There are a few different ways to get vitamin D. Vitamin D may come from foods or vitamin supplements; vitamin D can also be made by the skin when it is exposed to ultraviolet rays (UV light).

Vitamin D deficiency is often missed because there are no real symptoms associated with it. Rickets and osteomalacia (softening of the bones) are the most common signs of vitamin D deficiency but there is no way for parents to tell if their child is suffering from these illnesses. The only way to prove that your child is vitamin D deficient is by completing a blood test which screens for a particular form of vitamin D, called 25-hydroxyvitamin D (25(OH)D).

Think that name sounds complicated? Unfortunately, many doctors do too. In fact, doctors often order the wrong blood test when assessing vitamin D levels. Be sure to ask for 25(OH) D blood test not 1, 25-dihydroxy-vitamin D (aka calcitriol). With such complicated names, it is no wonder that such mistakes are made!

Vitamin D deficiency exists when 25(OH) D levels fall below 25 ng/mL. Levels may vary depending on time of year, direct sunlight exposure, skin color and vitamin D consumption. Levels should be between 50 - 80 ng/mL year-round for both children and adults.

As a doctor, I am finding more and more children with low levels of vitamin D, mainly because kids are spending less time in the sun. These days, toddlers are more often inside watching TV than playing outside. And if they are in the sun, they are lathered with sun block, which reflects the sun’s rays and decreases vitamin D formation. Obviously, sunscreen is important and should not be avoided! But it does lead to lower levels of vitamin D. Also, many toddlers do not get enough vitamin D to meet their needs since there are limited food sources of high vitamin D content.

The current recommendation is 400 IU per day in the form on of vitamin D3 (cholecalciferol). New studies are showing that higher levels may be needed to prevent the diseases discussed above. Many are now recommending 1,000 IU per day in the form of vitamin D3 (cholecalciferol). If your child doesn’t get this amount of vitamin D in his diet, you may want to consider a multivitamin that contains vitamin D.

What Should I do?

1. Get at least 10 minutes, 3 times per week of sun exposure.

Although this may sound easy to do, certain location like colder regions may not provided enough UV light and in warmer climate this may increase the risk of skin cancer.

2. Consume foods that contain vitamin D.

Foods that contain Vitamin D include fortified milk, fortified yogurt, fortified breakfast cereals, wild salmon, canned tuna, cod liver oil, sun-dried shitake mushrooms and egg yolks.

3. Take a supplement.

Taking a daily vitamin supplement is the most effective means of meeting vitamin D needs.  Take one multi-vitamin that contains at least 1000 IU of vitamin D daily OR supplement with a calcium pill that contains at least 1000 IU of vitamin D per day.

 Article by Joanna Dolgoff, M.D.
Joanna Dolgoff, M.D. is a pediatrician and child obesity specialist. Dr. Dolgoff's Weigh: Child and Adolescent Weight Management practice boasts a 96% weight loss success rate. There is a national online component (www.DrWeigh.com) to the program which children all over the country have been using to lose weight.

by Children's Hospital Boston staff on November 10, 2009

Most children have some fear of needles and may get scared before a vaccination. You might think the best way to handle this anxiety is to avoid telling your child about a vaccination ahead of time. But, like usual, honesty is the best strategy. Here, Child Life specialists offer tips and techniques for preparing your child for vaccination.

Before the vaccination

• Choose a quiet time to talk with your child and speak with a calm and relaxed tone of voice. Use honest, simple explanations that your child can understand. For example, you could say “We need to make sure that you stay healthy. This medicine will help keep you from getting the flu.”
• Avoid making promises you can’t keep, like, “You won’t feel anything when you have the vaccination.” This may be misleading.
• Avoid statements like, “Don’t be nervous,” or “Big boys don’t cry.” These statements could make your child feel ashamed if he/she does feel nervous or needs to cry. Never use threats such as, “You won’t get a prize if you cry,” or “I will leave the room if you don’t sit still.” These comments could make your child feel worse about the situation by adding an additional fear (i.e. fear that mom or dad will leave them alone, or fear of not earning a prize).
• If your child says, “I don’t want to do that!” respond with a firm but reassuring comment such as, “It’s important that we do this, so let’s work together to make it as easy as possible for you.”
• Listen to soothing music in the car, or watch a calm movie on the way to your appointment. Leave plenty of time to get to your appointment. If you are tense in traffic or rushing to arrive on time, your child will feel tense too.

