con-
those
water
for
K deficiency
is seen
usually
associated
Vitamin
It
is
low in
supple-
breast-fed
especially
with
through
the
administration
a decrease
the
intestinal
soy
or other
occasionally
with
diarrhea
in the
microflora.
the
based
past,
antibiotics,
the
formulas24’25
ciated
with vitamin
in part
to the type
K deficiency,
of oil used
1976, the Committee
formulas,
particularly
required
to contain
recommended
non-milk-based
an appropriate
K by
feeding
was
deficiency
and
Folic
has
folic
acid
mixes
vitamin
E in a
infants,
glycol
been
such
1000
as d-
succinate.27
in preterm
reported
acid should
be included
in the
is not in liquid
multivitaminbecause
of its lack of stability.
However,
because
generally
be in a hospital,
the
period
of administration
folate
can
will
be added
multivitamin
preparation
in the hospital
in a concentration
to provide
0.1 mg (the
per daily
dose.
The
shelf
life should
be
to a
pharmacy
US RDA)
limited
to
when
there
E.3#{176}
Neonatal
iron
needs
during
is insufficient
iron stores
of
asso-
which
was related
in the formula.26
In
that
all infant
formulas,
be
level of vitamin
absorption
stifi abundant,
are
for erythropoiesis
are
physiologic
postnatal
the
of
relatively
decline
in
hemoglobin
concentration.
After
several
weeks
of age, when
the infant
is
consuming
more
than
300 kcal/day
or when
the
body
weight
exceeds
2.5 kg, a multivitamin
supplement
is no longer
needed,
but it is a convenient
method
for providing
may
be
ticulaly
probably
of
in inand
of vitamin
synthesis
In
non-milk
of
include
preterm
the
required.
few
specific
These
in breast-fed
results
from
breast
milk,
contrast
condition
mentation.
premature
the low
which
has
D supplementation
quired
months
at a level
of
of age because
become
depleted
fore it is appropriate
of rickets,
only
150
par-
mg/liter
fortified
solid
plies sufficient
foods.
iron
in preterm
is helpful.33
2 mg/kg/day
neonatal
earlier
that
D,
infants.31’32
This
phosphorus
content
to about
450 mg/liter
in formulas.
is also correctable
with phosphate
However,
there
is also
evidence
vitamin
ciency
nutrients
vitamin
include
iron, and possibly
folic acid.28
There
have been
sporadic
reports
infants.
fants.
acid
stifi
Ready-to-use
with
water
for fluoride
to
to
or
supplements
of fluoride.
similar
if
preferable
fluoride
than
be
are
by
polyethylene
infants,m’
regimen.
multimineral
and
small
supple-
If powdered
less
should
the
and
used,
be administered
fluoride,
in
of iron
contains
mentation
of
ideally
absorbed
anemia
vitamin
not
in the
require
foods.
After
4 months
and/or
iron-fortified
convenient
should
do not
pat
the
centrated
do
supplementation
are
of iron
of commerin keeping
with
Committee23
They
latter
continues
bination
iron-fortified
are
the
mineral
of life.
during
formula
amounts
which
of
vitamin
first
adequate
formulas
should
well
one month,
and the label
should
read
“shake
well”
because
folate
will gradually
precipitate.
Iron
supplementation
is best delayed
until after the first few
weeks of life because
extra
iron may predispose
to
Infants
consuming
cial
form
Folic
also
could
of age.22
are
supplement
a-tocopheryl
but
supplementation
it is acceptable
the
period.
Committee
supplements
breast-fed
supplements
combination
Thus,
if iron
this
the
fluoride
fluoride
6 months
Fluoride
during
views,
initiating
birth
recognized
initiated
effect
opposing
than
to supply
iron
in
The
supplethat
Iron
is re-
starting
stores
by 2
may
in term
infants-beiron in the form
of
Iron-fortified
formula
aLso supfor the prevention
of iron defiinfants.
K.23
Preterm
are
Home-Prepared
Formulas
Infants
The needs
of preterm
infants
for certain
nutrients
proportionately
greater
than
those
of term
in-
fants
because
rapid
rate
of
absorption.
