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We've made it through the summer holidays and now the next challenge is strengthening your child’s immune system for the return to school. A healthy diet is paramount to provide all the nutrients they need to ensure a robust immune system. If you’re not sure which nutrients are important, or what to do if and when your children get poorly, we’ve gathered our top nutritional and lifestyle tips all in one place, so read on to learn more.
Throughout their early years, our children are constantly developing their immune system, which needs to learn to adapt to the outside world, in order to equip them with a functioning immune response in adulthood. An undeveloped immune system is one of the reasons why children are very prone to infections, in particular upper respiratory tract infections (URTIs), including otitis media (glue ear), tonsillitis, bronchitis, and the common cold.
Vitamin D deficiency is common and has been linked to an increased risk of URTIs, such as tonsillitis in children,1 so ensuring adequate supply could be useful in preventing infection. The Department of Health recommends a daily supplement of 10mcg (400iu) for children from 6 months to 5 years of age. However, higher levels (1200iu) in school children have been shown to reduce the incidence of flu by 40%.2 In times of need, you can increase the level for a short period (approximately 1-2 weeks).
Vitamin D upper limits for short-term in children (as clinically necessary):
Vitamin A is a fat-soluble vitamin which is important in maintaining the barrier membranes in the body and can amplify the immune response when needed.3 Vitamin A may also be lost in substantial amounts in urine during an infection.4 In children, it has been found effective in managing measles infections5 and hand, foot and mouth disease.6
If your child is following a vegan or vegetarian diet, it is important to supplement with vitamin A in its active form (as retinol) to ensure adequate intake for immune health.
Our germ-fighting white blood cells need vitamin C to perform their tasks efficiently and they accumulate it for times of viral and bacterial invasion. In children, supplemental vitamin C can decrease the duration and symptoms of respiratory tract infections,7 including pneumonia.8
Vitamin C rich foods include peppers, broccoli, spinach, strawberries, pineapple, oranges, kiwi fruit, cantaloupe, and cauliflower, and should be consumed raw or only lightly steamed to conserve their vitamin C content. Easy ways to do this include smoothies, fruit salads, or even fruit ‘kebabs’. Vegetables can often be trickier to increase, so finely chopping or grating them, making them into crudités, and adding to soups or sauces can often help.
A good daily dose of vitamin C for children from one year is 250mg, which can often be found in a good quality multivitamin. This can however be increased for a short period (1-2 weeks) whilst fighting infections (see table below). If using vitamin C in a powder form, it is really easy to add to a water bottle or beaker that the child can sip on throughout the day.
Vitamin C upper limits for short-term in children (as clinically necessary):
The main role of zinc in the immune system is preventing the spread to bacteria and virus by reducing their replication.9 It also maintains strong barrier membranes in the skin and respiratory tract to prevent microbial entry.10 Zinc-deficient individuals often experience increased susceptibility to a variety of pathogens.11
Zinc rich foods include seafood, beef and lamb, spinach, pumpkin seeds, cocoa, chicken, beans, mushrooms.
A good quality multinutrient will provide enough zinc for a daily dose, however for additional short-term immune support it can be increased.
Zinc upper limits for short-term in children (as clinically necessary):
Research shows elderberry extract supports immune function by enabling the immune cells to recognise and stop viral invaders, and it comes with a long history of safe and effective use. Research shows that it has the potential to ‘blunt’ the spikes on the outside of certain viruses and stop them from entering the cells where they would otherwise replicate.12 Elderberry is therefore often best taken at first signs of infection to stop the virus entering the cells and multiplying, alongside the vitamins and minerals mentioned above which collectively help to strengthen and balance the immune system.
Our gut bacteria stimulate, support, and enhance the maturation of the immune system. A recent research study involved giving children aged 3-6 years, a combination of probiotics containing Lactobacillus acidophilus, Bifidobacterium lactic and Bifidobacterium bifidum, alongside a small amount of vitamin C daily, for 6 months. The results showed a 50% reduction in coughs and colds, antibiotic use and reduced absence from school.13 Another specific strain Lactobacillus rhamnosus GG has also been shown to be effective in decreasing the number, severity and duration of respiratory tract infections in children in several clinical studies.14,15
A great strategy for supporting immunity in children would be a comprehensive children’s multinutrient formula which includes a range of immune-supporting nutrients such as vitamin A and zinc. It would also provide assurance of optimal daily nutrient intake, especially if children are fussy-eaters or have varying appetites. Alongside a multinutrient a probiotic would be worth considering, and extra vitamin C and elderberry, when needing additional support.
Don’t be afraid to experiment, you will be surprised by your child’s ability to try new flavours. Be inspired by colour, variety and the seasons. Some great books to get you started are Natasha Corrett’s Family Kitchen and Lucinda Miller’s The Good Stuff.
We hope that this blog has inspired you with some practical tips about how to support your children’s immune health as they head back into school. If you need further tailored advice, please do not hesitate to contact our Nutrition Team or seek the advice of a Registered Nutritional Therapist or other healthcare practitioner.
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1. Yildiz I, Unuvar E, Zeybek U, et al. The role of vitamin D in children with recurrent Tonsillopharyngitis. Ital J Pediatr. 2012;38(1):25. doi:10.1186/1824-7288-38-25
2. Urashima M, Segawa T, Okazaki M, Kurihara M, Wada Y, Ida H. Randomized trial of vitamin D supplementation to prevent seasonal influenza A in schoolchildren. Am J Clin Nutr. 2010;91(5):1255-1260. doi:10.3945/ajcn.2009.29094
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8. Khan IM, Shabbier A, Naeemullah S, et al. Efficacy of Vitamin C in Reducing Duration of Severe Pneumonia in Children. Vol 18.; 2014. Accessed August 25, 2020. https://www.journalrmc.com/index.php/JRMC/article/...
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11. Gammoh NZ, Rink L. Zinc in infection and inflammation. Nutrients. 2017;9(6). doi:10.3390/nu9060624
12. Weng JR, Lin CS, Lai HC, et al. Antiviral activity of Sambucus FormosanaNakai ethanol extract and related phenolic acid constituents against human coronavirus NL63. Virus Res. 2019;273:197767. doi:10.1016/j.virusres.2019.197767
13. Garaiova I, Muchová J, Nagyová Z, et al. Probiotics and vitamin C for the prevention of respiratory tract infections in children attending preschool: A randomised controlled pilot study. Eur J Clin Nutr. 2015;69(3):373-379. doi:10.1038/ejcn.2014.174
14. Kumpu M, Lehtoranta L, Roivainen M, et al. The use of the probiotic Lactobacillus rhamnosus GG and viral findings in the nasopharynx of children attending day care. J Med Virol. 2013;85(9):1632-1638. doi:10.1002/jmv.23623
15. Hojsak I, Snovak N, Abdović S, Szajewska H, Mišak Z, Kolaček S. Lactobacillus GG in the prevention of gastrointestinal and respiratory tract infections in children who attend day care centers: A randomized, double-blind, placebo-controlled trial. Clin Nutr. 2010;29(3):312-316. doi:10.1016/j.clnu.2009.09.008
16. Childs CE, Calder PC, Miles EA. Diet and immune function. Nutrients. 2019;11(8). doi:10.3390/nu11081933
17. Thompson RA. Stress and child development. Futur Child. 2014;24(1):41-59. doi:10.1353/foc.2014.0004