During the visit

Much of the unpleasantness of having a vaccination comes from anticipation and a child’s feeling of helplessness. To help restore your child’s sense of control, try offering him or her these choices:

• Ask if your child wants to sit on your lap, or by him/herself, or even go into the room alone. Parents are always welcome and encouraged to stay and help their child during the procedure. If you can’t bear the sight of needles or would prefer not to stay, ask someone your child knows well (such as an aunt or grandparent) to come and offer your child support. Sometimes, older children prefer to go into the room on their own.
• Ask if they’d like to hold your hand or use a stress ball. Even many adults like to use a stress ball to help keep their hands and mind busy!
• Use distraction. Your child can choose an interesting toy or book to bring from home. Bubbles, light-up toys and look-and-find books can help keep your child’s attention away from the needle.  Some families use cell phones as a distraction too.
• Have them count to three. Many children like to know exactly when the needle will go in.  If your child would like, ask the clinician count to three, ask your child take a deep breath in, and then exhale slowly as the vaccination is given.
• Tell them to “breathe in the roses, blow out the candles.” Slow, deep breaths will help your child’s body relax. You and your child can practice this at home before your child’s visit and use again in other stressful situations.

For additional articles regarding children's health issues, please go to Childrens Hospital Boston

by Children's Hospital Boston staff on November 9, 2009

Sometimes the best perspectives come from far away places and few places are farther from Boston than Singapore, a small yet highly developed island nation in southeast Asia where I spent much of October.

The distance between Boston and Singapore is more than geographic, however. While I was away, H1N1 reclaimed the national spotlight back home. Not a day went by without mention of it in the news. It became the topic of conversation among doctors and patients everywhere. Well, almost everywhere.

While everyone in Singapore knew of H1N1, it was hardly the hot topic it had become in the States. During my stay, the main paper in Singapore ran just one article on H1N1 informing its readership that the first vaccine doses wouldn’t arrive for several more weeks.

To my surprise, the Singaporeans I met took this news in stride. One reason for this is that many Singaporeans perceive (and rightly so) that H1N1 is, in many ways, no worse than the seasonal flu that comes every year.  In addition, Singaporeans have endured two much more deadly epidemics in the past decade, making H1N1 pale in comparison. In 1998, the first known outbreak of Nipah virus occurred in Malaysia and Singapore infecting 276 people, 105 of whom died. In this and eight subsequent outbreaks in India and Bangladesh the virus has earned the grim reputation of being one of the deadliest viruses known, with a mortality rate between 40 and 80 percent. Nipah virus resides in bats (the “reservoir”, as bats do not get sick when infected). Bats infect pigs, and exposure to infected pigs causes disease in humans.

In 2003, severe acute respiratory syndrome (SARS) emerged in China and quickly spread to Singapore where it infected about as many people (238) as Canada (251) and far more than in all of the United States (27). The SARS virus reservoir is also bats, which transmitted the infection to humans via the palm civet cat. The mortality rate for SARS was about 6-17%. In comparison, the flu mortality rate is well below 1%.

This comparison is not made to belittle H1N1 and its ill effects. But if you’ve seen viruses like SARS and Nipah, H1N1 doesn’t look so bad.

Being in Singapore helped me identify another dimension of the H1N1 pandemic. H1N1 turns out to be a mutt of a virus, containing genes from bird and pig flu viruses. Some of the present H1N1 pandemic strain genes likely originated in birds that live in southeast Asia. Recognizing that all three of these viruses – SARS, Nipah and H1N1 – have roots in southeast Asia should spur consideration of the conditions that make that corner of the world a crucible for emerging diseases.

For Nipah virus, the rapid expansion of pig farming had a hand in the disease’s emergence; for SARS, the dietary diversity of some Chinese, who eat a variety of exotic animals, played a key role in stoking demand for palm civet cats in outdoor markets where they commingled with an astonishing array of creatures. Farming and diet, however, only pertain to the intermediate hosts – pigs and cats. Still other and perhaps more significant contributions may come from what has been happening to the viral reservoirs.

