Health

Welcome to the Kids Health Annual 2013

Thu, 09 May 2013 12:28:00 -0700

AT OHSU DOERNBECHER CHILDREN’S HOSPITAL, a vital part of our mission is to share the knowledge gained here with families throughout our community. We are dedicated to bringing you the latest discoveries, treatments, and therapies to help your family stay healthy.

In this issue of the Kids’ Health Annual, presented by Doernbecher and SagaCity Media, you’ll read advice on vitamins and supplements, vaccines, the importance of oral health, and more. We also provide ideas for entertaining kids staying home from school for the day—and how to help them sleep at night.

Raising a family is more hectic than ever. Work, school, and home responsibilities are increasing, as is the number of screens competing for your (and your kids’) attention. Sometimes it all may seem overwhelming. At Doernbecher, we’re here to guide you: In addition to pediatric specialty care, our programs, community events, and the information on our blog at Doernbecher.com are all ways you can learn more and keep your family well. You only want the best for your family. At Doernbecher, so do we: Every child deserves the best.

H. Stacy Nicholson, MD, MPH
Chair, OHSU Department of Pediatrics
Physician-in-Chief, Doernbecher Children’s Hospital

What You Should Do if Your Kid Gets a Concussion

Thu, 02 May 2013 15:24:00 -0700

Image: Carolyn Richardson

Things that go bump in the night can scare your kids. But a hard enough bump on the head can cause a concussion, the most common brain injury.

Children are more vulnerable to concussions than adults, says Lissa Baird, a pediatric neurosurgeon at OHSU Doernbecher Children’s Hospital. Their heads are larger relative to their bodies, so when kids fall they tend to land on their heads. Their weaker necks also make them less able to support and protect their heads. Babies and young children have soft skulls that transmit impact to the brain more readily than harder noggins.

“Symptoms of concussion fall into four basic categories: thinking and remembering, emotional, sleep, and physical symptoms,” says Dr. Baird. After a concussion, a child might have trouble thinking clearly, remembering things, or concentrating, or might act cranky, anxious, or hyper. Your child might sleep more or less than normal or have trouble going to sleep. Physical symptoms can include headaches, vomiting, dizziness, balance problems, lack of energy, and sensitivity to light or noise.

Physical and mental rest is the most important part of recovery. Babies should rest and sleep as much as possible. For toddlers, avoid rough play and stimulation from loud music and TV. School-age children should take time off school, including homework. They should also avoid texting, TV, video games, and loud music. “Anything that requires concentration should be off limits while the brain is healing,” says Dr. Baird. When your child goes back to school, tell teachers he or she might need extra help for a while.

To avoid another head injury, children and teens should avoid sports, recess games, PE, and vigorous play until cleared by a doctor. “Kids are more vulnerable to another injury if the brain is still healing,” says Dr. Baird. Healing can take time, but with rest and care, most kids make a full recovery.

If your child experiences a concussion,
talk with your pediatrician immediately or call 503-346-0640.

Kids Health Annual 2013

Thu, 02 May 2013 15:20:00 -0700

Kids Health Annual 2013 Presented by SagaCity Media and OHSU Doernbecher Children’s Hospital

Healthy Teeth, Healthy Tot

Thu, 02 May 2013 15:16:00 -0700

Image: Greg Pizzoli

Tooth decay is one of the biggest health issues our children face today,” says John Engle, a pediatric dentist and instructor at OHSU’s School of Dentistry, who frequently sees proof of the problem in his own dental chair. “But if we can get parents and families involved early on in developing healthy dental habits, the majority of these instances are entirely preventable.”

Given that the mouth is a gateway and barometer for the health of the whole body (recent studies have found possible links between gum disease and increased incidence of diabetes, heart disease, and, for pregnant women, complications such as low birth weight), Dr. Engle counsels parents to begin these habits long before the first baby tooth makes its appearance. From day one, gently wipe out your baby’s mouth with a soft piece of cloth or gauze, developing a familiar habit that will make it easier to introduce more complex routines later. When teeth begin to appear, gently wipe those as well, with cloth, gauze, or a store-bought teething brush.

By the time children are in elementary school, flossing should be incorporated into the routine. Kids will need help at first, but at what age should children begin brushing and flossing on their own? Dr. Engle argues against a “one size fits all” answer. “In the old days, they would say to hand them the toothbrush when their handwriting is legible,” he jokes. “But for some kids I know, this would mean heading to college with their parents still brushing their teeth.” He advises parents to pass on the responsibilities slowly, monitoring children carefully for as long as it takes to develop diligent teeth-cleaning habits of their own.

