Vitamin A Drops For Baby

Vitamin A supplementation reduces child morbidity and mortality and is recommended for infants and children 6–59 months when VAD is a public health

Vitamin a Drops for Babies Benefits

The majority of countries where vitamin A deficiency (VAD) is known to be a severe public health problem have policies supporting the distribution of vitamin A. This article provides guidelines for vitamin A supplementation in children and women and discusses when it is safe to phase out supplementation.Vitamin A supplements for young children aged 6–59 months

The World Health Organization (WHO) recommends that all children aged 6–59 months should receive supplements if they live in a community where VAD is a public health problem. These are communities where the prevalence of night blindness is ≥ 1% in children aged 24–59 months, or where the prevalence of VAD is ≥ 20% in infants and children aged 6–59 months.

The suggested vitamin A supplementation scheme for prevention of deficiency in children aged 6–59 months in areas where VAD is a severe public health problem is shown in Table ​Table11.

Vitamin A supplements for newborns and children aged 1–5 months

Vitamin A supplementation of newborns and children aged 1–5 months is not yet recommended by WHO. Exclusive breastfeeding of infants is encouraged for the first six months of life, to help achieve optimal growth, development and health.

Vitamin A supplements for pregnant women are not routinely recommended

Although women are highly susceptible to VAD during pregnancy, vitamin A supplementation during pregnancy is not recommended, as high-dose vitamin A from supplements may cause harm to the developing baby. Instead, pregnant women are encouraged to meet their increased requirements by eating enough vitamin A-rich foods (see pages 65 and 72); this is unlikely to harm the developing foetus.

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High-dose vitamin A in oral liquid form is given to a child

The only circumstance in which vitamin A supplementation during pregnancy may be considered is when women live in an area where VAD is a severe public health problem (i.e. ≥5% of pregnant women in that area have night blindness). It is very important to note that far lower doses are needed for pregnant women than for children, and doses need to be given on a more frequent basis (see Table ​Table11).Vitamin A supplements for women who have recently given birth are not routinely recommended

Giving high-dose vitamin A to women immediately after delivery is also not recommended by the WHO (2011 Guidelines).

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When to phase out vitamin A supplements

WHO and the United Nations Children’s Fund (UNICEF) recommend phasing out vitamin A supplementation when VAD is no longer a public health problem. This means there must be clear evidence that the prevalence of night blindness or reduced serum retinol levels are well below the minimum public health thresholds for an extended period of time and, at the same time, that mortality rates in under-5s are in long-term decline.

Table 1. High-dose vitamin A supplementation to prevent deficiency in children aged 6–59 months

Target age groupOral doseFrequencyRoute of administration
6–11 months100,000 IUOnceOral liquid, oil-based preparation of retinyl palmitate or retinyl acetate
12–59 months200,000 IUEvery 4–6 monthsOral liquid, oil-based preparation of retinyl palmitate or retinyl acetate

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Table 2. Low-dose vitamin A supplementation to prevent deficiency in pregnant women (Note: ONLY in areas where vitamin A deficiency is a severe public health problem)

Target groupOral doseFrequencyRoute of administrationDuration
Pregnant womenUp to 10,000 IU vitamin A ORDaily doseOral liquid, oil-based preparation of retinyl palmitate or retinyl acetateA minimum of 12 weeks during pregnancy, until delivery
Up to 25,000 IU vitamin AWeekly dose

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Safety

Pregnant women

Vitamin A supplements are not routinely recommended for pregnant women unless there is a severe public health problem. The far lower doses recommended in Table ​Table22 are safe. Higher doses are contra-indicated because of uncertain effects on the unborn child.

Children

Vitamin A supplementation reduces child morbidity and mortality and is recommended for infants and children 6–59 months when VAD is a public health problem. Vitamin A supplements given to children will not cause any significant side effects when the recommended age-specific vitamin A dose is administered. Trials of vitamin A supplementation of infants and children aged 6–59 months have found uncommon, transient, and mild adverse symptoms (irritability, headache, fever, diarrhoea, nausea and vomiting). The impact of high-dose vitamin A supplements on preventing blindness and mortality, however, far outweigh these rare and transient side effects.

Vitamin a Drops for Babies Dosage

Vitamin A plays an essential role in vision, normal differentiation and maintenance of epithelial cells, adequate immune function (T-cell function), reproduction, growth and development. Normal fetal development of the eye requires adequate vitamin A intake and stores [1]. Symptoms of vitamin A deficiency include night-blindness, xerophthalmia progressing to corneal ulceration, and hyperkeratotic skin lesions and an increased susceptibility to infections. Vitamin A deficiency is also associated with poor bone growth, nonspecific dermatologic problems (eg, hyperkeratosis), and impaired immune function. Preterm infants are at increased risk of micronutrient deficiencies as a result of low body stores, maternal deficiencies, and inadequate supplementation and are usually given vitamin A supplements once enteral feeding has been established.

