Growing Interest, Growing Bodies

References

From high chairs to high school, the market is ripe for products meeting the nutritional and safety needs of children. A 2005 report by the U.S. Department of Agriculture (USDA) showed on average, 46 percent of children aged 1 to 4, and 30 percent of children aged 5 to 18 take a vitamin and/or mineral supplement.¹ And according to San Francisco-based research firm SPINS, sales of children’s vitamins and minerals in natural products stores grew almost 10 percent from November 2001 to November 2002. SPINS also cites products formulated for children as one of the top trends in the natural products industry. “This encouraging trend spanned all segments: natural personal care and clothing, organic baby food, juices, yogurts and snacks ... even bottled water.”

Parents are becoming more educated about healthy eating and using multivitamins to supplement nutritious meals and exercise. With obesity and related diseases, and other potential health problems on the horizon for children, it is important to find a stable dietary regime the little ones can take with them into adulthood. In fact, over the past three decades, the childhood obesity rate has more than doubled for preschool children aged 2 to 5 years and adolescents aged 12 to 19 years, and it has more than tripled for children aged 6 to 11 years. At present, approximately nine million children over 6 years of age are considered obese (Institute of Medicine 2004).

“For infants and children, [nutritional intervention] is directly related to the awareness and education of the parents and particularly the mother,” explained Murray Clarke, M.D., homeopathic physician and president of ChildLife. And Kate Jones, vice president of Nutrition Now, agreed: “Parents have always been concerned about keeping their children healthy. But as more details surface concerning environmental health risks and an increase in the number of people with chronic illnesses, the more parents want their children to have the healthiest start possible.”

Joseph D. Brasco, M.D., Garden of Life, said parents are increasingly aware of the power of good nutrition early in childhood. “While some parents look to natural remedies because their children are experiencing health challenges, for a lot of them it’s more preventive,” he said.

“There definitely seems to be a growing interest in natural remedies for infants and children, and subsequently an increase in the number of products targeted toward their special needs,” said Nena Dockery, technical and regulatory manager for National Enzyme Co.

The prevalence of dietary supplement use among the youngest children is evidenced in one study done where a national random sample of 3,022 infants and toddlers age 4 to 24 months found, overall, 8 percent of infants aged 4 to 5 months received some type of dietary supplement.² The prevalence of supplement use also increased with age, to 19 percent among infants 6 to 11 months and 31 percent among toddlers 12 to 24 months. The vast majority of supplement users (97 percent) received only one type of supplement, most commonly a multivitamin and/or mineral supplement. Results also showed it was usually the first-born child or a picky eater that had taken the supplements.

Retailers who educate themselves about children’s health issues and learn what both parents and children look for in products are in a prime position to increase short-term product sales. “People are taking a more active approach to their children’s health,” affirmed Diane Pollock, sales marketing manager for MOM Enterprises. “There is definitely a growing interest in the children’s market and a wellness trend.”

As much as it is important to consume the right vitamins, it is vital to only give children the correct amount. Retailers should read the directions on each product and determine whether it is designed to meet the needs of children before shelving it in the children’s product section. On the other side, parents should discuss with a health care provider the use of such products to address compatibility and effect on any special health conditions.

Nutrition for children is essentially the same as nutrition for adults. In fact, everyone, regardless of age, needs the same types of nutrients, just in different amounts. Compared to adults, small children actually need more nutrients in proportion to their body weight. As bones, muscles, teeth and blood volume are developing, nutrient intake must be adequate to support this process, and also to keep up with the growing child’s increasing activity. A challenge also arises when growth spurts alternate with periods of no or slow growth.

The benefits of improved childhood nutrition are apparent. One out of three parents surveyed by The Healthy Foundation said their children earned higher grades since taking daily multivitamins through the Vitamin Relief USA program (www.vitaminrelief.org). In addition, 59 percent of parents said their children were eating better, and 48 percent said their children were feeling better and were more active.

But, choosing the right supplement can be difficult, and retailers should help parents make good choices by thoroughly familiarizing themselves with the details of available products. For instance, some children cannot or will not swallow tablets or capsules; trying to force a child to take a bad tasting supplement will not result in the benefits intended, but a headache for the parent or, in some cases, vitamins mysteriously buried in a convenient household plant. Thus, flavored, chewable products are popular with children because they taste good; and parents are happy because children will take them.