During
first
tion of about
weight
of 2.5
300
kg),
provides
1018
increased
and
less
demands
of
complete
intestinal
a more
the
should
weeks
equivalent
be
VITAMIN
of life
kcal per day
a multivitamin
of
supplied.
AND
the
The
(prior
RDAs
for
components
MINERAL
a body
that
term
in-
of this
SUPPLEMENT
but
other
countries.
The
need
they
need
milk wifi depend
is fortified.
Term
additional
levels).
Supplemental
later
than
4 months
day) for term
age (at a dose
Milk
formulas
America,
may
to consump-
or reaching
supplement
Home-prepared
North
evaporated
aration
2
the
fants
the
of growth
Evaporated
vitamins
iron
of age
or Cow’s
are
are
seldom
in
for
Milk
used
extensive
supplements
on whether
and
premature
C and
D (at
in
use
in
with
the
prepinfants
US
RDA
should
be started
no
(at a dose
of 1 mg/kg/
infants
and no later
than
2 months
of
of 2 mg/kg/day)
for preterm
infants.
NEEDS
Downloaded from pediatrics.aappublications.org by guest on August 22, 2014
Preterm
preparation
vitamin
Older
infants
will also
that
includes
E and will require
need a daily multivitamin
a well absorbed
form
folate.29
of
Infants
children
During
the second
six months
infant
may be on a diet of milk
feedings,
and
Cow’s
milk,
with vitamin
vitamin
Children
who
are an example.
2. Children
and capricious
increased
if used
D and
and
amounts
at this
cereal
mineral
required,
include
special
although
an adequate
nutritional
onomic
require
disadvantage,
multivitamin
of life, the
or formula,
of
supplements
are
usually
regimens
teenagers.
by these
it is important
that
the
diet
source
of vitamin
C. Infants
at
risk as a result
of lifestyle,
econ-
tional
more
needs
fully
committee
Obstetricians
ian
diets
Recent
have
national
shown
inadequacies,
school
dietary
little
with
children
most
food.”
vitamin
children,
creases
after
quacy
as the
an
basis
and
in-
in
fluoride
recently
in the
revised
fluoride
supple-
for
iron,
rate
need
nutritional
the
lying
on
and/or
supply
those
essential
nutrients
most
at risk do not
of foods
means
disadvantages
mineral
defor
made-
fortification
most
effective
Among
the
dealing
of re-
supplements
to
that
some
of
to the supple-
ments
or may not comply
with
long-term
medication. Poor
long-term
compliance
is a difficult
problem with respect
to supplying
fluoride
supplements
in children
residing
inareas
where
drinking
water
contains
less,
inadequate
some
indicated,
these
There
in which
supplements
and
will
these
these
Groups
lies.
nutrients
and
Although
surveys36
vileged
require
within
families,
vitamin
this
approximately
nutritional
indicates
that
in general,
supplements,
group
that
may
used
risk
from
from
be
for
include:
the
economically
faminational
underpri-
eat wisely
and do not
there
is a special
submay
be
malnourished.
most
need
vitamin
B,2
foods.
This vitamin
in recent
reports
in
respects,
these
NEEDS
guidelines
for
the
use
of
can
be conveniently
met
with
curpreparations.
However,
at present,
to supply
trace
minerals
other
than
iron to infants
and children
who are considered
to
be in high
nutritional
risk categories.
This
is because
multimineral
preparations
have
required
the
inclusion
of calcium,
phosphorus,
and magnesium
in relatively
large
quantities
that would
be difficult
there
in a liquid
may
tamin-trace
prove
or small
to be
mineral
tablet
a clinical
supplement
form.
role
for
that
would
However,
a multiviinclude
iron,
zinc,
and
copper,
and
possibly
other
minerals,
which
could
probably
be more
prepared
in liquid
or small
tablet
form.
preparations
ments
nium,44
RDA
deprived
In
supplements
rently
available
it is difficult
neral
nonethe-
When
vegetable
described
may
trace
readily
There
is sufficient
evidence
to support
the
sion of zinc4’ and copper
in multivitamin-multimi-
supplements
should
be
and minerals
that
adolescents
evidence
are,
listed.
