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Dr. A. Clark
Dr. A. Clark, Pediatrician
Category: Pediatrics
Satisfied Customers: 4437
Experience:  33 years of experience as a general pediatrician in private practice and in pediatric urgent care.
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I began investigating vitamin a as my pediatrician is recommending

Resolved Question:

I began investigating vitamin a as my pediatrician is recommending vitamin d only for my newborn as opposed to the poly tri vi sol he recommended for my older son in infancy.
I did the math. Upper safe limits of preformed vitamin a is 2,000 iu for 1-2 year old. I estimate that my my now 3.5 year old son had about 2,300 - 2,500 iu for 9 months to a year from 14 months to about 2. I continued poly tri vi sol that had been recommended in his infancy as label said for toddlers also. I was unaware of potential danger of vitamin a toxicity. He was drinking whole milk and eating cheese and yogurt also. I also was giving him the max amount of protein as well. I am concerned I may have inadvertently caused liver and or kidney damage.

He is very healthy. Very active. 3 year appointment was perfect as was urine specimen. No blood tests, of course. Please advise as my guilt is getting the better of me.
Submitted: 11 months ago.
Category: Pediatrics
Expert:  Dr. A. Clark replied 11 months ago.

Dr. A. Clark :

I'm happy that you have asked me to assist you with your child and hope that you can benefit from my many years of helping parents like you.

Dr. A. Clark :

Vitamin A toxicity is very rare, especially in children who have amazing abilities to metabolize medications and toxins.

Dr. A. Clark :

The dosage of vitamins A,C and D found in both Tri-vi-sol and Poly-vi-sol are safe and did not harm your child. The FDA recommended daily allowance is the minimum and 1500 IU is what is posted and looking at the labels of these vitamins I'm confused as to how he got 2300 - 2500 IU when the dose only contains 1500 IU.

Dr. A. Clark :

I assume you are adding up the vitamin plus what was in his diet to come to that number but again, toxicity is extremely rare and for many of my practice years I followed the American Academy of Pediatrics and FDA recommendation of giving vitamins to breastfed babies but not to formula fed babies with no ill effects, even in babies whose mothers insisted on giving vitamins in addition to the formula, where the label on the can clearly states that the vitamins are already in it.

Dr. A. Clark :

I would not be concerned at all since the bioavailability of Vit A from foods is very low. For instance, a sweet potato has 28,058 IU per serving but only a fraction as actually absorbed and stored!

Dr. A. Clark :

I see you are offline so I'll exit and watch for your return to chat but I can almost guarantee you that your child is fine and his liver enzymes are completely normal as I've never seen Vitamin A toxicity in my over 35 years of pediatric training and practice and this in spite of some pretty aggressive Vit A treatments for certain medical conditions where it is used.

Customer: Hello! Thank you for getting to my question. I added in only preformed vitamin a from the whole milk, yogurt and cheese he was eating from 14 months on while I continued the tri vi sol until approximately 2 years of age. I am not concerned about veggie sources.
Customer: Your response is very helpful. Would 2,500 iu of vitamin a for a year be considered aggressive? Could his liver enzymes be abnormal in complete absence of any other symptoms? Did high end protein in his diet complicate matters? Again, dairy sources and lean meat such as organic turkey.
Customer: Also, we do little to no dairy now. He does not like it. Lots of good fats like avocados. Lots of hummus, steel cut oats, lean poultry, salmon...
Customer: i just fear my first child will suffer from my ignorance...
Dr. A. Clark :

After weaning from breast or formula and especially after 2 children do not need additional vitamins as long as they are consuming a fairly normal and well balanced diet.

Dr. A. Clark :

You were following your doctor's recommendation and that of the manufacturer as the RDA assumes everyone is consuming a normal diet that contains vitamins and the only deficiency we ever see is with iron in kids who don't transition to a diet of foods and stay on cow's milk without any other vitamin sources and become iron deficient.

Dr. A. Clark :

I assure you he is fine and I've never seen toxicity from A in children consuming a normal diet and taking vitamins. I had a large ADHD and epilepsy population in my former practice and did liver enzymes all the time to monitor for toxicity from the medications they were taking. Many were on vitamins due to their poor diet as a side effect of the treatment and their liver enzymes never rose as a result of vitamins.

Customer: His vitamin regimen is as follows: Dr. Fudrhman's pixie vites food based vitamin powder, vitamin d (I am a sun protective mom) 1,100 iu daily, dha/EPA from Dr.Furhman, and raw children's pro biotic. Would you eliminate vitamin powder?
Dr. A. Clark :

He likely does not need it if he is eating a pretty normal diet. Granted, toddlers eat pretty strange diets sometimes.