However, with the tempting flavors comes the danger of over-ingestion of product. Vitamin and mineral supplements can help infants and toddlers with special nutrient needs and achieve adequate intakes, but care must be taken to ensure that supplements do not lead to excessive consumption. For this reason, vitamins are best stored in childproof containers. Another detail to consider, some children’s chewables contain artificial sweeteners, colors, flavors and hydrogenated fats, all of which “natural” parents are trying to avoid.

The Dietary Reference Intakes (DRIs), which include the Recommended Dietary Allowances (RDAs) and Adequate Intakes (AIs), should serve as guides to prevent deficiencies in each age group. However, most of the levels set for preschoolers and toddlers are based on values established for infants and adults. In addition, the DRIs include a built-in margin of safety that exceeds the requirements for most children in the United States. Therefore, an intake that is less than the DRI is not necessarily a reason for concern.

“Children’s products are designed especially for a child’s needs, so be sure to follow the directions carefully,” explained Jones. “If the child has a health condition or is on any type of medication, whether prescription or over-the-counter, the parents should check with their health care provider to be sure which supplements are best suited for the child.”

For parents, a more practical approach to ensuring proper nutrient intake is to use the Food Guide Pyramid for Young Children, devised by USDA. In January 2005, USDA and the Department of Health and Human Services (HHS) jointly released the 2005 Dietary Guidelines for Americans (www.health.gov/dietaryguidelines). These new guidelines outline recommendations to promote health and reduce the risk of chronic disease through nutritious eating and physical activity.

The new guidelines encourage Americans over 2 years of age to eat a variety of nutrient-dense foods. Recommended items include fruits, vegetables, fat-free or low-fat milk and milk products, lean meats, poultry, fish, beans, eggs, nuts and whole grains. Conversely, they recommend a diet low in saturated fats, trans fats, cholesterol, salt (sodium), and added sugars (www.nih.gov).

Intakes of some key nutrients are low during the period of dietary transition in early childhood, and intakes for some nutrients actually decrease despite increases in energy intake. And because a considerable portion of children (ages 12 to 18 months) consume low-fat diets, it is clear that many parents are not following the only pediatric nutrition recommendations that currently exist.³ While severe nutrient deficiencies are rare in the United States, levels of calcium, iron, zinc, vitamin B6, folic acid and vitamin A are the nutrients most likely to be low in children as a result of poor dietary habits. It is therefore vital that parents make wise choices in choosing foods that are good sources of protein, mono- and polyunsaturated fatty acids, complex carbohydrates, vitamins and minerals, which can be a challenging task.

“Once children transition from breast milk or formula to solid food, it can become more challenging to ensure that they receive the nutrients needed to maintain health,” Dockery said. “They may be getting ample protein, fat and carbohydrate calories, but still be undernourished because of a lack of beneficial forms of these macronutrients or a deficiency in micronutrients (vitamins, minerals or fiber).”

Since children are generally at risk for micronutrient deficiency, retailers should direct parents toward micronutrient supplements containing a complete range of essential vitamins, minerals, antioxidants and trace elements probably absent from their diet. Some of the micronutrients to pay particular attention to are vitamins C and E, along with iron, magnesium and calcium.

Also known as ascorbate and ascorbic acid, vitamin C is a water-soluble antioxidant. It is required for the maintenance of normal connective tissue, for wound healing and for the remodeling of bone. Vitamin C is also needed as a cofactor in the synthesis of epinephrine (adrenalin) and bile acids, as well as thyroxin (thyroid hormone) synthesis, amino acid metabolism, strengthening resistance to infection, and aiding in the absorption of iron.⁴ While it has a range of benefits for children, one interesting recent study found greater vitamin C intakes were associated with fewer therapy delays, less toxicity and fewer days spent in the hospital in children being treated for leukemia with chemotherapy.⁵

Vitamin E is a fat-soluble vitamin that exists in eight different forms. Each form has its own biological activity, which is the measure of potency or functional use in the body. Alpha-tocopherol is the most active form of vitamin E, and it is also a powerful biological antioxidant.⁶ Its natural form (Dalpha-tocopherol) is more effective than the synthetic analogue (D,L-alphatocopherol), and is generally sold as alphatocopheryl acetate, a form that protects its ability to function as an antioxidant.

