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Vitamin A
I heard that vitamin A is good for the skin, especially for acne. What does that have to do with my baby's diet?
A vitamin A preparation called retinoic acid, either taken by mouth or applied to the skin as an ointment or cream, is useful to treat various skin diseases such as acne and psoriasis. Certain vitamin A compounds may even be of value to treat or prevent skin cancer. None of these skin diseases, however, are common in infants. Acne is common in children in their late teens. Psoriasis, a condition of scaly patches of skin, occurs in children more than 6 years of age and in adults. Skin cancer is mostly seen in adults.
Your baby's diet should contain vitamin A, not to prevent skin disease such as acne, but to prevent vitamin A deficiency. Vitamin A is important for the skin and eyes and to prevent infection. Dry and scaly skin, particularly on the arms, legs, shoulders, and buttocks, is seen in malnourished babies who are also vitamin A deficient.
Are there many different kinds of vitamin A?
Vitamin A (retinol) was first discovered in chemicals in 1912 as a part of the diet necessary for growth. Various chemicals with vitamin A activity are called retinoids. Retinol is present in milk and in meats. Retinol can also be made from a chemical precursor called carotene, which is present in most plants.
Humans do not make vitamin A. We obtain vitamin A either as carotene from natural plant sources or as retinol from animal foods. Because we are dependent on these outside sources for vitamin A, it is called an essential nutrient. Vitamins are, by definition, essential nutrients!
I took large amounts of vitamin A when I was pregnant; has it damaged my baby?
Vitamin A taken by a pregnant woman can cross over the placenta to the fetus. Whether this harms the fetus depends on the dose and time of taking vitamin A, how mature the fetus was at the time of taking vitamin A, and the type of vitamin A. The World Health Organization (WHO) and the International Vitamin A Consultative Group have recommended that daily doses of vitamin A above 10,000 IU should not be given at any time during pregnancy. More recently, the American College of Obstetricians and Gynecologists (ACOG) has recommended that pregnant women limit their daily intake of supplemental vitamin A to 5,000 IU. The period between the fourth and tenth weeks of pregnancy is particularly dangerous because, at that time, various organs inside the fetus are being formed, and the risk of birth defects is therefore high.
A type of vitamin A called retinoic acid, when used for treatment of acne during early pregnancy (before 19 weeks), may cause spontaneous abortions (miscarriages) and birth defects in the newborn. The common birth defects caused by excess vitamin A include abnormalities of head and face, heart defects, and increased water in the brain (hydrocephalus). With newer techniques such as ultrasound examination, it may be possible to determine whether the fetus is affected by birth defects. To be safe, it is advisable to avoid taking excess vitamin A during pregnancy, particularly vitamin A with high retinoic acid content.
Is vitamin A the most important vitamin since it is called A?
All vitamins are important nutrients. The vitamins are divided into two groups: fat-soluble and water-soluble vitamins. The fat-soluble vitamins include vitamins A, D, E, and K. Among these vitamins, vitamin A was the first one discovered, hence the label vitamin A. The name vitamin A does not imply that it is more important than the others.
I thought that vitamin A is necessary for good nutrition. Can my baby take more vitamin A?
The vitamin A content of a diet is often calculated as International Units (IU). Your baby receives vitamin A from various foods, including breast milk, milk formula, multivitamin drops, and semisolid and solid foods, such as cereals, fruits, vegetables, strained canned meats, eggs, and starchy foods. Mature breast milk contains approximately 150 IU of vitamin A in every 100 mL. The vitamin A content of other food sources for babies can be found on the label on these products. From this information on vitamin A content, and from the amount of each of these foods received by your baby in a day, you can estimate the daily vitamin A intake of your child.
The recommended daily allowance of vitamin A during the first year of life of a baby is between 1,200 and 1,400 IU per day. Your baby's diet should contain roughly this recommended amount of vitamin A.
Giving too much of vitamin A can be hazardous to your baby. Vitamin A toxicity can occur if an infant is given more than 100,000 IU of vitamin A in a single dose. Vitamin A toxicity can also occur if an infant is given more than 25,000 IU of vitamin A daily for a week or more. High-dose vitamin A supplementation by mouth (200,000 IU) on two consecutive days has been shown to be protective against mortality related to measles and diarrhea in children from developing countries where malnutrition is rampant and infectious diseases are endemic. Although no untoward effects were demonstrated in these studies, the risk of vitamin A toxicity at these high doses has not been systematically evaluated. Vitamin A toxicity in an infant can cause increased water and pressure in the brain. The infant may vomit, be drowsy and irritable, and have poor feeding. The soft spot on the head may feel tense or bulging. Vitamin A toxicity in an infant can also cause pain in the bones and joints. The infant, as a result, may become irritable and may refuse to be handled. The skin may look pale or yellowish. Because vitamin A toxicity has all these harmful side effects, it is important to avoid giving too much of vitamin A beyond the recommended daily allowance.