Imagine for a moment that you were in charge of preventing the spread of H1N1. Would you put an infected person in a small room filled to capacity with uninfected people? Likely not. And yet, this is precisely what is occurring in Southeast Asia where rates of deforestation are some of the highest in the world. As habitat dwindles for the birds and bats that carry viruses that may infect humans, their populations concentrate, probably increasing the likelihood that they will spread viruses among themselves and in turn, deliver them to us.

Ultimately to prevent epidemics like H1N1 we need ample supplies of hand sanitizer, masks, medicines and vaccines. But if we are wise, we can steal some of the H1N1 spotlight to focus attention of public health officials on the connection between ecological changes half a world away and public health back home.

By Aaron Bernstein, MD, MPH, physician in Medicine at Children’s and faculty, Center for Health and the Global Environment

For additional articles regarding children's health issues, please go to Childrens Hospital Boston

Most kids love animals and would like to have a pet.  In fact, kids often beg for pets when they see them ... "Can I have a puppy ... please?"  But parents need to think long and hard before introducing a pet into a household.  And of utmost importance is the type of pet your family will be the happiest with and that the pet will be the happiest with and well-cared for.

While some families can deal with a new puppy, others cannot plus puppies are a lot of work ... sort of like having a new baby.  And that is not a joke.  So, even though Susie is begging for a dog or cat, do a little reasearch first ... maybe a bird or fish will fill the pet need, but even little pets need daily care.

Regardless of what pet your family decides on,  you, as parent, should be making this decision by the way, make sure your child will be involved in the care of the pet if they are the one asking for the pet.  Get some books beforehand rather than rushing out to get some little unsuspecting animal.  Read up, with your child, on how much care will be involved, what type of food the animal eats and any other important information.  There are many book that can be borrowed from the library and this is another fun outing that can be part of the Pet planning process.

Explain to your child that they are expected to help care for the pet and really talk about what exactly they will have to do every day.  Whether it is a cat or a bird, explain that not only does the animal need food and water daily, but they must be given attention.  Obviously, depending on the pet, different pets will require different types of attention.  Cats need petting, dogs need exercising, birds like to be talked to.

One of the prime concepts to get across to kids, however, is that no matter what type of pet they have they should remember to always to KIND to pets and other animals.  This is an important lesson that can carry through to how they also treat other people, always with kindness.

It has just been brought to our attention that some children's face paints contain lead, which is a neurotoxin that can harm the brain at low doses.  So, the face is the last place you would want to be applying this stuff ... and certainly not on our children!  This info comes from a report by the Campaign for Safe Cosmetics, a national coalition of nonprofit health and environmental groups.

In some of the paints tested, the lab identified the heavy metals nickel, cobalt and chromium, which are skin allergens, even in products labeled "non-toxic" and "hypoallergenic."  Since these metals are not listed on product labels, parents shopping for Halloween makeup have no way of knowing which products are safe. The only way to know if a cosmetic product contains lead or other heavy metals is to test the product at a laboratory, which the Campaign for Safe Cosmetics did for their report.

The Campaign for Safe Cosmetics sent 10 children's face paints to an independent lab to test for heavy metals.

The lab test results found:

• All 10 of the children's face paints tested contained lead at levels ranging from 0.05 to 0.65 parts per million. 
• Six out of 10 face paints contained nickel, cobalt and/or chromium at levels ranging from 1.6 to 120 ppm - far exceeding industry safety recommendations of one ppm.
• Snazaroo Face Paint, labeled as "non-toxic" and "hypoallergenic," contained some of the highest levels of lead, nickel and cobalt found in the study.

"Lead is dangerous to the developing brains of children at any level. It is now widely accepted in the scientific community that there is no threshold level below which lead is safe," said Phil Landrigan, M.D., director of the Children's Environmental Health Center Mount Sinai School of Medicine. It is recommended that parents avoid using cosmetics on their children, to avoid any possible contamination with lead.