In addition to its antioxidant support, vitamin E has interesting effects on immune function. For example, in a recent study of 1,290 pregnant women, those who took vitamin E and zinc had children who were less likely to have wheezing or asthma during the first two years of life.⁷

Children also have a great need for iron, but many children’s multiple vitamin/mineral chewables do not contain iron because of taste issues as well as concern over toxicity. According to The Southern Medical Journal, it is reported that an estimated 3,000 children experience iron poisoning, a number which has increased two-fold since the 1980s.⁸ Federal law now requires all iron-containing drugs and dietary supplements to carry a warning about the risk of acute iron poisoning in children under 6 and the need to keep the products out of reach of children. For parents wary of iron, there are strictly iron-free supplements. “We do not have any iron in our products,” said Kathy Martino, sales manager at Hero Nutritionals. “The taste of our supplements is so delicious; some children tend to eat more that recommended, so to avoid any toxicity issues, we do not include iron in our supplements.”

But iron is a required nutrient, and supplementation may be necessary if the child does not consume meat. In fact, children up to 3 years of age are at high risk for iron-deficiency anemia if they don’t meet the RDA for iron for both toddlers and preschoolers of 10 mg/d. Even more serious, approximately 25 percent of adolescent girls have iron deficiencies. On average these girls eat more fast food and junk food with empty calories and less nutrient-dense foods high in iron than older women. Some adolescent girls also abstain from eating meat, which creates a greater risk of iron deficiency and an increased need to supplement with an iron-fortified supplement or food product.⁹ Iron deficiency has been found to possibly contribute to the physiopathology of attention-deficit/hyperactivity disorder (ADHD).¹⁰ Researchers evaluated the effects of iron deficiency in children diagnosed with ADHD versus iron deficiency in an age- and sex-matched control group. The researchers concluded ADHD-diagnosed children may benefit from iron supplementation because low iron stores contribute to ADHD.

For infant health, consider combining zinc with iron. Formulas with both can offer better absorption than taking one independent of the other. For example, in a study on Thai infants, iron supplementation improved hemoglobin, iron status and ponderal growth, and zinc supplementation improved zinc status when taken together.¹¹ 

Another important mineral in children’s health is calcium, which plays vital roles in blood clotting, heart rhythm, nerve transmission, muscle growth and contraction, and proper functioning of cell membranes. However, it is best known for its function in development and maintenance of bone mass.

Interestingly, studies have shown contradicting evidence for calcium actually improving bone mineral density (BMD). One meta-analysis of 19 studies involving more than 2,800 children reported calcium supplementation improved total bone mineral content and upper limb BMD,¹² while another study found calcium supplements helped reduce absolute fracture risk in children by a very slight amount.¹³ However, British researchers reported calcium may not be as effective as once thought in children or later in life among people given calcium as children.¹⁴ “Growing bone might need a combination of materials, such as calcium combined with vitamin D, to grow stronger.” said David L. Katz, Ph.D., associate professor of public health and director of the Prevention Research Center at Yale University School of Medicine.

As important as calcium is, without magnesium, a child’s body could not absorb calcium. Magnesium not only benefits the bones, but also keeps the body’s metabolism in balance, and helps the muscles, including the heart, work properly. It is important to assisting sodium and potassium move across cell membranes. Magnesium is also important to the metabolism of proteins and activates most of the body’s essential enzymes. It is the fourth most abundant mineral in the body and is essential to good health.

Magnesium plays important roles in all the major metabolisms: in oxidation-reduction and in ionic regulation, among others. More specifically, the full genetic potential of the child for physical growth and mental development may be compromised due to deficiency of micronutrients such as magnesium. Children and adolescents with poor nutritional status are exposed to the chance of decreasing mental and behavioral functions that can be corrected by dietary measures, but only to a certain extent.¹⁵

Beyond basic nutrition, use of complementary and alternative medicine (CAM) and specialty nutrients is on the rise. One of the hottest is the use of essential fatty acids (EFAs). A sufficient dietary intake of numerous varieties of EFAs is another factor crucial to achieving optimal nutrition in youngsters. EFAs, which include omega- 3s and omega-6s, help manage cholesterol levels, regulate body temperature and control blood pressure. From the beginning of life they are also essential for growth and development of hair, skin and nails and carry the fat-soluble A, D, E and K vitamins. Further, EFAs play an important role in brain development and cognitive performance.

In fact, there is a growth spurt in the human brain during the last trimester of pregnancy and the first postnatal months, with a large increase in the cerebral content of docosahexaenoic acid (DHA). In one study, researchers examined the effect of supplementing pregnant women with DHA, and found maternal intake of very-long-chain omega-3 fatty acids during pregnancy and lactation may be favorable for later mental development of children.¹⁶ To that end, several companies are now offering specialty DHA EFA products for pregnant women.