at
at particular
Children
1.
the
multivitamins
of the
provide
levels.
be
of children,
groups
composed
set
fluoride.
situations
with
of
vegetar-
products
particularly
from
been
College
consuming
dairy
nutri-
literature.
to supply
of
is the fact
have access
The
are discussed
of an ad hoc
American
adolescents
adequate
folic
uncer-
status
in those
conwarrants
use of a
PROVIDING
VITAMIN
AND MINERAL
WITH AVAILABLE
PREPARATIONS
for
is insufficient
Committee
seems
to be the
with
the problem.
vitamin
simply
growth
is the
of significant
as with
the
exception
An
evidence
pre-
supplementation
recommendations
arises,
In
status,
is little
mineral
the
obesity.
mineral
iron.
was
there
especially
there
The
of
lack
infancy.
where
water.
surveys’m
or
socioeconomic
Thus,
and
normal
its dosage
ments.22
When
exception
nutritional
of
fluoride
drinking
the
health
of vitamin
of lower
prevalent
sufficiency
routine
and
evidence
risk
on nutrition
of the
and Gynecologists.37
without
poor
also
and
probably
women,
but
supplement.
which
is absent
deficiency
has
Infancy
or abuse
to manage
of the pregnant
woman
in the recommendations
4. Children
may
neglect
Iron
young
about
overall
nutritional
at special
nutritional
supplementation,
After
parental
multi-vitamin-multimineral
not
or intercurrent
illness
and mineral
supplements.
on dietary
tainty
sidered
food.
be fortified
iron. Other
from
and adolescents
with
anorexia,
appetites,
or poor eating
habits;
3. Pregnant
acid are needed
normal
mixed
table
time,
should
fortified
with
suffer
are
under
for other
chromium,
in
tablet
form.42
trace
minerals,43
manganese,
and
investigation;
figures
for
The
inclu-
require-
(such
as selemolybdenum)
these
nutrients
are included
in the 1980 RDAS.
These
trace
mmerals
might
eventually
be considered
for inclusion
in supplements
for infants
and
children
because
evidence
to warrant
their
use may be forthcoming.
However,
at present,
there
is insufficient
information on which
to base detailed
recommendations
for
dosage
The
and appropriate
combination
of
ages for administration.
vitamin
A, C, and
D
for
infants
(with
vitamin
E and/or
iron
as optional
ingredients)was
originally
designed
to complement
home-prepared
formulas.
Now
that
most
infants
are fed proprietary
formulas
or breast
milk,
these
AMERICAN
ACADEMY
OF
PEDIATRICS
Downloaded from pediatrics.aappublications.org by guest on August 22, 2014
1019
needs
have
shifted
Table,
there
would
somewhat.
seem
In
to be roles
referring
to
in infant
for combinations
of vitamin
D with iron, vitamin
with vitamin
E and possibly
folate,
and vitamins
E, folate,
and iron.
Although
some
comments
in this statement
relevant
to future
developments
in supplementation,
currently
available
supplements
and
13.
D,
are
foods
can
needs
emphasized
recorded
the infant
breast-fed
the normal,
mother
has
mother,45’46
well nourished
not been
shown
conclusively
vitamin
and mineral
supplement.
no evidence
that
supplementation
the
full-term,
formula-fed
properly
nourished
normal
of
in
to need
any specific
Similarly,
there
is
is necessary
for
infant
child.
and
for
the
infants.
Committee
on
water-soluble
D
be used
to meet
all recognized
nutritional
infants
and
children.
It must
also be
that,
although
deficiencies
have
been
of a malnourished
infant
of the
weight
the
feeding
14.
The
pediatrics.
Committee
on
15.
of this
report
was supported
16.
19.
20.
Nutrition:
Siimes
MA,
dining
Pediatr
concentration
Scand
68:29,
Saarinen
Vuori
UM,
infants:
High
by
extrinsic
the
ON
A. Barness,
MD,
Peter
R. Dailman,
MD
Buford
L. Nichols,
Claude
Roy,
26.