In the old days, they would say to hand them the toothbrush when their handwriting is legible.

The importance of regular brushing and flossing can’t be overstated, but dietary choices have a profound impact on dental health, too. Infants who are put down to sleep with bottles develop tooth decay at a higher rate than those who aren’t, as do young children who snack often. “Obviously, carrots are better than gummy bears, but their teeth need a break between snack sessions regardless of what they’re eating,” Dr. Engle says.

Before he sends them home, Dr. Engle has more than just flossing techniques to pass along to his young patients: “Brush your teeth, clean your room, quit fighting with your sister, and be nice to your parents,” he advises. “That’s really all you need to know.”

If your child needs to be evaluated for gum disease,
talk with your dentist or pediatrician.

Doctors Are Parents, Too

Thu, 02 May 2013 15:15:00 -0700

Image: Carolyn Richardson

Breast-feeding at work. Ear infections. How a mom who happens to be a pediatrician balances work and family. All these are topics on the Healthy Families blog from OHSU Doernbecher. Since mid-2012, the blog has offered advice from pediatric health professionals alongside personal stories by patient families, nurses, and doctors.

If you’ve wondered if doctors are like other people, the blog shows that the answer is yes—and that pediatricians are as concerned about kids’ health and safety as any parent. “In medicine, we’ve become almost paranoid about privacy, which is good—but it’s taken away some of the humanity and sense of community,” says Nathan Selden, Doernbecher’s head of pediatric neurosurgery. “The blog reconnects us to the community in a personal way.”

It also helps families get to know the hospital before they ever need help. “It’s rare for parents in the community to meet Doernbecher’s specialists unless they have a child with an unusual diagnosis,” Dr. Selden says. “The blog allows them to get comfortable with what is available to families here.”

In addition to demystifying doctors, Healthy Families provides reliable, timely medical information. For example, October brings a post on Halloween safety, and flu shots are a hot topic in early winter. “Although it’s informal, the blog provides parents with a source of accurate medical information,” says Dr. Selden. “There’s so much misleading information on the Internet about medicine. Writing the blog helps us correct some of that.”

When you read a Healthy Families post, it comes directly from a pediatric health expert. “We try not to edit too much,” says OHSU social media manager Brycie Jones. “We want their voices to come through.” Doctors, nurses, and pediatric residents take turns writing the posts (including one explaining what a “pediatric resident” is).

Readers can comment directly on the Doernbecher blog, and the blog authors often respond to questions posted there. Readers can also respond on the hospital’s Facebook page. “When there’s a new Healthy Families post, people who like Doernbecher on Facebook get it in their feeds,” Jones says. A recent post on a rock band made up of former OHSU medical students drew 130 “likes” and the suggestion that the band play in the Doernbecher lobby.

Patients and families, including the young designers of the Nike/Doernbecher Freestyle sneakers, also tell their stories on the blog. “We’ve shared some very personal stories about the care of children,” says Dr. Selden. “Every time I’ve asked a family whether they were willing to share, they’ve said yes. It’s amazing how generous people are. Their experiences can help and encourage other families.”

Visit ohsudoernbecher.com/healthyfamilies for more information

Myths and Misconceptions About Life-Saving Vaccines

Thu, 02 May 2013 15:15:00 -0700

Image: Courtesy Shutterstock

A baby spends months in the ICU. A teen has seizures for three straight days. Another child dies in the hospital. What made them sick? Whooping cough, chicken pox, and bacterial meningitis, all preventable by vaccines.

There’s plenty of vaccine information out there, much of it contradictory or from celebrities with no medical background. Who’s a parent to trust? Judy Guzman-Cottrill, a pediatric infectious disease specialist at OHSU Doernbecher Children’s Hospital, explains how vaccine schedules—what shot to give and when—are developed and dispels some common myths.

“When a vaccine is added to the schedule, it’s undergone extensive research,” Dr. Guzman-Cottrill says. “When manufacturers create vaccines, they conduct rigorous studies of safety and effectiveness. The Food and Drug Administration reviews those studies, sometimes sending vaccines back for more tests.”

Once the FDA approves a vaccine, a group called the Advisory Committee on Immunization Practices makes a recommendation to the Centers for Disease Control and Prevention about who should get it and when. These age recommendations take into account when kids are at the highest risk of contracting the disease and when the disease is likely to do the most damage.

