What springs to mind when you think of vitamin A? That carrots make you see in the dark? Whilst, this isn’t completely accurate (read on to find out why), there are many more reasons why vitamin A is an essential nutrient for children!
This blog will give you all you need to know about vitamin A deficiency in children, its impact, and things you can do to prevent it!
What is vitamin A and why is it important?
Vitamin A is a fat-soluble vitamin, meaning that when consumed it is absorbed and transported in the body with the help of lipids (more commonly known as fats). It is stored in the liver and released gradually as the body requires it.
Vitamin A has several essential functions in the body. It supports the normal functioning of the immune system, helps with vision, growth, skin, and it even helps cell growth supporting the formation and maintenance of the heart, lungs, and other organs [1]. Additionally, a recent study indicated that vitamin A nutritional status was a key determinant of bone mass in children aged 6-9 years [2].
Requirements of vitamin A for children
Children require a significant amount of vitamin A because of their rapid growth and development. In the UK the reference nutrient intake (RNI) for children is categorised by age and also gender in teenage years [3]. Vitamin A requirements increase in teenage years, alongside many other nutrients so it is essential to reassess requirements against intake at this vulnerable time.
The infographic below can be used to understand different vitamin A sources and the amount of vitamin A (µg) per 100g.
Do you need to supplement your child’s intake of vitamin A?
A food first approach is always recommended with a diet rich in fruits and vegetables to support a growing child! That being said, the government recommends all children aged 6 months to 5 years are given vitamin drops containing vitamins A, C and D every day, unless they are having more than 500ml of formula milk per day because formula is fortified with vitamins A, C and D and other nutrients [4]. You may be entitled to free vitamin drops if you qualify for the governments Healthy Start scheme.
The impact of vitamin A deficiency in children
Globally, vitamin A deficiency is a major public health problem, affecting 190 million preschool-age children, mostly in Africa and South-East Asia. Severe vitamin A deficiencies are the leading cause of preventable blindness worldwide due to the development of xerophthalmia [5]. Beyond permanent blindness, vitamin A deficiency can also affect growth, impact the risk of infections and cause visual symptoms such as dry eyes, night blindness and peripheral vision loss.
In the UK, deficiency is rare, but cases have been found in children with autism and ARFID (avoidant restrictive food intake disorder) [6,7]. Recently, I had a conversation with the mum of a 16-year-old girl called Bella who I am saddened to say that in 2021, lost her vision due to malnutrition. Bella is a non-verbal autistic child who’s struggled with eating difficulties, otherwise known as ARFID (avoidant restrictive food intake disorder) for most of her life. Bella permanently lost her vision as a result of vitamin A deficiency. This was sadly missed, as although Bella had a very restrictive diet and blood tests were taken, she was not routinely tested for Vitamin A deficiency and other micronutrients.
In light of this, parents campaigned for a change to NICE Guidance Guidance “Autism spectrum disorder in under 19s: support and management” https://www.nice.org.uk/guidance/cg170 which now states: “As part of a full nutritional assessment and monitoring, blood tests to check for nutritional deficiencies may be required. [2021]” [8]. The visual (and avoidable) complications of Vitamin A deficiency and restrictive eating can have a truly devastating impact on children and families, making it essential that vitamin A deficiency is better understood. prevented and treated.
In the general population, it is also estimated that 9 % of children aged 1 and a half to 3 years, 11% of 4-to-10-year age group, 18% of the 11-to-18-year age group have intakes below the Lower Reference Nutrient Intake (LRNI) according to Public Health England [9]. However, this is only a representative sample of around 1,000 people, and figures may be higher in children with complex conditions.
Keep reading to find out about the best sources of vitamin A to support your child’s health!
Sources of vitamin A
Foods that contain vitamin A tend to be split into two categories: preformed vitamin A (meat and dairy) and provitamin A (plant-based).
