Thursday, December 27, 2007

Sickly Children with Pale Faces: Vitamin C, Niacin, and Multivitamins Can Help

Working together vitamin D, vitamin C, niacin, and multivitamin can accelerate the return of good health to a sickly infant or toddler. Vitamin D is best obtained from sunshine. Vitamin C, niacin, and multivitamins are best obtained as supplements. The word accelerate is used to acknowledge that most sickly children will regain ordinary health by following standard pediatric care. The vitamin supplements and plentiful sunshine complement the treatments provided by pediatricians. The best results are obtained by using sunshine and supplements in addition to any medications/treatments advised by a child’s pediatrician.

I recommend three supplements that are inexpensive and easy to find. These are 500 mg chewable vitamin C tablets, children’s chewable multivitamins, and 250 mg time-release niacin gel caps or tablets. If you have a toddler with a pale face and dark circles under the eyes, feed him or her 6 of the vitamin C tablets, one multivitamin, and 1/2 of one 250 mg time-release niacin gel cap or tablet. Follow up with 4 more vitamin C tablets before bedtime. Many toddlers are happy to take one kid’s chewable multivitamin and lots of chewable vitamin C. These taste good. The half niacin gel cap or tablet is the only toddler-unfriendly ingredient. Fortunately, niacin has a mild flavor. Add half the contents of the gel cap (or a half tablet crushed into chunks) to ice cream or pudding, or some other soft, toddler-friendly food. The niacin may cause the toddler to flush – a temporary reddening of the skin. Although the flushing can be unpleasant, it is harmless. Further, flushing is unusual with time-release niacin gel caps at such a low dosage. Keep going with 125 mg/day of time release niacin and the vitamin C, 4 chewable tablets every morning and every bedtime until the dark circles are gone and are replaced by rosy cheeks. 4 chewable vitamin C tablets and a multivitamin should be taken every day, even when healthy. I recommend 1/2 of one 250 mg time-release niacin supplement once or twice per week for healthy kids.

I also recommend plentiful sunshine. The idea is to expose as much skin as possible for well less than the amount of time it takes to burn. Sunburns are really unpleasant. The kids will figure it out for themselves. Your job as a parent is to teach them to lie down and expose skin to the sun that usually hidden by clothing. When they go to the beach, teach them to wear a hat and shirt to protect from burns. Managing sun exposure is part of taking care of yourself, just like eating well. It's not simple, but it is natural. I don't recommend vitamin D supplements (beyond what's in milk and the multivitamins) for small children because of side effects that are difficult to manage, and slow to recede.

Several lines of reasoning supporting my recommendations follow. Vitamins are necessary catalysts used to complete the challenging task of transforming an egg and sperm into a healthy adult. Read more here and here. Vitamins help children develop immunity towards infectious diseases. This is especially important during the early daycare years when a typical child gets 8 to 10 colds per year. Read more here, here, here, and here. Environmental toxins (heavy metals are of particular concern) are steadily accumulating in the environment making the utopian goal of error-free growth and development even more challenging. Read more here, here, here, here, and here. The ordinary rough and tumble of a healthy childhood typically causes uncountable minor injuries (wounds) such as bruises, scrapes, inflammation from viral or bacterial infections, and burns (including sun burns and chemical burns such a poison ivy). Read more here, here, and here. Finally, vitamin deficiency diseases have not been completely eliminated. Self-starvation in adolescence remains tragically common and is most often referred to as anorexia and bulimia (eating disorders). Read more here and here.

The primary concern of parents and regulators is safety. Parents can confidently provide their children with up to 4,000 mg/day of vitamin C every day and up to 10,000 mg/day when they are fighting colds. The only risk is short-term discomfort. If 500 or 1000 mg turns out to be the optimal dose for their specific child, no parent will care as long as 4000 mg/day is safe and remains free of discomforts. In other words, if a parent is supplementing his/her children with 4000 mg/day and the children are healthy and happy, that parent is unlikely to explore lower doses in order to find an optimum.

All parents, not just those of sickly children with pale faces, should consider vitamin C, time-release niacin, and multivitamin supplements for their children. The children have everything to gain and almost nothing to lose by giving this approach a try.