Customer: Could it be detrimental? It is all natural food based. Oh - what are your thoughts on vitamin k with vitamin d!
Customer: i take a d & k supplement. I have been giving my son the k for the last couple of months.
Customer: http://www.drfuhrman.com/shop/pixievite.aspx
Dr. A. Clark :

D is a good idea since sun exposure should be limited, however it is rare that a kid does not get enough exposure as it only takes a few minutes daily. As to Vit K, it is very poorly absorbed and we manufacture our own K in our intestines so not really necessary.

Customer: Ok. So not dangerous but not necessary. I will eliminate it.
Dr. A. Clark :

Right.

Customer: Your thoughts on pro biotic, vegan dha/EPA and pixie cites!
Dr. A. Clark :

Here is a link to a good reference for age appropriate vitamin RDA:

Dr. A. Clark :

https://www.consumerlab.com/rdas/

Dr. A. Clark :

Probiotics are fine when taking antibiotics to help restore the depleted "good" bacteria.

Customer: Not daily? My allergist suggested a probiotic - he said that contained in horizon milk and yogurt was sufficient, but my son no longer likes dairy.
Dr. A. Clark :

I looked at his website and have to say that while none of it looks harmful, to your body a vitamin is a vitamin! It doesn't matter whether it is manufactured or synthetic as it looks the same to your metabolic systems relying on these co-factors to work properly. Folate is just another name for folic acid so this is a "distinction without a difference" I'm afraid!

Dr. A. Clark :

I tell parents to buy the cheapest brand of vitamin they can as the FDA regulates the contents, just as it does the makeup of generic medications, which are identical to the brand name but way less expensive.

Customer: So, yes or no on vitamins? Can they be harmful? Linked to cancer or anything? Can they be helpful? Dha/EPA?
Dr. A. Clark :

I'm always a bit wary of "experts" who sell stuff, even Dr. Oz who the medical community generally dislikes for all of his endorsements of some pretty hokey products, for which he is paid millions!

Customer: Got it. I will continue the vitamin d. I just want to make sure I haven't damaged my first "guinea pig" child.
Dr. A. Clark :

Vitamins are fine taken as directed. As to the beneficial effects of manufacturers and websites like Dr. Furhman, it remains to be seen as their really isn't much real research to back up most of their claims. I always follow the sage old advice we get in medical school: primum non nocere, which translates as "first do no harm"!

Dr. A. Clark :

I'm sure he is fine as kids have the ability to withstand all kinds of things thrown at them by parents and well-intentioned doctors even!

Customer: Thank you. I still want your opinion though on dha/EPA, daily probiotic and multi vitamin.
Customer: fine as directed - helpful yes or no!
Dr. A. Clark :

DHA/EPA are essential for healthy brain growth and added to all formulas now. Beyond infancy they are less important and consumed in lots of products anyway but the brain is not as dependent later. A daily probiotic for allergies has no real science behind it nor does a daily multivitamin but are NOT harmful so don't worry.

Dr. A. Clark :

FYI: I take a multivitamin, 3000 IU of Vitamin D, C, CoenzymeQ, and a mouthful of other supplements myself but at the doses supported by such real experts as Dr. XXXXX XXXXX, here in Dallas.

Customer: Thank you. I read something about leukemia and vitamins a while back.
Dr. A. Clark :

Not to worry.

Dr. A. Clark :

Here is a good article by an internist regarding Dr. Fuhrman's assertions:

Customer: Got ya. I take my prenatal and 3,500 vit d.
Dr. A. Clark :

All women need vitamins with D and folate (or folic acid!)

Dr. A. Clark :

And iron for sure.

Dr. A. Clark :

A prenatal vitamin fulfills all of those requirements.

Dr. A. Clark :

I recommend all girls start such a vitamin at puberty.

Customer: Would you give your own 3 year old aa multi? The million dollar question...
Customer: Do I need to open a new question to ask about my 3.5 year olds on and off dry cough? Mostly morning and bedtime. Also nap time. I can hear him now....
Dr. A. Clark :

Not if they were eating a pretty good diet (cheerios, mac and cheese, PBJ!) or if my wife or any mother was worried.

Customer: So if wife was worried, you would?
Dr. A. Clark :

Yep as it won't hurt them and keeps peace in the family.

Customer: i want to provide the most optimal setting for his good health but do not want to upset his system in any way.
Customer: Dry cough?
Customer: .?
Dr. A. Clark :

Any persistent cough in a child needs to be evaluated for the common causes as it is never normal: sinusitis, bronchitis, asthma, allergy, etc.