Vitamin A supplementation may be required in infants and children with liver disease, particularly cholestatic liver disease, or short Bowel syndrome due to the malabsorption of fat soluble vitamins. Treatment is sometimes initiated with very high doses of vitamin A and the child should be monitored closely; very high doses are associated with acute toxicity.

Vitamin A may have benefits for preterm infants in the prevention of chronic lung disease, retinopathy of prematurity, and necrotising enterocolitis [2-4]. A meta-analysis of relatively high-dose vitamin A supplementations in infants <1500 g concluded that the incidence of oxygen requirement by 36 weeks corrected age was reduced, and there was a trend towards reductions of retinopathy and sepsis [2].

High-dose supplementation with this essential vitamin improves a child’s chance of survival by 12 to 24 per cent in some parts of the world; it bolsters the immune system, helps protect against life-threatening infections like measles and diarrheal disease, and is needed for vision and bone growth.

Ideally, children should get enough vitamin A from a balanced, healthy diet that includes milk, cheese, eggs, fruits and vegetables like mangoes, papaya, carrots, yams and squash or foods fortified with vitamin A. However, in low-income countries, young children often do not eat a well-balanced diet rich in the appropriate vitamins needed for growth, development and survival. These children are especially vulnerable to vitamin A deficiency and its devastating consequences.

Vitamin A deficiency is a public health problem affecting over 250 million children in more than half of countries worldwide. As of 2013, 29 per cent of children – or nearly one in three – ages 6 to 59 months were vitamin A deficient. About half of these affected children lived in sub-Saharan Africa and South Asia.

Protection with two doses

Vitamin A capsules
© UNICEF/UNI112542/SattarVitamin A blue capsules, which are administered to infants between the age of 6-11months, and vitamin A red capsules, which are administered to children between the ages of 1-4 years.

In areas where under-five mortality is high or deficiency is a public health issue, two high-dose vitamin A supplements per year can save lives. Supplementation is safe, only costs 2 cents per dose, and when delivered through platforms like Child Health Events, can be an equitable way of reaching the most vulnerable.

There have been dramatic improvements since 2000, when only five countries in sub-Saharan Africa reached at least 80 per cent of target children with the two required doses. According to recent data, this number had more than tripled in 2014, to 17 countries in the region. Despite these gains, there is an urgent need to make further progress to reach the hardest hit boys and girls who continue to lack vitamin A that is essential for them to survive and thrive.

In 2014, UNICEF supported vitamin A supplementation programmes focusing on sub-Saharan Africa and South Asia where the needs are greatest. These critical child survival interventions protected 92 million children living in the least developed countries. Nevertheless, 46 million of the world’s most vulnerable children were left behind, putting them at an increased risk of disease and death. Future efforts need to focus on the marginalized, the poorest and the least educated, who are disproportionately affected by child mortality and vitamin A deficiency.

Child health events: equitable and effective

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Vitamin A supplements are often delivered during Child Health Events alongside other high-impact health interventions such as vaccination, mosquito net provision and deworming. Child Health Events are one of the most equitable delivery strategies because they extend the reach of health systems, bringing vitamin A supplements directly to communities in need. This helps ensure that every child is fully protected. The events are especially successful at reaching vulnerable children in hard-to-reach communities and in fragile settings with weak health services. Particularly in sub-Saharan Africa, countries that have adopted this approach have effectively reached boys and girls with the required two doses each year.

Since twice-yearly events were introduced in 2001, the United Republic of Tanzania has maintained high coverage of vitamin A supplementation among children ages 6 to 59 months. The country holds community-based Child Health Days to address malaria, hookworm, vitamin A deficiency and growth monitoring. The vitamin A component has been highly successful: between 2005 and 2011, national two-dose coverage exceeded 90 per cent, coinciding with the country’s declining rate of child mortality, from 126 deaths per 1,000 live births in 2000 to 68 per 1,000 in 2011.

Moving forward

Currently, Child Health Events are the best way to reach all boys and girls in sub-Saharan Africa with the two doses per year that are needed to improve their chances early on in life. The events succeed because they target and reach vulnerable communities, where routine health systems are weak and under-five mortality rates are high. Since health needs and service delivery vary greatly from country to country, Child Health Events must be tailored specifically to each context in order to ensure that no child is forgotten.

Over the long-term, other strategies for addressing vitamin A deficiency – such as food fortification and education in nutrition and the importance of a diverse diet – are critical to ending vitamin A deficiency. Until such programmes are sustained at scale, however, vitamin A supplementation through Child Health Events remains essential to ensuring child survival today.

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