At 1:30 PM, Anonymous Anonymous said...

my daughter has dark cirles under her eyes. She has had them since she was very young and they tend to get worse when she has a cold. They seem to be getting more intense as she is getting older. She is three years old and I had them when I was young as well. I consulted her doctor and she recommended half a multivitamin with iron. My doctor when I was young recommended vitamin b shots. I am just afraid that your dosage would be too much for her system.

At 8:46 PM, Blogger Steve said...


I understand your fear. I researched vitamin side effects intensively before I provided my children with vitamin C, niacin, and multivitamins.

Your situation with your daughter is not an emergency. , so you can proceed with caution. Go ahead and start with two 500 mg tablets of chewable vitamin C (one at breakfast and one at dinner), one kids chewable vitamin, and 60 mg of time-release niacin (cut the 250 mg tablet into quarters instead of halves). Then build up to the dose I recommend. I'd be really surprised if your daughter had a bad reaction to these doses. Once you built up to my recommendations, I'd be surprised, but not shocked, if your daughter developed a side effect.

I consider these doses conservative. I supplemented my son with more than double these doses. That said, everyone in my family has suffered some from vitamin side effects. We are not sorry - the benefits have greatly exceeded the discomforts.

At 1:22 PM, Anonymous Anonymous said...

thanks for your comment, I have two question regarding your answer.
First how often do I do the conservative dosage (once a week??daily; for how long?) and what would be some of the side effects?

At 10:49 PM, Blogger Steve said...


I was thinking daily. If you did this every other day, it would be twice as conservative, and you'd be that much farther away from the daily doses recommended in the main post. That said, every other day is also a perfectly good action to take.

Regarding side effects, I highly recommend a book called "The Right Dose" by Patricia Hausman. There are lots of known side effects from vitamins. All of the side effects cause discomfort. None of them cause any permanent harm. If you are worried that the vitamins are causing your daughter discomfort, stop the vitamins for a few days. If the vitamin is the cause, she will get steadily better. Then reintroduce the vitamin at double the normal dose. If the vitamin is the cause, the discomfort will return immediately.

The multivitamin is highly unlikely to cause any side effects since it contains only 1 RDA of vitamins and minerals. I'd have to review Hausman's entire book to communicate all the potential side effects of all the nutrients.

The side effects from vitamin C are overwhelmingly gastrointestinal - cramps, bloating, gas, loose stool. The Food and Nutrition Board has determined that these side effects are rare in adults at doses below 2000 mg/day. In my experience, toddlers have a significantly higher tolerance for vitamin C. I do not believe in dosing vitamins by body weight. Anyway, the vitamin C side effects will be obvious to both you and your daughter.

Niacin causes one obvious side effects. Niacin causes flushing - a temporary reddening of the skin. The intensity of the flush is generally proportional to the dose. The experience can range from minor reddening and tingling to turning lobster red and feeling like you are on fire. The flush lasts no more than 1 hour.

The next most common side effect is nausea. Should you decide to stick with niacin supplements as I recommend, I strongly recommend stopping all the vitamins whenever your child has a sick stomach.

Other niacin side effects are rare - but there are so many that taken together, to experience one is not so rare. Lots of them are neurological - itchy spots, vision problems, ringing ears, bad feelings. I've personally experienced many of these side effects. Oddly enough, they are not reproducible. I still take niacin and I am not currently experiencing any of these odd side effects. If you supplement your daughter, and she experiences any discomforts, please come back to the blog and ask, "could this problem be a vitamin side effects". I obsessively collect reports of vitamin side effects and can speak knowledgably to any specific question. For whatever it is worth, I have seen no vitamin side effects in the 20-odd toddlers I know who took these vitamins in the dose range I recommend. I know lots of adults that have had trouble with side effects.

A final comment - please click on the links in the main post to previous posts on using extra vitamin C and extra niacin to fight off colds. Toddlers can sometimes feel the effect of extra vitamin C and niacin immediately. Many toddlers like the taste of the orange chewable vitamin C tablets and will ask for more when they have a cold. When your daughter has a cold is the right time to test your comfort zone. Think about giving her more and asking her if it makes her feel better and if she wants even more.