MD
MD
28.
1953
2. Wickes
IG: A history
of infant
feeding.
I. Primitive
peoples:
works:
Renaissance
writers.
Arch Dis Child 28:151,
29.
IG: A history
30.
centuries.
3. Wickes
nineteenth
4. Wickes
IG: A history
of infant
feeding.
IV. Nineteenth
century
continued.
Arch Dis Child 28:416,
1953
5. Wickes
IG: A history
ofinfant
feeding.
V. Nineteenth
century
concluded
and the twentieth
century.
Arch Dis Child 28:495,
1953
6. Woodruff
infant
CW: The science of infant
JAMA
240:657, 1978
nutrition
and
the art
SJ, Filer
feeding
U
Jr,
Anderson
TA,
et al:
9.
Food
tamins
for
normal
infants.
Administration:
and Drug
Administration:
Dietary
supplements
and minerals.
Code ofFederal
Regulations
1977
10. Food and Nutrition
ommended
Dietary
tional
Academy
1 1.
Committee
12.
49:456,
1972
Committee
1020
of
Recominenda-
Pediatrics
63:52, 1979
8. Food and Drug
Label statements
relating
vitamins
and label
statements
relating
to minerals.
Code
Federal
Regulations
21:125.1, 1973
tions
of Sciences,
on
VITAMIN
to
of
of vi-
21:105.85,
1980
Fluoride
Nutrition:
AND
as a nutrient.
Nutritional
MINERAL
needs
Pediatrics
of
in
for
and
48:483,
tag
for
1971
milk
PR:
Iron
milk
of iron
absorption
ferritin.
J Pediatr
Iron
iron-a
de-
of lactation.
of breast
method
Acta
absorption
iron
and by the
1977
for infants.
91:36,
supplementation
supplementation:
1979
Commentary
on breast
proposed
standards
in
as indicated
Fluoride
Pediatrics
Revised
63:150,
Committee
on Nutrition:
infant
formulas,
including
with
a soy
protein
Amadio
P:
Vitamin
Association
Breast
Dallman
bleeding
formula.
feeding
and
for formulas.
in a young inAm JDiS Child
1969
Goldman
HI,
newborn
period.
Schneider
of infant
DL, Fluckiger
formula
products.
Pediatrics
K
deficiency
44:745,
1969
Manes
JD:
HB,
Stevens
D,
Burman
low-birth-
SUPPLEMENT
Strelling
D,
Strelling
in low birth
MK,
MK,
weight
Blackledge
DG,
Williams
ML,
Shott
RJ,
the
after
Vitamin
31.
Rowe
JC,
phosphatemic
N Engl
32.
JMed
O’Connor
infants
who
Clin Pediatr
33.
Wood
Goodall
K, content
300:293,
acid
HB:
et al: The
anemia
sup64:333,
Diagnosis
weight
and
infants.
role of dietary
of infancy.
N
1975
et
al: Nutritional
infant
fed breast
hypomilk.
1979
D deficiency
were not receiving
16:361, 1977
HoffN,
Haddad
of 25-hydroxyvitamin
Folic
Pediatrics
in low birth
DH,
Rowe
DW,
rickets
in a premature
P: Vitamin
et al:
infants.
O’Neal
PL,
E deficiency
rickets
vitamin
in two
breast-fed
D supplementation.
J, Teitelbaum
S, et al: Serum
concentrations
D in rickets
of extremely
premature
infants.
J Pediatr
94:469, 1979
Owen G, Kram KM, Garry
PJ, et al: A study of nutritional
status of preschool
children
in the United
States,
1968-1970.
Pediatrics
53:597,
1974
35. Dietary
Intake
Findings,
1971-74.
National
Health
Survey.
DHEW Publication
No. (HRA)
77-1647.
Hyattsville,
MD,
National
Center
Health
Statistics,
Series 11, No. 202, 1977
36. TenState
Nutrition
Survey,
1968-70:
Highlights.