“Despite years of research on vaccine safety, there are still myths, such as that the MMR vaccine causes autism,” says Dr. Guzman-Cottrill. “Several well-conducted studies have proved that it doesn’t, and the doctor who claimed this was discredited. I know parents who never vaccinated because of autism concerns—and their children have autism.”

Another misconception is about thimerosal, a preservative based on ethyl mercury. “It’s eliminated from the body and is not the same as the methyl mercury found in the environment,” says Dr. Guzman-Cottrill. “But to maintain high immunization rates, virtually all vaccines are now mercury-free.” Recently, Dr. Guzman-Cottrill treated a child with a serious infection from chicken pox. “His mom said he didn’t get the vaccine because of mercury in the preservatives. She had no idea it was taken out years ago.”

When a vaccine is added to the schedule, it’s undergone extensive research.

“Parents are afraid vaccines might be harmful,” says Dr. Guzman-Cottrill. “They don’t see what infectious diseases do to beautiful, healthy children.”

Some diseases seem long ago and far away, but with global travel visitors from other countries can bring these infections to kids who never leave home. Dr. Guzman-Cottrill suggests asking parents and grandparents what measles, whooping cough, and other infectious diseases were like before vaccines.

“When the polio vaccine came out, parents stood in line for hours because they’d seen so many children become debilitated or die,“ she says. “In the US, kids don’t suffer and die in those numbers anymore. We’re very lucky.”

If you have questions about vaccinations,
talk to your pediatrician or call 503-346-0640.

The Sick Day Dilemma

Thu, 02 May 2013 15:15:00 -0700

Image: Jonathan Hill

Remember staying home from school? Sure, the sniffles and sore throat were no fun, but the novelty of watching TV all day and being waited on by Mom or Dad often made up for it. If you have kids of your own, you now appreciate the decisions they had to make about whether to send you to class or take a day off work themselves to bring you that chicken soup. And they weren’t thinking just about you: there were also classmates, other family members, and coworkers to consider, especially during the cold and flu season or local outbreaks like last winter’s norovirus.

Jane Kim-Hoffman, a pediatrician at OHSU, has some basic guidelines for when a child should stay out of school. A child sick with a fever, vomiting, diarrhea, or pinkeye may be contagious and needs to stay home until those symptoms have subsided for 24 hours. Take your child’s energy level into account as well. As Dr. Kim-Hoffman points out, “If the child is fever-free but not willing to move off the couch, he probably wouldn’t do well in class.” But if he has a mild cough and no fever, he’s probably fine to return to school.

Next comes deciding whether to take a sick day yourself—assuming you have a sick day. In March, the Portland City Council passed a new law requiring paid sick time for most employers, but it takes effect next year.

If you have an enclosed office and can limit your coworkers’ exposure, it might be fine to bring your child to work (assuming there’s no vomiting or diarrhea). A babysitter, friend, or family member can provide at-home care, but be careful to protect older family members from your child’s illness. Dr. Kim-Hoffman says it’s not uncommon to see older individuals struggle with their health when they contract the flu or other illnesses as a result of caring for sick grandkids.

To help make these decisions, an OHSU smartphone app and website called MD4Kids can keep recommendations at your fingertips. The app provides useful, reassuring facts, like the normal duration of illnesses and indicators of real emergencies, as well as schedules of action to take based on your child’s symptoms, from “Call your doctor now” to “Manage care at home.” “MD4Kids is a great resource,” says Dr. Kim-Hoffman. “If parents are unsure if they need to go to the emergency room or if they can send their kids to school, it can help answer those questions.”

No matter where your child ends up, you’ll have to pass the time. The kid who feels well enough to get bored and the parent who thinks six hours of television is pushing it will need to find some other entertainment. Build a fort using couch cushions, pillows, and blankets to create a space where your child can rest or play with toys. Card games, board games, and puzzles can occupy an hour or two at home or at the office. Be prepared for sick kids to get frustrated more easily than normal—this is not the time to challenge them. As an alternative to reading or coloring, you and your child can look through pictures and create a scrapbook, or just flip through family photo albums.

However your family decides to spend the day, if you trust your instincts, use your resources, and go to your doctor with any concerns, you and your child should make it through the next cold and flu season just fine.