“In fact, DHA which is plentiful in fish oil makes up half the fat in the brain and eyes; unlike the heart and kidneys, these organs can never truly be transplanted,” said Corinna Benoit, national sales manager at Nordic Naturals. “We need to get the right fats early to make these children as healthy as possible.”

Another fast-growing category in the children’s aisle is digestive support. Brasco noted probiotics help in three main areas of concern. “First, probiotics help support digestive health and can minimize digestive discomfort as bloating or constipation,” he said. “Second, they help support nutrient absorption and assimilation. And third, probiotics help support the health and vitality of the immune system.” Probiotics are defined as live microorganisms, including Lactobacillus, Bifidobacterium and yeasts that may beneficially affect the host upon ingestion by improving the balance of the intestinal microflora. Any yeast-based probiotics should be avoided if the child is allergic to yeast.

Newborns, especially those that are breast-fed, are colonized with bifidobacteria within days after birth; however, supplementation can ensure a healthy gut from the start. Several companies offer specialty formulas for the children’s market. For example, Primal Defense® Kids (Garden of Life) probiotic powder is a good option because it contains clinically studied probiotics naturally found in a child’s gut. And Nutrition Now developed Rhino FOS & Acidophilus with probiotic strains and counts to maintain digestive health in children.

There is presently much active research focusing on the development of target-specific probiotics. These new probiotics are entering the marketplace in the form of nutritional supplements and functional foods, such as yogurt functional food products. And different types of probiotics show promise as effective therapies for antibiotic-associated diarrhea (AAD), a common complication of most antibiotics and also Clostridium difficile disease (CDD) in children. Three types of probiotics (Saccharomyces boulardii, Lactobacillus rhamnosus GG and probiotic mixtures) significantly reduced the development of antibiotic-associated diarrhea.¹⁷ Only S. boulardii was effective for CDD.

Probiotics also help support the health and vitality of the immune system. “Seventy-five percent of the body’s immune cells actually reside in the gut,” Brasco added. “There are actually studies that show children in cultures that regularly consume probiotic-rich fermented foods in their diet have less instances of asthma and allergies.”

When it comes to the children’s market, it’s also important to bring the “fun”in, whether in delivery forms or at the shelf.Some of the standard delivery forms for children include chewables, liquids (which can be mixed into other beverages), drink mixes and even gummy “candies” or lollipops.

There are innovative delivery forms making inroads into the children’s nutrition market. For example, Nutrition Now developed Rhino Echinacea pops with pectin—ice pops that deliver botanicals to soothe sore throats during the cold and flu season. And Enzymedica launched an effervescent plant-based digestive enzyme powder that, when mixed with juice, turns into a fizzy drink. “It is a fun alternative to kids’ digestive aids that typically come in hard-to-swallow capsules,” said Tom Bohager, president of Enzymedica. “Kids Digest also contains the friendly bacteria acidophilus, and xylitol, a natural sweetener found in such plants as cauliflower.”

And don’t let the fun stop at the shelf. “Retailers should do their best to have fun with the merchandising of children’s products,” noted Benoit. Draw children in with colorful displays and samples to take home, as well as activities geared to growing minds. This offers children a chance to be involved with their health and their local health retailer and makes them more likely to continue their involvement into adulthood.

Devoting a complete section exclusively to children’s products can bring parents to a one-stop kid shop allowing them to focus on a variety of children’s needs, not just one symptom or use. “Another option to merchandising children’s products is to provide a children’s remedy section,” Pollock suggested. For example, when parents seek a product to relieve cold symptoms they will see a children’s version beside it. This makes it easier for parents to grab products for their children while shopping for their own needs. “If a parent is looking for a cold product for herself and sees the children’s products nearby, she may be enticed to buy the children’s product just in case,” said Jones.

Whatever the plan, making it fun for children and easy for parents can address nutrition needs now and build consumer interest for the generation to come.

Almost 25 percent of parents are using some type of alternative medicine for their children—mostly micronutrients and herbal remedies, according to the American Academy of Pediatrics. “With information about herbs becoming more available, many people are increasingly comfortable with using safe, time tested herbs for children,” said Ellen Kamhi, Ph.D., RN, The Natural Nurse. “But I’m often surprised when parents ask if it is safe to use herbs with children.”

