Nowadays, some parents of children often say to our doctors, why do children still appear in the symptoms of calcium deficiency every day, in fact, the timing of calcium supplementation and the choice of calcium supplements is very important, the first thing is to determine whether the child has symptoms of calcium deficiency, because the main reason for calcium deficiency in the baby’s body is the lack of vitamin D. Vitamin D can promote the absorption and utilization of calcium. When the baby’s body is deficient in vitamin D, the absorption of calcium will be reduced. The growth and development of the baby’s bones are affected and “rickets” occurs, which is commonly referred to as “calcium deficiency”. When a small baby is deficient in calcium there are usually some symptoms such as: 1, sweating: lack of vitamin D will make the baby appear with the room temperature, the season is not related to sweating, sweating and more in the second half of the night after going to sleep, mostly for the head sweating. The baby’s head is itchy because of sweating, so when he lies down, he likes to rub his head to stop the itch, and over time, the hair at the back of his head is worn out, forming a pillow bald circle. 2.Spiritual irritability: The baby is irritable, disobedient, crying, not interested in the surroundings, not as lively as before, strange temper, etc. 3.Sleep restlessness: baby is not easy to fall asleep, easy to wake up, night terrors, early awakening, and difficult to stop crying after waking up. 4, late teething: normal babies start teething at 4-8 months, while some “calcium deficient” babies are still not teething at 1.5 years old. 5, late closure of fontanel: normal baby 1.5 years old before the fontanel closed, “calcium deficient” baby is wide fontanel, closure delayed. Skeletal abnormalities: 1, square cranium: rib edge outward; chest ribs have like abacus beads on the bulge, “rib beads”; sternum convexity or lower edge inward, “chicken chest” and “funnel chest”; when the baby stands or walks, because the bones are soft, the body’s gravity makes the baby’s two legs bend inward or outward, the so-called “X” shaped legs or “O” shaped legs. 2, poor immune function: the baby is prone to upper respiratory tract infections, pneumonia, diarrhea and other diseases. If you observe that your baby has more than 2-3 of the above, you should take your baby to the hospital to clarify whether your baby is suffering from rickets, so that timely treatment. 3.Some parents ask us when is the best time for children to take calcium supplements, and until when should it last? Do babies with normal diets need to take calcium supplements too? Due to the rapid growth and development of babies, cod liver oil needs to be supplemented to ensure the effective absorption of calcium from food. Babies should take vitamin D from 2-4 weeks after birth to prevent “calcium deficiency”. The recommended dose of vitamin D is 400-800 IU per day until about 2 years of age, or until the end of winter if it is winter when the baby is 2 years old. For babies with a normal diet, cod liver oil supplementation is also necessary. With a moderate intake of vitamin D, some calcium supplements are available to meet your baby’s daily calcium needs, especially for hand-fed babies. The timing of calcium supplementation is basically the same as that of vitamin D. Vitamin D must be supplemented in a timely manner. For breastfed babies, if the diet is high in calcium, it is fine not to take additional calcium supplements, preferably according to the specific situation of the child. How to choose an effective calcium supplement for your baby? At present, it has become a difficult task for parents. Clinically, calcium supplements are mainly judged by the amount of available calcium elements, solubility and absorption rate. There is a significant difference in the proportion of available calcium elements in different calcium supplements, and calcium supplements with good solubility are relatively easy to absorb. L-lactate calcium has the best solubility, followed by calcium chloride, calcium gluconate, calcium amino acid and calcium carbonate. Calcium carbonate has high calcium content but low solubility. To improve solubility, calcium carbonate is ground into ultra-fine powder during the manufacturing process and then bonded so that the drug can disintegrate quickly to overcome its low solubility. Since the absorption of calcium requires the assistance of vitamin D. Usually the absorption rate of calcium supplementation is 25-50%. When the baby’s body is deficient in calcium, the absorption rate of calcium will increase. The choice of calcium for babies also needs to consider factors such as good taste and low stomach irritation, so it is ideal to choose calcium preparations such as calcium levulinate and calcium carbonate. However, there are some parents who blindly supplement calcium for their children, in fact, calcium must be supplemented scientifically, the daily calcium needs of babies of different ages are different. Generally, babies within 6 months of age need 400 mg of calcium per day; babies between 7 months and 2 years of age need 600 mg of calcium per day; babies over 3 years of age need 800 mg of calcium per day. The amount of additional calcium supplementation per day varies due to the structure of the diet provided. For babies under 2 years of age, 400-800 IU per day of cod liver oil is required to meet the needs of the child’s growth and development. Now we often have some patients in the clinic, parents only supplement cod liver oil without calcium supplements, so that the child has some vomiting, irritable symptoms, and even the symptoms of fontanelle bulge, a reasonable supplement is very necessary. How should a breastfed child take calcium supplements? Although breast milk contains only 34 mg of calcium per 100 ml, while cow’s milk