Technology & Children's Health

Thu, 02 May 2013 15:15:00 -0700

Image: Luke Bott

In some circles, technology has gotten a pretty bad rap—smartphones, video games, movies, and TV have been blamed for everything from rising levels of childhood obesity and ADD/ADHD to sleep disorders, classroom temper tantrums, and risky adolescent sexual behaviors. But technology serves a positive purpose, too: sending a child out of the house with a cell phone in hand and Mom’s number on speed-dial calms the nerves of many a parent. Kids are asked to do their homework on computers increasingly often, and are no longer limited to the research they can do in their school library. And whether we like it or not, much of the crucial social development that used to take place on the school playground has migrated to Facebook walls and Twitter feeds.

News headlines lament the loss of a “real human connection,” while others celebrate the new opportunities for communication and collaboration offered by media and technology. “There are a lot of people in this discussion with very strong opinions,” says Darren Janzen, a pediatric psychologist at OHSU’s Doernbecher Children’s Hospital and a father of two. “But it’s not going away. We can’t fear technology, but we can be mindful of it, and we can decide how our kids will interact with it.”

“Background media use—that is, parents’ consumption of media—distracts them from interacting with their children.”

This isn’t to say there aren’t serious concerns to address. Managing the role that technology use plays in rising child obesity levels is a difficult job for parents of kids who would rather exercise their thumbs on a video game controller than kick a soccer ball around outside. “Obesity is complicated, but at some level it’s calories coming in versus calories going out—and if kids aren’t active, they’re falling behind,” explains Carrie Phillipi, a pediatrician at OHSU Doernbecher and a mother of four. She encourages parents to advocate for recess and free-play at their children’s schools, where children can get the person-to-person social interaction and the physical exercise they need.

Image: Luke Bott

Attention deficit disorders have been a hot-button issue for parents, politicians, and pediatricians for years, including rising worries about the relationship between technology use and these health issues. “Access to media doesn’t cause ADHD—the vast majority of these cases are related to genetics,” Dr. Janzen explains. “But because ADHD is a deficit of self-regulation, kids with it can get sucked into TV and video games much more intensely than other kids can. It’s not causing the disorder, but there can certainly be greater challenges in pulling away from media and moving to other important activities.”

While overexposure to media may not cause clinical attention disorders, it can breed attention-jumping habits. Rather than learning to focus on one task or subject for a long period of time, kids can jump from video to video on YouTube, or scroll through a Facebook feed looking for an interesting snippet of entertainment. “Too much media time may take away from the practice of other important skills or activities,” Dr. Janzen says.

Parenting a child in an increasingly technology-saturated world means navigating the ins and outs of rapidly changing communication devices, social media sites, and entertainment options. Restricting access to age-inappropriate material, limiting time spent parked in front of a TV (or smartphone, computer, or tablet), and limiting where and when they access those screens are all crucial aspects of fostering children’s healthy relationship with new media and technology. What, where, when, and how much media kids should consume is hotly debated by technology advocates and adversaries—but pediatricians are on the front line, dispensing useful advice to curious and concerned parents.

Image: Luke Bott

START SLOW

Today’s children spend an average of seven hours a day tuned in to some kind of entertainment media—televisions, computers, and smartphones are virtually unavoidable, from the screens lining the walls at some restaurants and retail stores to the new computers appearing in grade school classrooms every year. While some exposure to media is unavoidable, parents should be in control of the bulk of the time their children spend engaging with technology.

For children under 2, doctors recommend no screen time at all. Sorry, parents—this means no “Baby Einstein,” either. “Infants and young children learn by playing and interacting with humans, not screens,” says Dr. Phillipi. But keeping young kids away from screens is only half the battle. It’s especially important in these early stages of development for parents to unplug from their own devices. “Background media use—that is, parents’ consumption of media—distracts them from interacting with their children,” she says.

After 2 years of age, doctors recommend a maximum of two hours of digital media a day, a guideline echoed by the American Academy of Pediatrics. “This can be hard to follow, though, especially as kids are asked to do more of their schoolwork on the computer,” says Dr. Janzen. “I usually start by encouraging parents to limit kids to two hours of media for entertainment purposes, outside of what’s needed for school.”

Even when media access is carefully controlled at home, kids may have additional exposure elsewhere. Communicating with children, their friends, teachers, and other adults in their lives about the activities that take place when parents aren’t present can provide a clearer snapshot of their actual media consumption.

CONTENT IS KEY

After their children are 2, parents should be vigilant about small doses of age-appropriate media. “With young kids, it is best when content is slower-paced, sends a pro-social message, and is educational in some way,” Dr. Janzen says.