Dr. A. Clark :

Any cough lasting more than 2 weeks need to be evaluated.

Customer: doc listened to his lungs a couple of weeks ago when it was active. All clear. I started cool mist humidifier last night, it is morning, night, and laying down time.
Customer: definitely on and off for longer than that. But on for a week, then off for a few.
Customer: any cancer in the differential ? Big fear of mine obviously.... He is very active, full of energy, great appetite...
Customer: He does get dark circles under eyes that seem to improve with nasal saline use.
Dr. A. Clark :

Cancer is not in the differential for a child with a chronic cough. I suspect he has allergies and perhaps a little asthma so I would ask his doctor first to rule out an infection, even without fever, and then maybe a trial on a bronchodilator like albuterol to see if that helps.

Dr. A. Clark :

Dark circles can be allergies, sinus infection, or both.

Customer: Thank you for everything. I think it's allergies. It's been one of our worst seasons for it in Cali.
Dr. A. Clark, Pediatrician
Category: Pediatrics
Satisfied Customers: 4437
Experience: 33 years of experience as a general pediatrician in private practice and in pediatric urgent care.
Dr. A. Clark and other Pediatrics Specialists are ready to help you
Expert:  Dr. A. Clark replied 11 months ago.
You are quite welcome and I trust that if you found my advice helpful you will rate me favorably, as that is the only way we are compensated for our time spent working with parents. I wish you and your family well.
Customer: replied 11 months ago.
Dr. Clark -
Just to clarify - I'm giving my 3 year old 1,200 iu daily of vitamin d. Should I cut to 1000? My pediatrician said there is no risk at these levels and that AAP is considering doubling daily recommendation to 800 iu.

Your thoughts?
Expert:  Dr. A. Clark replied 11 months ago.
The reference from the NIH states that a child 1-3 years of age can take 2000 IU daily. The confusion is the standardized nomenclature of measuring Vit A and difference between Vit A as IU, which nutrition experts don't use anymore, to RAE (retinol activity equivalents).

Here is the reference that explains all of this and it is likely more than most people want to know but you might find it interesting. You just have to compare apples to apples, not IUs to RAEs!
http://ods.od.nih.gov/factsheets/VitaminA-HealthProfessional/
Customer: replied 11 months ago.
Hi. I asked about vitamin D.
Expert:  Dr. A. Clark replied 11 months ago.
Oh. Sorry. The Vitamin D RDA is 600 IU daily and there is talk of raising it but for now I'd stick with that dose.
Customer: replied 11 months ago.
Even with very limited sun exposure? My ped said 1,000 - 1,200 was ok, but I don't want to cause any harm so seeking other opinions. Vitamin D council says 1,000 iu per 25 lb of body weight.
Expert:  Dr. A. Clark replied 11 months ago.
I don't think you need to worry about the dose so much as with any sun exposure plus the D that is in foods and dairy, he will get plenty. The issue with the fat-soluble vitamins (A,D,E and K) is that they are stored and excessive amounts can have side effects. As I said earlier many believe that 3000 IU is appropriate for adults, which is what I take.
Customer: replied 11 months ago.
So, is 1,000 ok? He's not much into dairy these days.
Expert:  Dr. A. Clark replied 11 months ago.
Sure as the RDA assumes you are eating foods containing a portion, if not all, of your vitamins plus getting some sun exposure, anyway so most kids and adults consume more than the minimum. I would not worry, especially with the sun protection/avoidance we all should be doing these days.
Dr. A. Clark, Pediatrician
Category: Pediatrics
Satisfied Customers: 4437
Experience: 33 years of experience as a general pediatrician in private practice and in pediatric urgent care.
Dr. A. Clark and other Pediatrics Specialists are ready to help you
Customer: replied 10 months ago.
Thank you! So sun protection and vitamin d supplement is possibly preferable? My son gets exposure on hands, ankles a few hours a day. I use light sun protective clothing and a hat as to not douse him with sunblock, although the one I use is quite good and supposedly filters out UVA but allows UVB.

http://www.sunumbra.com/sunumbra-sunkids.html

Does your vitamin D doctor have a recommendation for children?