My whole family has poor vision. I understand vitamin A is helpful for vision. How can I make sure my baby gets enough?
The part of the eye that is responsible for vision is called the retina. The retina is somewhat like the film in a camera. The retina contains a pigment called rhodopsin that is necessary for absorbing light. Rhodopsin consists mostly of a form of vitamin A. In vitamin A deficiency, there is a lack of rhodopsin in the eye, which in turn affects the ability of the eye to absorb light. Blindness, particularly in dim light, is the end result. One of the earliest eye problems of vitamin A deficiency is night blindness, or blindness that becomes apparent only at night.
To prevent eye problems, your baby's diet should contain recommended amounts of vitamin A. Because there is plenty of vitamin A in breast milk from healthy, well-nourished mothers and in commercial infant formulas, babies receiving normal amounts of milk will also receive normal amounts of vitamin A. As vitamin A-rich semisolid and solid foods, such as vegetables and fruits, are introduced into the diet after about six months of age, your baby will also receive additional amounts of vitamin A from these food sources. Vitamin A deficiency affecting vision is very rare in developed countries, unless there is very poor nutrition in the family, but it is common in developing countries.
I am taking Accutane (vitamin A) for acne and I am breastfeeding my baby. Is that a problem?
Accutane, also called isotretinoin, is a type of vitamin A product used for the treatment of severe acne. It is not known if isotretinoin is excreted into human milk. Because vitamin A is excreted into human milk, one may expect to find isotretinoin in human milk as well. The risk of toxicity will depend on the isotretinoin content of your milk and the volume of milk received by your baby. There have been no reports of isotretinoin toxicity in breastfed infants whose mothers were treated with Accutane. The risk of this problem, therefore, appears to be small. Nonetheless, it is generally advisable for breastfeeding mothers to avoid medications that are excreted into breast milk, so that any side effects of these medications on the infants can be prevented.
I heard that vitamin A is important for infections. Should I make sure that my baby gets enough vitamin A when he has an infection?
Vitamin A is known to stimulate the immune system in humans and animals. The immune system includes white blood cells and other factors that combat infections caused by bacteria, viruses, and other germs. Vitamin A-deficient children have frequent infections such as bronchitis, pneumonia, gastroenteritis, and diarrhea. A recent study from Southern India, where malnutrition and vitamin A deficiency are rampant, has shown that giving large doses of vitamin A to infants and young children can lower the risk of death and complications from measles infection.
When your baby has an infection, you should consult your doctor. The doctor is likely to find out the source and severity of the infection and the germs causing theinfection. Your baby will be treated with appropriate antibiotics. If your baby has been receiving good nutrition and the recommended amounts of vitamin A all along, it is extremely unlikely that he will have vitamin A deficiency. Giving extra vitamin A under these conditions is not necessary.
What about carrots? Someone told me that carrots have lots of vitamin A. Is that true? Should I give my baby carrots?
Carrots are rich in carotene. Carotene is a natural substance that can be changed to vitamin A. Other plant sources rich in carotene include spinach, squash, green peppers, sweet potatoes, pineapples, oranges, cranberries, figs, grapes, peaches, prunes, apples, pears, strawberries, and watermelons.
Is there enough vitamin A in the baby's diet normally?
Breast milk is the primary source of food for the majority of newborn infants in the world. Breast milk secreted in the first two to three days after the birth of an infant is called colostrum. The colostrum is rich in many nutrients, including vitamin A, and also in several immune factors that help fight infection. The composition of breast milk changes gradually until mature milk is established at about 10 days. There is plenty of vitamin A in mature breast milk from healthy, well-nourished mothers. Likewise, most of the commercial milk formulas used for infant feeding contain plenty of vitamin A. Therefore, infants less than 6 months of age fed only their mother's breast milk or commercial infant formula are not at risk for becoming vitamin A deficient and hence do not need additional vitamin A from other food sources. As semisolid and solid foods are introduced after about six months of age, as is common in infant feeding, the infants will receive additional vitamin A from these other food sources.
Vitamin A is one of those fat-soluble vitamins. Is that true? What does that mean?
Scientists divide vitamins into two general groups: fat-soluble and water-soluble. Vitamin A is one of the 4 fat-soluble vitamins. The other three are vitamins D, E, and K. These vitamins dissolve in fats, but not in water. Hence the term fat-soluble is given to this group of vitamins. Water-soluble vitamins include the B-complex vitamins, folic acid, and vitamin C. These vitamins dissolve in water.
I have heard that vitamin A is good for prevention of cancer. Should I start my child on this when she is young?
There is some evidence, based on animal studies and treatment of human diseases, that vitamin A may be important for the prevention of cancer. Cancer results when certain body cells lose control, and grow, divide, and multiply in a chaotic manner. If left untreated, these cancer cells can invade an organ, destroy other normal cells of that organ, and cause problems with normal functions of that organ. In late stages of untreated cancer, the cancer cells can spread to other organs of the body as well.