DHEW
Publication
No. (HSM) 72-8134. Atlanta,
Center for Disease
Control,
1970
37. Pitkin
RM, Kaminetzky
HA, Newton
M, et al: Maternal
nutrition:
A selective
review
of clinical
topics.
J Obstet
Gynecol
40:773, 1972
38. Finberg
L: Human
choice, vegetable
deficiencies,
and vege34.
Board, National
Research
Council: RecAllowances,
ed 9. Washington,
DC, Na-
on Nutrition:
1979
MA,
iron and fat on vitamin
Engl JMed
292:887,
feeding.
7. Fomon
supplementation
formulas
course
management
of folate deficiency
Arch Dis Child 54:271, 1979
of infant feeding.
II. Seventeenth
and
Arch Dis Child 28:232,
1953
IG: A history
of infant feeding.
III. Eighteenth
and
century
writers.
Arch Dis Child 28:332,
1953
eighteenth
P:
the
bioavailabiity
plementation
1979
REFERENCES
Wickes
Ancient
and
Pediatrics
53:273, 1974
27. Gross S, Melhorn
DK: Vitamin
E-dependent
anemia
in the
premature
infant.
III. Comparative
hemoglobin,
vitamin
E,
and erythrocyte
phospholipid
responses
following
absorption
of either water-soluble
or fat-soluble
d-alpha
tocopheryL
J
Pediatr
85:753, 1974
W. Allan
Walker,
MD
Calvin
W. Woodruff,
MD
1.
Kuitunen
during
Siimes
schedule.
117:540,
25.
Anderson,
MD
Jack
Collipp,
MD
Jr,
E,
on Nutrition:
58:765,
1976
on Nutrition:
Committee
fant:
Chairman
Homer
Platon
the
and
prophylaxis
compounds
K
Pediatrics
57:278, 1976
24. Moss MH: Hypoprothrombinemic
NUTRITION
Lewis
Vitamin
of serum
Committee
dosage
23.
COMMITTEE
K
871, 1979
17. Higginbottom
MC, Sweetman
L, Nyhan
WL: A syndrome
of
methylmalomc
aciduria,
homocystinuria,
megaloblastic
anemia,
and neurologic
abnormalities
in a vitamin
B,2-deficient
breast-fed
infant of a strict vegetarian.
N Engl J Med 299:
317,
1978
18. Gopalan
C, Belavady
B: Nutrition
and lactation.
Fed Proc
20(suppl
7, pt 3):177, 1961
22.
by FDA
1977
Lakdawala
DR, Widdowson
EM: Vitamin
D in human
milk.
Lancet
1:167, 1977
Bachrach
S, Fisher
J, Parks
JS: An outbreak
of vitamin
D
deficiency
rickets
in a susceptible
population.
Pediatrics
64:
Pediatrics
223-76-2091.
Vitamin
infants
receiving
milk substitute
infant
those with fat malabsorption.
Pediatrics
21.
preparation
contract
60:519,
Nutrition:
analogues:
Use in therapy
Pediatrics
28:500, 1961
concentration
ACKNOWLEDGMENT
Pediatrics
NEEDS
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tarian
39. Dwyer
rickets
rickets. Am J Dis Child 133:129, 1979
JT, Dietz WH, Ham G, et al: Risk of nutritional
among vegetarian
children.
Am J Dis Child 133:134,
Child 49:589, 1974
43. Underwood
EJ: Trace
Elements
in Human
and
Nutrition.
ed 4. New York, Academic
Press, 1977
1979
44.
Of all the therapies
in 1831, is the most
far more
important
A boy of robust
activity
acquired
of stammering
and florid
and body,
readiness
as to be
physicians
were
aspect,
of a healthy
Bonnermann
B, et
al:
Selenium
incapable
they
confessed
of more
three
years
affected
of uttering
their
the following,
published
“tincture
of time”
was not
constitution,
when
between
two and
in speaking,
was suddenly
almost
consulted:
K,
STAMMERING,
SUCCESSFULLY
TREATED
BY
USE OF CATHARTICS,
AS REPORTED
IN 1831
I have read about
for stammering,
unusual.’
