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There's No Excuse for Rickets - Vitamins Are Free!

Increasing numbers of toddlers are not meeting their requirements of some micro nutrients (vitamins and minerals) because they don't eat enough nutritious food and also are not being given the recommended toddler vitamin supplement.

In light of the Chief Medical Officer's recent decision to consider free vitamin drops for all children under 5, I'd suggest she might look at how we can increase the uptake of the free vitamins that are already available? Many children are already entitled to free vitamin drops and as few as 1% of those children ever receive them.

Increasing numbers of toddlers are not meeting their requirements of some micro nutrients (vitamins and minerals) because they don't eat enough nutritious food and also are not being given the recommended toddler vitamin supplement.

Nutrient deficiencies are not caused by toddlers eating poorly for a day or two or even a week or two -when they are unwell for instance. Most toddlers have body stores of a lot of nutrients and poor eating for a day or two won't deplete them. Just like adults, toddlers eat better some days than others. We need to think about the quality of the diet over the week rather than just judging it on one day in isolation.

There's no escaping that our relatively affluent, sedentary lifestyle promotes the over consumption of energy rich foods and the under consumption of dietary fibre, fruit, vegetables, whole grains and fish- all of which are valuable sources of key nutrients.

The most common toddler nutrition problems can often be spotted if you know what to look for. As well as the provision of vitamin drops, we need to educate parents and child care workers about children's nutrition. Here are my top tips

Iron deficiency anaemia:

  • Up to 12% of toddlers don't eat enough iron rich foods and have poor iron stores.
  • Other toddlers at risk of poor iron status are vegetarians and vegans and those toddlers with poor general dietary intake and an over dependence on milk.
  • The most common cause for iron deficiency is a low intake of haem iron (iron found in meat) and a failure to eat foods rich in vitamin C which helps the absorption of iron, this is especially important when you eat non haem iron from vegetables or cereals. Toddlers who are given tea to drink or high bran cereals to eat can also struggle to get enough iron- both of these foods restrict iron absorption.
  • The best food sources of iron are lean read meat, breakfast cereals, eggs, dark leafy green vegetables and pulses like beans and lentils.
  • Toddlers with a low iron status may be pale, lethargic and lacking energy. Anaemia in the early years has been shown to be linked with poor cognitive development.

Vitamin D deficiency:

Vitamin D deficiency and the resurgence of the deficiency disease rickets was the trigger for Dame Sally Davies's decision to look at free vitamin drops for all children. The only dietary sources of Vitamin D are oily fish, margarines, follow on formula and some breakfast cereals- these foods all have vitamin D added to them. Vitamin D is also produced in the skin via sunlight. The Department of Health already recommends that all children under the age of 5 take a daily supplement of Vitamin D, A and C- e.g. Healthy Start vitamin drops are FREE to families receiving benefits For those who don't qualify for free vitamin drops, there are a wide selection of inexpensive children's vitamin supplements available.

Choose a known branded supplement which provides 7.5ug vitamin D per day.

All children under 5 should be given a daily supplement of 7.5ug Vitamin D.

Other less common nutrient deficiencies:

Some toddlers have low levels of other nutrients because they are not eating well. Low intakes of vitamin B6, folic acid, calcium and zinc as well as iron are not uncommon in toddlers. If a toddler has generally poor eating habits it's wise to consider a multi vitamin and mineral supplement formulated for the under 5s.


Some toddlers don't eat enough fibre rich foods like fruits and vegetables or whole grain cereals. A diet low in fibre can cause constipation. You mustn't over load toddlers with high fibre food though, otherwise they become too full and can go off their food. As always it's all about balance. If a toddler eats a low fibre cereal at breakfast they can have some whole grain pasta at lunch or a sandwich made with a mix of white and whole meal bread at tea time. Keep a mixture of whole grain cereal foods and refined (white) cereal foods and serve a variety. Vegetables and pulses can be added to sauces, soups and gravies to increase the fibre content and try to serve fruit as part of desserts more often.

Omega 3 fats:

Diets have changed to contain more omega 6 fats and less omega 3 fats- this is partly because we all eat more omega 6 rich vegetable oils and spreads - a good thing to reduce saturated fat intake. However to balance the increase in omega 6 fats children need to increase their intake of omega 3 fats- the best source of omega 3 fats is oily fish like salmon, mackerel, sardines pilchards and trout.

Ideally toddlers need to eat at least two servings of fish per week- one serving can be from white fish or canned tuna (canned tuna doesn't count as an oily fish) the other serving should be from oily fish.

Choosing the right oils can help increase omega 3 fats too. Olive oil and soya oil for dressings and rapeseed oil for cooking gives a good balance of omega 3 and 6 fats. Pure vegetable oil is usually (but not always) rapeseed oil. For toddlers who do not eat any fish a toddler's omega 3 supplement may be necessary to balance their intake of fats.

At Grub4Life we applaud any initiative which focuses attention on toddlers diets- but there's more to consider here than simply increasing the provision of free vitamins. The early years is a critical time for laying down the foundations of lifelong dietary habits and health. Nutrition supplements have an essential part to play in our children's health and well-being- but unless parents are educated to make sure their children receive them we could just be burying our head in the sand.

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