“Content is a big concern for me,” says Dr. Phillipi. While the cool factor of on-screen smoking has been tarnished by the aggressive campaigning of anti-tobacco groups, that still leaves the violence, sexual promiscuity, and other risky behaviors that feature prominently on popular TV shows, websites, and video games. She counsels parents to communicate very clearly and directly about inappropriate media use, and to familiarize themselves with the content and storylines of their kids’ favorite shows and games.

There are rating systems in place for movies and video games, which can serve as helpful guidelines for what may or may not be appropriate for your child. “But don’t take their word for it—just because a movie is rated PG-13 doesn’t mean your 13-year-old is ready for it,” Dr. Janzen says. “Similarly, some kids can handle content rated slightly above their age level when appropriate guidance and oversight is provided.”

Image: Luke Bott

LEAD BY EXAMPLE

An easy way to demonstrate healthy interaction with technology is to set rules for common areas of the house that all family members have to follow. “No phones at the dinner table, no checking your e-mail while you help with homework,” says Dr. Phillipi. Watching TV with one eye and a third-grader practicing handstands with the other means both your favorite show and your gymnast-in-training aren’t getting the attention they deserve.

It may seem simple, but parents should be wary of the content they watch while kids are in the room. Even if they’re busy with another activity, kids who aren’t ready for “grown-up” jokes and plotlines can easily misinterpret the snippets of information they pick up.

Watching shows and movies as a family is an easy way to enjoy time together, while keeping watch on the ways kids react to different types of content. If themes or issues are presented that kids respond negatively to or have questions about, parents can address them right away.

SCREEN-FREE ZONES

Designating “screen-free zones” in the house can also help a parent keep track of the time kids spend with their devices, and what kind of content they consume. Dr. Phillipi recommends setting up a computer for doing homework in the living room or kitchen, where parents are likely to pass by often.

“It is important to consciously reward good behaviors in our children, rather than giving in to bad ones.”

For children of all ages, it’s important to cut off screen time at least an hour before bed. Set up phone chargers outside of the bedroom, so kids and teens aren’t awakened in the middle of the night with a text from a friend (or tempted by the sudden urge to post a photo of their footie pajamas on Instagram).

Image: Luke Bott

STRIKING A BALANCE

Dr. Janzen is no stranger to temptation. When his kids’ energy levels are a little too high to be safely contained inside a moving vehicle, the flip-down TV screen in the backseat looks better by the minute. “Doctors struggle with the same things everyone else does,” he says. He advises parents to set clear and consistent rules for technology use, and follow them whenever possible, to make saying “no” easier—even in the middle of a full-blown temper tantrum.

Sometimes, though, long-term parenting goals have to yield to surviving a trip to the grocery store—and that’s OK. “We try to save screens in the car for long rides, not short trips around town,” Dr. Janzen says. “Every once in a while, these things are
nice to have. However, it is important to consciously reward good behaviors in our children, rather than giving in to bad ones.”

For better or for worse, much of the younger generation’s social development is wrapped up in media. Complex social interactions take place on Facebook, and profound personal revelations are shared on Twitter. Kids who are completely cut off from social media and other technologies may have trouble relating to their peers, or keeping up with conversations.

Walking the line between too much media, not enough media, the right kinds of media, and media in the right places, at the right times, is a big job—but one that, if managed carefully, can ultimately benefit the entire family.

“Technology isn’t all bad,” says Dr. Phillipi. “My daughter just left for college, and it’s great being able to talk or text with her regularly. We use technology to connect as a family, and I love that.”

MEDIA OVERLOAD: WHAT TO WATCH FOR

Increased Aggression: Kids exposed to violent content can exhibit more of these behaviors when they aren’t in front of the screen.

Flexibility: Can they follow the rules parents have set, or do they throw a tantrum? If kids consistently have a hard time tearing themselves away from the TV, it’s time to reevaluate their technology access.

Sleep Problems: If children have difficulties “winding down” or going to sleep, it may mean screens need to be turned off earlier in the evening.

For more on raising active kids in a tech-heavy world, check out
the Healthy Families blog from OHSU Doernbecher experts.

Health & Nutrition for Young Athletes

Thu, 02 May 2013 15:14:00 -0700

It’s not easy being a kid—growing strong bones, healthy muscles, and a sharp mind is a big job! For young athletes, the physical demands of participating in sports make getting plenty of rest and a balanced diet even more crucial. High-performance athletes age 8 to 80 can get personalized nutrition and training recommendations at OHSU’s Human Performance Lab. Its director, Dr. Kerry Kuehl, offers a few reminders for active kids.