One wonders
whether
than
the use of cathartics.
form
both of mind
considerable
OF
I, Kaspereck
content
of human
milk, cow’s milk and cow’s milk infant
formulas.
Eur J Pediatr
129:139, 1978
45. Fomon
SJ, Strauss
RG: Nutrient
deficiencies
in breast-fed
infants.
N Engl J Med 299:355, 1978
46. Waterlow
JC, Thomson
AM: Observations
on the adequacy
of breast-feeding.
Lancet
2:238,
1979
40. Zmora
E, Gorodischer
R, Bar-Ziv
J: Multiple
nutritional
deficiencies
in infants
from a strict vegetarian
community.
Am J Dis Child 133:141, 1979
41. Committee
on Nutrition:
Zinc.
Pediatrics
62:408, 1978
42. Alexander
FW: Copper
metabolism
in children.
Arch Dis
HISTORY
OF A CASE
THE LONG CONTINUED
Lombeck
Animal
a single
inability
old,
with
than
syllable.
Two
any
specific
to propose
ordinary
and after having
so great
a degree
eminent
plan
of
treatment
which might afford a prospect
of success,
but in consequence
of a somewhat
plethoric
state of the child, they advised
that a strong
purgative
should
be given. The
effect of the medicine
appeared
so favourable,
that it was repeated
three or four times,
and each time with such decided
benefit,
as to leave no doubt on this point in the minds
either of the parents
or the practitioners.
The complaint,
however,
shortly
recurred,
was
again attacked
with the same remedy,
and was again subdued.
After this plan had been
continued
for some time, it was conceived
that, in addition
to the purgative
system,
the
effect
of which,
although
so salutary,
was temporary,
further
advantage
might
be
obtained
by adopting
a system
of diet which should
permanently
reduce
the plethoric
habit, and obviate
the necessity
for the continual
repetition
of the purgatives.
This was
accordingly
abstained
with
the support
By
of the system
a steady
at bay;
omitted
length,
relaxation
and the
discipline.
and was
which,
done,
and was rigidly
from,
and even vegetables
adherence
to
adhered
were
to for several
years.
Animal
taken
in as sparing
a quantity
food was totally
as was consistent
...
this
discipline
for
about
eight
years,
the
complaint
was
kept
but whenever
or too long
any relaxation
in the diet took place, or when the purgatives
were
delayed,
symptoms
of the impediment
immediately
appeared.
At
when
about
twelve
years
of age, the tendency
seemed
so far subdued,
that a
of the restrictions
was not followed
by the usual unfavourable
consequences,
boy being then at a public
school,
it was not so easy to maintain
the former
For some time no bad effects
ensued,
but at length
the complaint
recurred,
unusually
obstinate,
so as to require
a long and severe
course
of purgatives,
however,
was
finally
successful
...
With
respect
to the purgatives
employed
in this case, it appeared
to be of little
importance
which were used, provided
the bowels were very completely
evacuated.
What
was the most frequently
employed
was a full dose of calomel
and jalap,
succeeded
by
Epsom
salts
.
...
Noted
by T.E.C.,
Jr,
MD
REFERENCE
1.
Bostock
cathartics.
J: History
Transylv
of a case of stammering,
successfully
J Med Assoc 4:136, 1831
AMERICAN
treated
by the
ACADEMY
long
continued
OF
use of
PEDIATRICS
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1021
Vitamin and Mineral Supplement Needs in Normal Children in the United States
Lewis A. Barness, Peter R. Dallman, Homer Anderson, Platon Jack Collipp, Buford L.
Nichols, Jr, Claude Roy, W. Allan Walker and Calvin W. Woodruff
Pediatrics 1980;66;1015
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PEDIATRICS is the official journal of the American Academy of Pediatrics. A monthly publication, it
has been published continuously since 1948. PEDIATRICS is owned, published, and trademarked by the
American Academy of Pediatrics, 141 Northwest Point Boulevard, Elk Grove Village, Illinois, 60007.
Copyright © 1980 by the American Academy of Pediatrics. All rights reserved. Print ISSN: 0031-4005.
Online ISSN: 1098-4275.
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