I want to optimize his health, and don't want to be over zealous one way or the other.
Expert:  Dr. A. Clark replied 10 months ago.
It only takes about 10 minutes daily to get enough sun exposure, even with limited skin exposed. I would simply give him the dose you are using now and not worry about it is it will not harm him.
Dr. A. Clark, Pediatrician
Category: Pediatrics
Satisfied Customers: 4437
Experience: 33 years of experience as a general pediatrician in private practice and in pediatric urgent care.
Dr. A. Clark and other Pediatrics Specialists are ready to help you
Customer: replied 10 months ago.
Hello. My 2.5 week olds poop was yellow and green tonight. It was green/blue a few times in first week but consistently plentiful and yellow for the last week. Fewer dirty diapers today, plenty of wet. Is color normal?
Expert:  Dr. A. Clark replied 10 months ago.
Baby poop is like the weather here in Texas- just wait a few minutes and it'll change!

Honestly, at his age most babies are having lots of changes in color, consistency and frequency due to the change in their GI tract maturity. You need not worry about this and it will change again at 4-6 weeks when they will be thicker and he may skip a few days between stools and be gassy (but that's not constipation!).
Dr. A. Clark, Pediatrician
Category: Pediatrics
Satisfied Customers: 4437
Experience: 33 years of experience as a general pediatrician in private practice and in pediatric urgent care.
Dr. A. Clark and other Pediatrics Specialists are ready to help you
Customer: replied 10 months ago.
Hi Doc.

My baby is a healthy 4 weeks old.

I have a history of cols sores. I get about one a year. If that. I may have a very tiny one right now. I honestly can't quite tell. Very tiny irritation at the corner of my mouth. Maybe one tiny blister if that. Not spreading.

I'm curious if my baby has some immunity to HSV 1 due to my history. I am very cautious and have at most kissed him on the top of his head. Never on the face, lips, belly, or anything. I kissed the top of his head yesterday. The irritation/cold sore appeared today. I would have touched him with my lips not the corner of my mouth. I am also a fanatic about hand washing and do not touch my mouth or nose.

I am paranoid and Your guidance is appreciated.
Expert:  Dr. A. Clark replied 10 months ago.
Unfortunately no, your baby is not immune so as long as you have any open sore you should not kiss him anywhere. HSV1 (herpes simplex type 1) most often occurs on the lips but can be inoculated anywhere and we've seen lots of babies with fever blisters on their heads, hands, feet, etc for that reason.

Customer: replied 10 months ago.
I certainly didn't touch him with an open sore. I noticed bump on corner of my mouth yesterday morning. It may be a tiny cold sore and is already basically healed.mi just brushed the top of his head with the tips of my lips. I'm very careful, never kiss his skin, and warn others as well.

I'd transmission likely on top of his hair (he's hairy) with lips with no sores? The kiss was the previous night from noticing sore.
Expert:  Dr. A. Clark replied 10 months ago.
Great, then you don't need to worry. I doubt he was exposed just from kissing his head.

As long as the fluid that oozes from a herpes lesion does not come in contact with any skin or mucosa then it cannot be transmitted so no kissing and good hand washing are all that is needed to protect him.
Customer: replied 10 months ago.
Thank u. The sore looks completely healed. Can a cold sore arrive and heal in 1-2 days?
Customer: replied 10 months ago.
Is it safe to kiss my children with no sores? My breakouts are minor and about 12 months apart.
Expert:  Dr. A. Clark replied 10 months ago.
Yes, as long as you have no open sores you are fine.
Customer: replied 10 months ago.
Could herpes heal in 1-2 days? Sore is gone. Just mildly pink clean skin basicslly. I always wait 1 week however to be any less cautious
Expert:  Dr. A. Clark replied 10 months ago.
No, so more likely you just had what is known as angular cheilitis, which is just "medicalese" for a cracked corner of the mouth, usually due to chapping.
Customer: replied 10 months ago.
The skin was definitely raised. On the lip line it looks like a slightly enlarged follicle. On lip corner, looked like pimple/blister but that's gone and skin is pink and mildly raised. I always seem to have a little bump there. What could it be?
Expert:  Dr. A. Clark replied 10 months ago.
Not sure but it isn't herpes as it takes several days to disappear. Cheilitis is common (who knew there was a whole website about it!) so take a look at this link to see if this helps:

http://www.angularcheilitishelp.org


Customer: replied 10 months ago.
I just cleaned the spot with a q tip with alcohol. There may be 2 tiny healing vesicles not touching. It may be the smallest quickest healing cold sore. It's frustrating not knowing for sure, but I definitely didn't touch that part of my face to my baby or 3 year old.