contains up to 125 mg, the ratio of calcium to phosphorus in breast milk is 2:1, which is most suitable for calcium absorption. When the baby’s daily cod liver oil requirement is met, breastfed babies within 1 year of age can get 225-250 mg of calcium per day from breast milk, so for breastfed babies within 6 months of age, extra calcium supplementation is not emphasized, while breastfed babies between 6 months and 1 year of age also need only a little extra calcium supplementation, i.e. 75-100 mg of calcium per day. Breastfed babies within 6 months of age can be fed without additional calcium supplementation if the mother takes adequate calcium supplements during breastfeeding. What are those differences in calcium supplementation for mixed or artificially fed children? First of all, it is important to understand the role of calcium in the body. The amount of calcium supplementation should be based on the amount of milk your baby drinks every day. Due to the inappropriate ratio of calcium to phosphorus in cow’s milk, additional calcium supplementation is needed despite the high calcium content of cow’s milk. Generally, babies can only get slightly more than half an amount of calcium from food throughout the day, so additional supplementation is needed. How to supplement calcium for children after weaning has also become a question for parents? As the amount of calcium needed for growth and development increases after weaning due to the reduced amount of milk, it is important to increase the consumption of calcium containing foods. In addition to diet, it is also necessary to choose chewable tablets containing calcium carbonate to supplement calcium for babies at this time. Calcium carbonate contains 40% of available calcium elements, and babies can get at least 500 mg of calcium elements, plus babies get about 300 mg of calcium from food every day, which can meet the needs of the body. However, we have found that some patients are prone to some problems in the process of calcium supplementation. Many parents think that they give calcium to their babies every day, but why are they still deficient in calcium? There are several reasons for this situation: 1. Calcium supplementation is not accompanied by an appropriate amount of cod liver fish. This way, the extra calcium is excreted through the stool, which not only wastes calcium sources, but also easily leads to anorexia or constipation in babies. 2. Poor timing of cod liver oil supplementation. This can cause calcium not to be absorbed effectively, for example, the baby takes calcium supplements every morning and cod liver oil at night, the difference in time causes cod liver oil not to have the opportunity to absorb sufficient calcium in the small intestine. 3. The amount of calcium supplemented is not enough. If the baby is taking calcium gluconate preparations orally, because calcium gluconate available calcium element is low, must serve a larger dose, and often the baby is difficult to accept too much, so although the daily calcium in the service, but actually does not meet the baby needs. 4. The method of taking it is not appropriate. If the baby only takes it once a day, it causes the loss of calcium. Due to the characteristics of intestinal peristalsis, the absorption of calcium is completed about 4 hours after oral intake. 1 time large amount of calcium supplementation, the calcium absorption rate is only about 25%, while the calcium absorption rate can be higher than 50% with small amount of calcium supplementation in several times. Therefore, the effect of calcium supplementation in small amounts is better. 5, the calcium supplements with other foods, calcium absorption rate is low. If taken with milk, soy milk, juice, vegetable juice, rice soup, the absorption rate of calcium will be reduced. Therefore, calcium doses are best taken alone. We remind parents from the needs of clinical patients that the effectiveness of the treatment of calcium deficiency should not be judged according to the presence or absence of the signs of rickets. When babies are reasonably supplemented with cod liver oil and calcium, sweating will be reduced, sleep will be improved, night terrors will disappear, teeth will erupt faster, etc. However, the signs of rickets will not disappear soon, such as ring-shaped hair loss, square cranium, rib beads, rib edge ectropion, chicken chest, funnel chest, “O” shaped legs, etc., but they just do not continue to worsen. As the baby grows and develops, the muscles, gravity and bones are gradually coordinated, and the signs of rickets will disappear. Therefore, you can no longer judge the activity of rickets by the persistent signs such as ring-shaped hair loss, square skull, rib beads, and rib edge ectropion, but by the results of sleep, night terrors, and hospital tests (blood calcium and phosphorus product, bone-derived alkaline phosphatase, and calcification zone). Some of the conclusions of “calcium deficiency despite daily calcium supplementation” may also be inaccurate based on circular alopecia or ectropion of the rib cage. What is the most reasonable time for calcium and cod liver oil supplementation? It is possible that after some of the above explanations parents will have a new understanding of how to properly supplement calcium, the body needs the help of cod liver oil to absorb calcium, so it is necessary to supplement cod liver oil at the same time, and to supplement cod liver oil first, then give calcium to the baby in 2 or more doses to be effective. The composition of cod liver oil is vitamin A and vitamin D. The ratio of vitamin A and vitamin D in cod liver oil for babies and cod liver oil for adults is different, and the vitamin D content in cod liver oil for babies is greater, so cod liver oil for adults should not be given to babies, otherwise it will cause cod liver oil poisoning. There are various forms of cod