Vitamin A is important for orderly growth, division, and multiplication of various cells in the body. The vitamin A compounds may alter the disorderly multiplication that is typical of cancer cells. It is this effect of vitamin A on cell growth and differentiation that makes it likely that vitamin A may play a useful role in prevention and treatment of cancer.
Scientists have been conducting studies for years to determine if vitamin A can prevent cancer of the skin, lung, breast, urinary bladder, digestive tract, liver, pancreas, and other organs.
The evidence that vitamin A deficiency is a major cause of childhood cancer is much less compelling. Nonetheless, every child should receive the recommended intake of vitamin A from birth, not to prevent cancer but to prevent vitamin A deficiency and its ill effects. Likewise, there is no evidence that giving large doses of vitamin A from birth can prevent childhood cancer. As discussed elsewhere, giving too much vitamin A can be hazardous to your baby.
If I eat a lot of vegetables, will that affect the amount of vitamin A in my breast milk?
The amount of vitamin A in breast milk from healthy mothers is approximately 150 IU per 100 mL. If the mother takes a large amount of vitamin A (more than 50,000 IU), it is possible to increase the vitamin A content in her breast milk. However, if the mother is malnourished, as is true for some mothers from developing countries, the vitamin A content in her breast milk is only about half that found in breast milk from healthy mothers.
If you are healthy and eat a balanced diet, including a lot of vegetables, your breast milk should contain approximately 150 IU of vitamin A per 100 mL. This amount is enough to provide your baby with the recommended daily allowance of vitamin A during the first six months of life so long as your baby receives more than 20 ounces (600 mL) of milk every day. As semi-solid and solid foods rich in vitamin A are introduced into the diet after 6 months of age, your baby will also receive additional amounts of vitamin A from these food sources.
When I give my baby vegetables in his baby food, will that provide him with more or less vitamin A than when I am breastfeeding him?
Whether your baby will receive more or less vitamin A will depend on the vegetable added to your baby's diet. The carrot is a vegetable with the highest amount of vitamin A. Vegetables such as spinach, yellow sweet potato, and winter squash are also rich in vitamin A. Vegetables such as tomatoes and bananas are less rich in vitamin A. On the other hand, cereals such as rice, corn, and wheat contain almost no vitamin A.
The amount of vitamin A in breast milk from healthy, well-nourished mothers is approximately 50 IU per ounce. A one-ounce serving of carrots provides more than 1,000 IU of vitamin A, of spinach and yellow sweet potato between 500 and 1,000 IU of vitamin A, of tomato about 250 IU, and of banana about 50 IU of vitamin A.
What about meats in baby food? Do they give enough vitamin A?
Among the meat products, the richest vitamin A source is liver. A one-ounce serving of liver provides between 1,000 and 5,000 IU of vitamin A. A comparable serving of chicken provides between 10 and 30 IU of vitamin A, while that of a whole egg, about 50 IU of vitamin A, the same amount that is found in breast milk from healthy, well-nourished mothers.
Although liver is so rich in vitamin A, it cannot be recommended for infant feeding. There are published reports in medical literature about young children who have suffered from side effects of too much vitamin A when they were given chicken liver spread every day for long periods. Among the semi-solid foods introduced into a baby's diet, vegetables appear to be the better source of vitamin A.
Carrots make my baby look kind of yellow. Does this have something to do with yellow jaundice?
Carrots contain a yellow pigment called carotene. However, carrots do not cause yellow jaundice in babies. Jaundice results when a pigment called bilirubin accumulates in the skin and other body tissues. Bilirubin is produced when the red blood cells in the blood break down. The bilirubin is rapidly taken up by the liver and removed from the body when it is secreted by way of bile into the gut. Babies often develop jaundice soon after birth, particularly when they have a problem with excessive breakdown of red blood cells or when the liver is unable to handle the bilirubin. Breakdown of red blood cells, for example, may occur when the blood types of the mother and baby are different. The liver is unable to handle the bilirubin as a result of immaturity, as seen in premature newborn infants, or as a result of liver disease. If your baby develops yellow color of the skin, it is most likely to be due to jaundice from bilirubin. It is extremely unlikely to be due to the intake of carrots. Because jaundice from bilirubin can be dangerous, it is important to consult your physician to determine the cause and to treat it appropriately.
I understand that carotene is a kind of vitamin A. Isn't carotene some kind of pigment, and isn't it dangerous to eat pigments?
Carotene, a chemical that can be made into vitamin A, is found in a number of vegetables. One molecule of carotene can be split into two molecules of retinol (vitamin A). An enzyme is required for this splitting. This enzyme is found primarily in the intestine and in the liver. Because the amount of this enzyme in babies is low when compared to that in older children and adults, the absorption of carotene in the intestine is not efficient in babies. Therefore, it is extremely unlikely that harm can be done by giving carotene in moderate amounts in a baby's diet.
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