I wish a vaccine for herpes were coming. I'm quite diligent, but would love a surer prevention for my kids and husband.
Expert:  Dr. A. Clark replied 10 months ago.
I understand but it sounds like you are pretty diligent and aware so I would not worry.
Customer: replied 10 months ago.
I'm just paranoid. And annoyed. I have not ever kissed my newborn except on his hair and then just a graze but I still worry. My lips, with no sores, would not transmit virus with unopened sore at corner of my mouth, would they?

Also, I've noticed for past week or 2, his right eye has had a tiny bit of goop,a couple times. A week ago I put some breast milk in it. That seemed to work. It's not sticky. Just a bit of eye sleep. Again, I'm paranoid.

Feeding great. Not fussy. Eats, sleeps, poops.... Pretty much all day. Sometimes up for an hour or so.
Expert:  Dr. A. Clark replied 10 months ago.
There is no risk of transmission unless you have an open sore. It is normal for babies to have some discharge in the corners of the eyes but I wouldn't use breast milk. Just simply wipe it away and unless his eyes become very red with lots of pus draining (pink eye) I would not worry.
Customer: replied 10 months ago.
Not red. Not a lot of discharge. Very little. Just noticeable as left eye has none.

I called his ped. Going in tomorrow before sick kids get there if discharge gets worse/continuous.

Ok, so no transmission risk to intact head skin if sores not open. What are symptoms of herpes in baby? When is severe illness/ damage/ death no longer a risk? Does my antibody load due to 30 year infection protect him from severe infection?
Expert:  Dr. A. Clark replied 10 months ago.
No worries at all and if he caught it from you anywhere on his body he would have bumps that turn into vesicles and open sores, just as you've had on your lip. Herpes is really most dangerous when mother's are infected and that is with HSV 2, or genital herpes, which is why they deliver by C-section.

He has to develop his own antibodies to HSV and but you should know that 75% + of all of us have had HSV by the time we are adults and most of us are immune with very few, mostly women, having recurrent outbreaks.
Customer: replied 10 months ago.
I am missing one part. If he were to acquire a herpes infection now, is it deathly dangerous? I know he must develop immunity, but I thought infection posed less danger because of my longstanding infection, breast feeding, etc...
Customer: replied 10 months ago.
My concern is Herpes SEM, and more so disseminated Herpes and Herpes Encephalitis. Are these a concern after 4 weeks of age? How long is system and brain herpes a concern?
Expert:  Dr. A. Clark replied 10 months ago.
It is rare after the newborn period and only with HSV Type 2 (not type 1 herpes simplex) in mothers with genital herpes who deliver vaginally or have prolonged rupture of their membranes before delivery.
Customer: replied 10 months ago.
What is the newborn period - 6 weeks?

So, if I understand correctly, neonatal herpes acquired from a family member after birth will cause SEM Herpes and not disseminated or encephalitis?
Expert:  Dr. A. Clark replied 10 months ago.
Yes as those who contract it during delivery may take a few weeks to actually become ill. That is why when exposure is known (again this is Type 2) those newborns are automatically started on acyclovir IV.

Babies who get herpes from a family member after birth generally just have skin lesions.

Here is a scientific presentation on this topic that you might find helpful since it appears you have really researched this:
http://pediatrics.uchicago.edu/chiefs/documents/NeonatalHSV.pdf
Customer: replied 10 months ago.
Got it. As I am seropsitive HSV 1, seronegative HSV 2, scheduled c section, in tact membranes, no fetal scalp monitor and my baby is healthy and 1 month old on Friday, he is in the clear for devastating Herpes disease?
Expert:  Dr. A. Clark replied 10 months ago.
Sorry, had to go see a few patients.

Yep, your baby should be in the clear and everything was done by the book with your pregnancy and delivery.
Dr. A. Clark, Pediatrician
Category: Pediatrics
Satisfied Customers: 4437
Experience: 33 years of experience as a general pediatrician in private practice and in pediatric urgent care.
Dr. A. Clark and other Pediatrics Specialists are ready to help you
Customer: replied 8 months ago.
Hi doc. I just had this question answered, but I'd like your opinion.

My son is 3 months old. Exclusively breasted and very healthy. 90% weight/height and thriving. And now I am freaking out.

Doctor advised vitamin D3 supplement as I did with first son. About a month ago, I decided I didn't want to give him the enfamil brand with all of the artificial ingredients, and opted to do a kids drop and put it on my nipple per other moms recommendation. I just freaked as I realized the base is organic olive oil and flaxseed oil and am concerned that this would constitute early food exposure and complex protein exposure (flaxseed oil) thus putting him at risk for type 1 diabetes. Please help. Also, I read his big size already puts him at risk. Please help.

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