baby

MULTIVITAMINS AND A BABY

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NEW YORK TIMES COLUMN: FAMILIES TODAY:
MULTIVITAMINS AND A BABY
By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D

Q. Is it true that a baby’s multivitamin intake should be stopped after age 3 months to prevent vitamin dependency?

A. We all depend on vitamins – molecules by which our bodies carry out chemical reactions that keep us healthy. Ordinarily the necessary vitamins come from a balanced diet and a little sunshine (five to 15 minutes three times a week) to activate vitamin D.

Some diseases and medications interfere with the absorption and metabolism of vitamins. A few rare hereditary diseases also cause vitamin deficiencies, despite a healthy diet; among the potentially affected vitamins are B6, B12 and D.

Children with these diseases may need to take regular supplements of the deficient vitamin to overcome their body’s inability to absorb or metabolize it.

We have never heard about multivitamins’ causing vitamin dependency. Multivitamin supplements aren’t necessary if a child eats a balanced diet. But many children don’t eat such a diet, especially in the first few years, and multivitamins can help them get the vitamins they need.

During the first year or two, iron and vitamin D are likely to be in short supply. In the first weeks of a baby’s life, we recommend that parents discuss iron and vitamin D supplements with their pediatrician.

Although breast milk is the best source of nutrition for babies, breast-fed infants often don’t get enough vitamin D, nor do babies who take in less than a quart a day of formula, which is usually fortified with vitamin D. The American Academy of Pediatrics recommends that infants take in 400 international units of vitamin D per day. Your pediatrician can guide you to the proper dose for your baby.

Depending on a mother’s diet, breast milk may not contain enough iron, though iron in breast milk is better absorbed than the iron in fortified formula. Your pediatrician can also determine your baby’s need for iron supplements.

Inadequate amounts can cause iron-deficiency anemia. During the first years of life, when the brain is growing faster than at any other time, inadequate iron intake has also been linked to learning disabilities that may only become evident later. Paying attention to nutritional needs from the beginning can make a big difference.

Between about 12 and 36 months, many children struggle to control what they eat and often limit their food intake to a few familiar items that may not contain the nutrients they need.

Many children take time to adjust to new tastes and textures. Often a parent may have to introduce a small amount of the same new food up to 15 times before a child will even try it. The process goes more smoothly if a parent simply places the new food on the plate without comment or pressure. Even gentle cajoling leads to more resistance. If you only offer a tiny taste each time, it will be less overwhelming for the child – and a little easier for you to put up with her refusal.

Multivitamins and regular visits to the pediatrician can reassure parents that a child’s growth is on track. Then parents may be less tempted to wage food battles with their children – which parents will surely lose.

There is no way to make a child eat something against her will. Repeated struggles over food are likely to lead to more struggles and perhaps even more serious eating problems later.

Responses to questions are not intended to constitute or to take the place of medical or psychiatric evaluation, diagnosis or treatment. If you have a question about your child’s health or well-being, consult your child’s health-care provider.

Dr. Brazelton, prior to his passing, was the founder and head of the Brazelton Touchpoints Center, which promotes and supports community initiatives that are collaborative, strength-based, prevention-focused sources of support for families raising children in our increasingly stressful world. Dr. Sparrow, a child psychiatrist, is currently the Director of the Brazelton Touchpoints Center. Learn more about the Center at www.touchpoints.org.

Reprinted with permission from the authors.

A SIMPLE TEST OF A BABY’S DEVELOPMENT

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NEW YORK TIMES COLUMN: FAMILIES TODAY:
A SIMPLE TEST OF A BABY’S DEVELOPMENT
By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

Q. I am an infant-toddler teacher and first-time mother. I’m reading your book, “Touchpoints: Birth to Three,” and I want to learn more about the assessment you use to evaluate a 9-month-old’s belief in his or her own success or failure.

A. Careful observation is the key. I like to watch a 9-month-old take on a challenge. There is so much to learn from seeing how a child tries something new. I have a simple test that teaches about temperament, and I think it can also be a window into a child’s self-esteem.

I give a 9-month-old a wooden block, small enough to fit in his hand but too big to swallow. If he expects to succeed, this sequence often follows:

He reaches out to grab the block. He looks at it. Then he looks at me as if to say, “What do you want me to do?”

At this age, babies already know that information is written all over our faces, and they know how to read it. If I smile encouragingly, he looks back at the block, turning it around in his fingers.

Meanwhile I bang another block on the table. Ready to imitate, he bangs his block on the table, too. If I bang once, he bangs once. If I bang twice, he bangs twice.

If I tap his block with mine, he does the same thing – and then he looks up at me and smiles. Already, we are friends. Then he brings his block to his mouth and rubs it around – his way of getting to know it better.

A baby who expects to fail may not even reach for the block I offer to him. If he does, he’s likely to take it from me limply and then may let it drop. He may not bother to look back at me to see what I think. If he does, and if I smile my encouragement, he may not display the same curiosity or seem to care about pleasing me.

When I bang my block on the table, it gets his attention. But he watches passively instead of trying it for himself. Already he seems afraid of getting it wrong. Yet children can’t learn if they don’t dare make mistakes.

Next, I hold out a second wooden block. The 9-month-old who expects to succeed clutches the first one tightly, and extends his other hand for the new block. Then he studies it with the same curiosity he showed for the first one. While doing so, he may even forget about the first one and drop it.

But when I take my two blocks and slowly show him how I bang them together, he picks up his first block again and tries his hardest to imitate me. When he succeeds, he looks up at me as if to say, “I did it. I did it all by myself. Aren’t I great?”

The 9-month-old who expects to fail may not reach for the second block, having given up on himself with the first. I make it more enticing by turning it around In my fingers so he can look at it, or by banging it gently on the table. Then I put it down next to him – he’s likely to ignore it or just handle it briefly.

When I show him how to bang two blocks together, the response is a half-hearted try. He picks up a block with each hand, or I may need to hand them to him again. He may make a brief swipe to try to bring them together. But he misses and looks at me briefly, then at the ground. He won’t try again.

Hitting two blocks together is an item from the Denver Developmental Assessment. But when I’m watching to see if a child expects to succeed or fail, I’m not interested in whether he succeeds – but in how he approaches the task, and how he responds to his own success or failure.

Responses to questions are not intended to constitute or to take the place of medical or psychiatric evaluation, diagnosis or treatment. If you have a question about your child’s health or well-being, consult your child’s health-care provider.

Dr. Brazelton, prior to his passing, was the founder and head of the Brazelton Touchpoints Center, which promotes and supports community initiatives that are collaborative, strength-based, prevention-focused sources of support for families raising children in our increasingly stressful world. Dr. Sparrow, a child psychiatrist, is currently the Director of the Brazelton Touchpoints Center. Learn more about the Center at www.touchpoints.org.

Reprinted with permission from the authors.