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    Beware of nutritional supplements for kids

    Sales of nutritional supplements continue to rise, and available data indicate that use of these products is fairly common within the pediatric population.

    On Sunday, October 23, in a session titled “Nutritional supplements: Do patients really know what they are taking?” Cora Collette Breuner, MD, MPH, FAAP, discussed why and how pediatricians should be uncovering consumption of nutritional supplements by their patients. She also gave recommendations to counsel those who take supplements.

    Breuner, professor of Pediatrics and adjunct professor of Orthopedics and Sports Medicine, University of Washington, Seattle, and chair of the Committee for Adolescence for the American Academy of Pediatrics (AAP), reviewed the potential harms associated with nutritional supplements and the sparsity of evidence supporting purported benefits. She noted, however, that pediatricians may avoid asking about nutritional supplement use because they believe the query may prompt questions they are unable to answer. Reliable information, however, can be just a click away by accessing certain websites.

    “Asking about nutritional supplement use should be part of the routine at every visit,” said Breuner. “Pediatricians are the experts in taking care of kids, and our patients and their parents really do want our help with advice on this topic.”

    Concerns about nutritional supplement use relate in part to the fact that the industry is not regulated by the US Food and Drug Administration. “Buyers must beware because there are no requirements for standardization of active ingredients or purity of these products,” Breuner explained.

    Furthermore, there is potential for adverse effects with certain compounds, and the fact that most nutritional supplements are not packaged in childproof containers raises concern about their presence in households with young children.

    To find out about patient use of nutritional supplements, Breuner advised including an open-ended question as part of the medication history. Such timing makes the inquiry nonjudgmental and more likely to elicit an honest response.

    “Asking about supplement use during the social history along with questions about bicycle helmet use, smoking, or alcohol can make a positive response more stigmatizing,” Breuner said. “Often patients or their families have concerns about the safety of using nutritional supplements and they don’t mind telling us if they are using these products, but they may not admit to the fact if they fear they will be judged as doing something wrong.”

    Breuner encouraged pediatricians to become educated about nutritional supplements, and she recommended resources that give pediatricians ready access to information. At the same time, she reminded her colleagues that it is okay to push “going back to basics.”

    “All supplements are not necessarily bad, but they can be expensive. Often nutritional supplements are used to compensate for poor eating habits, and we should be advising patients about eating the right foods so they do not turn to nutritional supplements instead,” Breuner said.

    Resources for information about nutritional supplements include the following:


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