Image: Courtesy Shutterstock

Sleep

School, homework, sports, and a social life leave kids with little time for the sleep they desperately need. Balancing these responsibilities is crucial for the young athlete and requires careful monitoring by parents. “Unfortunately, I wish I had a secret,” says Dr. Kuehl. “The truth is, if you’re burning the candle at both ends, you’re going to pay for it sooner or later.”

Image: Courtesy Shutterstock

POWER UP

High-protein and high-antioxidant foods—lean meats, lots of vegetables—should power a young athlete’s diet. The highest protein intake of the day should come two hours before a workout, with a quick dose of antioxidants coming immediately afterward.

Image: Courtesy Shutterstock

LEAVE THE ENERGY DRINKS BEHIND

“There is absolutely no place for caffeine or energy drinks in the lives of healthy children or healthy athletes,” Dr. Kuehl says. “In fact, added to the stress of cardiovascular exercise, they can cause serious health complications.”

Image: Courtesy Shutterstock

Be Aware

A balanced diet and plenty of sleep should provide kids with the power they need to perform both on and off the court. If that’s not doing the trick, consult a doctor—health concerns unique to athletes (like runner’s anemia or other nutritional deficiencies) should be managed by a professional.

Kids & Vitamins: Playing It Safe

Thu, 02 May 2013 15:13:00 -0700

Image: Courtesy Shutterstock

From the early days of prenatal development through the last of the awkward adolescent growth spurts, kids need a special blend of vitamins and minerals to support the grueling process of growing up. Muscles need strengthening, immune systems need boosting, and the adult teeth that begin forming in early childhood have to be strong enough to last through a lifetime of chomping and chewing.

Confronted with the lofty promises leaping from the shelves of every pharmacy in town (“Enhances Brain Function!” “Supports Healthy Sleep Patterns!”), deciding which dietary supplements kids really need can be confusing at best, and potentially dangerous if done incorrectly. Natasha Polensek, a primary care physician at OHSU Doernbecher’s Healthy Lifestyles Clinic, suggests a quick look at the basics: what’s usually needed, what’s usually not, and what won’t hurt to try.

Iron supports healthy blood production and muscle growth in infants and children, and is closely watched by doctors in the first year of life. “After four to six months of breast-feeding, a mother’s iron stores are depleted,” explains Dr. Polensek. “This puts infants who haven’t yet been introduced to solid foods at risk for a deficiency.” Pediatricians advise parents to incorporate iron-rich foods into their infant’s diet from the moment solid foods are introduced, and to test for anemia at nine to 12 months. For bottle-fed babies, the American Academy of Pediatrics (AAP) recommends an iron-fortified formula, with careful monitoring to determine whether additional supplements are necessary.

After early childhood, iron is especially important to monitor in adolescent girls. Because an overdose of iron can be deadly, work with your doctor to determine whether and how much of the supplement is needed.

In the northern latitudes, we see virtually all vitamin D tests come back with low levels.

While iron deficiencies are determined on a case-by-case basis, there’s one vitamin doctors find lacking more often than not in residents of the Pacific Northwest: vitamin D. “In the northern latitudes, we see virtually all tests come back with low levels,” says Dr. Polensek.

Sunlight converts a naturally occurring compound in the skin into an active form of the vitamin, but Portland’s cloud cover and, when the sun’s out, parents’ well-intentioned slathering of sunblock prevent this crucial process from taking place. This means most children don’t have enough of the vitamin that supports tooth and bone formation and regulates the absorption of other mineral mainstays like calcium. “Vitamin D supports bone density,” Dr. Polensek says, “and a relatively small daily dose can protect against bone loss and osteoporosis later in life.” Four hundred units of vitamin D a day meets the AAP’s daily recommendation for infants, children, and adolescents.

Dr. Polensek’s own niece and nephew take a daily multivitamin and a vitamin D supplement, a combination she feels comfortable recommending to most parents of otherwise healthy children. Ideally, most of the vitamins and minerals crucial to childhood development can be incorporated into a healthy diet, but sometimes an “ideal diet” takes a backseat to getting your family through the day in one piece. In these cases—that is, in real life—carefully chosen vitamins and dietary supplements can bridge the gap between the practicalities of parenthood and the complex nutritional needs of growing kids.

If you have concerns about your child’s nutrition,
talk with your pediatrician or call 503-346-0640.