Vitamin A from diet is available as either as preformed vitamin A, known as retinol (found in animal-based sources) or from provitamin A, known as carotenoids (found in plant-based foods). For good sources look out for orange, yellow and red fruits and vegetables such as carrot and sweet potato and green leafy vegetables such as spinach and kale [1]. These foods contain a type of carotenoid known as beta-carotene, a natural pigment that gives these foods their vibrant colours that is converted by the body into vitamin A.
Therefore, the myth that carrots help you see in the dark isn’t as farfetched as you might think – in the sense that carrots contain beta-carotene which certainly will help to keep children’s eyes healthy! (Sadly, their night-vision superpowers are less true).
The infographics below can be used to understand good sources of vitamin A, and which are highest! If in doubt, encourage your child to eat the rainbow!
*Liver and liver products contain high amounts of vitamin A so having these too often (can mean your child could have too much Vitamin A. These products also aren’t recommended during pregnancy [10].
So now you know more about the importance of vitamin A and the impact of vitamin A deficiencies in children – and you know what foods can help increase those levels using the food first approach!
References
[1] Awasthi, S. and Awasthi, A. (2020) Role of vitamin a in child health and nutrition. Clinical Epidemiology and Global Health. [online]. 8(4). Available at: doi:https://doi.org/10.1016/j.cegh.2020.03.016.
[2] Zhang, X., Huang, J., Zhou, Y., Hong, Z., Lin, X., Chen, S., Ye, Y. and Zhang, Z. (2022) Vitamin A Nutritional Status Is a Key Determinant of Bone Mass in Children. Nutrients, [online] 14(21), p.4694. doi:https://doi.org/10.3390/nu14214694.
[3] Great Ormond Street Hospital for Children (2022) Nutritional requirements for children in health and disease.
[4] NHS (2020) Vitamins for children. [online]. Available at: https://www.nhs.uk/conditions/baby/weaning-and-feeding/vitamins-for-children/.
[5] World Health Organization (2009) Vitamin A deficiency. [online]. Available at: https://www.who.int/data/nutrition/nlis/info/vitamin-a-deficiency.
[6] Schimansky, S., Jasim, H., Pope, L., Hinds, P., Fernandez, D., Choleva, P., Dev Borman, A., Sharples, P.M., Smallbone, T. and Atan, D. (2023) Nutritional blindness from avoidant-restrictive food intake disorder – recommendations for the early diagnosis and multidisciplinary management of children at risk from restrictive eating. Archives of Disease in Childhood, [online] p.archdischild–2022-325189. doi:https://doi.org/10.1136/archdischild-2022-325189.
[7] Yule, S., Wanik, J., Holm, E.M., Bruder, M.B., Shanley, E., Sherman, C.Q., Fitterman, M., Lerner, J., Marcello, M., Parenchuck, N., Roman-White, C. and Ziff, M. (2021) Nutritional Deficiency Disease Secondary to ARFID Symptoms Associated with Autism and the Broad Autism Phenotype: A Qualitative Systematic Review of Case Reports and Case Series. Journal of the Academy of Nutrition and Dietetics, 121(3), pp.467–492. doi:https://doi.org/10.1016/j.jand.2020.10.017.
[8] NICE (2021) Overview | Autism spectrum disorder in under 19s: support and management | Guidance | NICE. [online]/. Available at: https://www.nice.org.uk/guidance/cg170.
[9] Public Health England (2020) NDNS: results from years 9 to 11 (2016 to 2017 and 2018 to 2019). [online]. Available at: https://www.gov.uk/government/statistics/ndns-results-from-years-9-to-11-2016-to-2017-and-2018-to-2019.
[10] Food Standards Agency (2024) Lay Summary of the Statement on the effects of excess Vitamin A on maternal health | Committee on Toxicity. [online]. Available at: https://cot.food.gov.uk/Lay%20Summary%20of%20the%20Statement%20on%20the%20effects%20of%20excess%20Vitamin%20A%20on%20maternal%20health.