liver oil for babies, such as liquid cod liver oil and single packaged cod liver oil in granules. If you choose liquid cod liver oil, you can put 5-7 drops directly into your baby’s mouth every morning, which is equivalent to 400-500 international units of vitamin D. If you choose single-package granular cod liver oil, you can squeeze 1 granular cod liver oil directly into your baby’s mouth every morning, which is equivalent to 400-500 international units of vitamin D. The maximum amount of cod liver oil your baby can take every day should not exceed 800 international units. How can I prevent an overdose of cod liver oil? It is also a clinically important issue in the correct administration of medication. In childhood, we emphasize that vitamin D supplementation must be in the right amount, otherwise less will lead to rickets and more will lead to poisoning. We have seen a 6-month-old patient, because of vomiting for 3 days, fontanel bulge for 2 days, when the grandmother took the child to the hospital, because the child’s mother is working in the field, before going out, told the child’s grandmother to give the child liver oil service and calcium tablets every day, the grandmother wrongly believed that liver oil service is a tonic, for this reason, he gave the child liver oil service every day, often three times a day, after more than a month of service, the above symptoms appeared After taking it for more than a month, the above symptoms appeared, which made his grandmother very anxious. When we told him that the disease was caused by an overdose of liver oil, he was really shocked. Vitamin D is often contained in multivitamins and health care preparations. If a child takes multivitamin health care preparations for a long time and takes vitamin D preparations at the same time, there is a possibility of vitamin D overdose, such as a baby taking 20,000 to 50,000 units of vitamin D daily, vitamin D toxicity will occur after 1 to 3 months. The manifestations of vitamin D toxicity: anorexia, nausea, vomiting, stubborn constipation, abdominal pain, bone pain, frequent urination, hematuria, urinary stones, etc.; some may also appear mental symptoms such as mental depression, drowsiness, indifferent expression and hallucinations. If your baby is found to have vitamin D poisoning, if the symptoms are mild, immediately stop taking various vitamin D preparations and calcium supplements; if the symptoms are severe, send your baby to the hospital for observation. The prognosis of vitamin D poisoning is usually better. It usually takes 1 to 3 months after the symptoms of poisoning have completely disappeared, and then the baby is given a preventive amount of vitamin D, i.e. 400 international units per day, under the guidance of a doctor. A number of parents know that vitamin D can be obtained from sunlight, because most vitamins are mainly obtained from food, vitamin D is more special and is mainly obtained by sunlight exposure. Since 7-dehydrocholesterol in the skin is exposed to ultraviolet light, it produces vitamin D. Therefore, babies over 2 years of age can be exposed to more sunlight without cod liver oil supplementation, but it is worth noting that ultraviolet light cannot pass through glass and cannot be separated from the glass when the child is in the sun, otherwise it will not play a preventive role. Children under the age of 2 years old do not have enough vitamin D due to their rapid growth and small skin area, so additional supplementation is needed. It is necessary to expose your child to sunlight because the vitamin D produced by the skin does not cause toxicity. When children are exposed to the sun it is important to avoid exposure to strong sunlight as children’s skin is relatively tender. Direct exposure to strong sunlight can damage the skin. The time spent outdoors in the sun should be gradually extended, starting with 10-15 minutes per day and then gradually extending to about 2 hours per day. The sun will expose as much of your baby’s skin as possible, and your child will get more sun exposure, so you can take less cod liver oil. Some children take not only calcium but also zinc supplements, because there are many zinc and calcium supplements on the market today. In fact, since zinc and calcium are both cations, they can interfere with each other when absorbing ions in the digestive tract, reducing the absorption rate of each other. Therefore, it is best not to take calcium and zinc together to avoid lower absorption rates and calcium and zinc deficiency. It is best to take them more than 2 to 3 hours apart. In clinical practice, some doctors emphasize calcium supplementation with medication, but some people think that calcium supplementation with food is better, so many parents ask whether food or medication is better. We believe that for babies under 2 years old, food calcium supplements should only be used as an aid. Especially for children under 1 year old, they are mainly fed with mother’s milk, and the calcium content in milk is high compared to other foods, plus children’s gastrointestinal function is fragile, and they cannot accept a lot of high calcium foods, such as fish, shrimp, kelp, rib soup, orange juice, etc. These foods can only be taken into account when children gradually add supplementary foods later. Also foods rich in vitamin D, such as pig liver, lamb liver, beef liver, etc., although they can promote the absorption of calcium, can only be consumed after the baby has been added to complementary foods. Therefore, we believe that it is best to supplement cod liver oil and calcium supplements to ensure the calcium needs of growing children within the age of 2 years, and must be scientific supplementation, not to listen to some incorrect methods of taking medication blindly supplementation cod liver oil and calcium supplements, so as not to supplement some medical source of disease.