Health care providers and parents should be encouraged to have an open dialogue regarding the use of alternative treatments for children. It is currently estimated only 45 percent of parents giving their children herbal products discuss the use of those products with the child’s primary health care provider (Pediatrics, 111, 5:981-5, 2003). One reason for the appeal of these products? Many botanical offerings can help children’s health issues. For example:

• Chamomile helps reduce anxiety and promotes calmness and relaxation.
• Oregon grape root is a natural immune modulator.
• Ginger naturally addresses upset tummies.
• Cherry bark supports respiratory health and soothes dry throats.

Also of interest are homeopathic remedies, which feature diluted remedies designed to bolster the body’s own immune response to a challenge. Safe and free of side-effects, homeopathic medicines are regulated as a category of drugs by the Food and Drug Administration (FDA), meaning they can be marketed for actual ailments. Among the popular homeopathic remedies for children are ones targeting colic, eczema, teething, chicken pox and insomnia.

"Growing Interest, Growing Bodies" References

1. Frazao, E. "46 percent of children aged 1 to 4, and 30 percent of children aged 5 to 18 take a vitamin and/or mineral supplement." U.S. Department of Agriculture Bulletin, Feb. 2005. www.ers.usda.gov/publications/aib796/aib796-4/aib796-4.pdf    

2. Briefel R, et al. "A national random sample of 3,022 infants and toddlers age 4 to 24 months found, overall, 8 percent of infants aged 4 to 5 months received some type of dietary supplement" J Am Diet Assoc. 106: 1 S52-65, 2006. http://journals.elsevierhealth.com/periodicals/yjada 

3. Frances Piciano, et al. "Iit is clear that many parents are not following the only pediatric nutrition recommendations that currently exist." PEDIATRICS 106, 1: 109-114, 2000. http://pediatrics.aappublications.org/ 

4. Singh M. "Role of micronutrients for physical growth and mental development." Indian J Pediatr. 71, 1:59-62, 2004. www.ijppediatricsindia.org     

5. Kennedy DD, et al. "Vitamin C intakes were associated with fewer therapy delays, less toxicity and fewer days spent in the hospital in children being treated for leukemia with chemotherapy" Am J Clin Nutr. 79:1029-1036, 2004. www.ajcn.org 

6. Office of Dietary Supplements, National Institutes of Health. "Vitamin E." Mar. 2005. www.ods.od.nih.gov/factsheets/vitamine.asp

7. Litonjua AA, et. al. "Maternal antioxidant intake in pregnancy and wheezing illnesses in children at 2 y of age." Am J Clin Nutr. (84, 4: 903-911, 2006). www.ajcn.org 

8. Morris CC., "It is reported that an estimated 3,000 children experience iron poisoning, a number which has increased two-fold since the 1980s." South Med J., 93, 4: 352-8, 2000. www.sma.org/smj 

9. Quilici-Timmcke, J. "Adolescent girls also abstain from eating meat, which creates a greater risk of iron deficiency" A Novel Approach to Delivering Iron.

10. Konofal E. et al. "Iron deficiency has been found in one study may contribute to the physiopathology of attention-deficit/hyperactivity disorder (ADHD)." Archives of Pediatrics and Adolescent Medicine, 158, 12:1113-15, 2004. http://archpedi.ama-assn.org/ 

11. Wasantwisut, et al. "Iron supplementation improved hemoglobin, iron status and ponderal growth, and zinc supplementation improved zinc status when taken together." American Society for Nutrition.136: 2405-2411, 2006. http://pubs.nutrition.org/ 

12. Winzenberg,et al. "Meta-analysis reported calcium supplementation improved total bone mineral content and upper limb BMD." BMJ. 333, 7572: 763-4., 2006.

13. Janet Barger-Lux, M, et al. "Calcium supplements helped reduce absolute fracture risk in children by a very slight amount." JN, 135:2362-66, 2005. http://jn.nutrition.org/ 

14. Shaw, K. et al."Calcium may not be as effective."BMJ.333:775, 2006. www.bmj.com/ 

15. Bourre JM. "Children and adolescents with poor nutritional status are exposed to the chance of decreasing mental and behavioral functions that can be corrected by dietary measures, but only to certain extent, J Nutr Health Aging, 10, 5: 377-385, 2006.  

16. Decsi T, Koletzko B. "Maternal intake of very-long-chain omega-3 fatty acids during pregnancy and lactation may be favorable for later mental development of children." Curr Opin Clin Nutr Metab Care. 8, 2:161-6, 2005.

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