OK - to your final question - for how long? Keeping up the regimen until the pale face and dark circles are gone, and returning to the regimen every time your daughter gets a cold (or other respiratory infection), is the minimum. I blog week after week to convince parents to maintain the regimen until children are full grown, but I can understand why you might choose to back off if your daughter regains excellent health.

Thanks for your excellent questions, and don't hesitate to ask for clarification.

At 11:58 AM, Anonymous Anonymous said...

my daughter is african american, 8yrs old, dark brown skin, with deep dark circle under her eyes! It's been fairly noticeable now for the last 2 years. She just doesn't look the same, sort of sickly. She is also sniffing and rubbing her nose alot which has not created a crease/line across her nose. Her Ped. says it's allergies (without testing her) and prescribed fexofenadine 5mg twice a day. She's been taking these now for over a year...with no change! I'm very concern. What do you think this could be. I thought it could be hereditary, since I too have slightly dark circles under my eyes, but I have very light skin.
She has had a few illnesses in the past, like mono & tested positive for salmonella several years ago. She also complains occasionally about her stomach aching or leg pains.
Please help!

Thank you.

At 11:47 AM, Anonymous Anonymous said...

Do you recommend any particular brands of Vitamin C, Multivitamin, and Niacin for a 3 year old. I'd like something that is as natural as possible, easy on the stomach, and with the least side effects. I noticed that they don't make children's vitamin c and niacin, so should I get the adults?

At 5:35 AM, Anonymous Anonymous said...

Dear Steve,

I have found your blog very interesting as my daughter has pale skin and dark bags under her eyes too and i am concerned. She has just turned 3 yrs old and for the last year she has been ill with colds every 2/3 weeks which turns into viral induced asthma. We are now giving her medicine to prevent the viral induced asthma however as she always looks so pale and ill I am looking at every alternative to get my daughter better. She eats good healthy food however only in small amounts so i feel that i need to boost her immune system with extra vitamins like you suggest.
Would the high dose of vitamins you suggest interfere with her viral medication and steriods?
Also, can i ask what experience you have in childrens health as many doctors would disagree with your vitamin suggestions?
Many thanks for your help.

At 9:29 PM, Blogger Steve said...


Thanks for your comments and questions.

Side effects and drug interactions are not determined using double-blind, placebo controlled trials. The best science can do is to collect and analyze anecdotal reports from users. I track down (I have access to excellent search tools for scientific publications) and read everything I can find on vitamin side effects and drug interactions. I am unaware of any reports concerning interactions between vitamins and steroids or vitamins and viral medications. Remember, everyone is eating vitamins every day anyway. Drugs that were sensitive to vitamins would be a problem.

Regarding my experience. I am a practicing scientist with a Ph.D. in chemistry. I am not a pediatrician. If I were a pediatrician, I could not be a specialist in vitamins. Somehow, through some twist of fate that I don't understand, 1 RDA multivitamins became the "standard of care" for children. Pediatricians risk losing their insurance coverage if they recommend treatments that deviate from the "standard of care". If they aren't free to make any judgements or take any actions, what incentive is there for them to study the safety and efficacy of vitamins for children?

That said, I personally consult with a group of physicians that specialize in vitamins. These physicians are known as "orthomoleculer" physicians and they hold yearly conferences. By trading regular communications we are actively developing a set of best practices. The recommendations I give in this blog are intended to be consistent with these best practices.

In addition, I have been conducting a small clinical practice for 15 years with friends and family. My "practice" is structured more like a users group. Special attention is paid to side effects. We have identified side effects that I have been unable to confirm from published reports in the literature.

There are a handful of children in the group, and all of them are doing fine. I have the most experience with my own two children. They are not especially healthy. They were in catastrophically poor health when I started them on vitamins as they turned 2 and 4 years old respectively. They are now turning 16 and 18 respectively. Every year our family faces multiple bouts of respiratory infections, intestinal viruses, and more. On the whole, my belief is that we are getting steadily healthier as a group as we become more experienced vitamin users.

One of the reasons that I am experienced is because my family is not healthy. With at least a dozen colds per year running through the family four 14 years we have been able to try different doses and combinations of vitamins over and over again.

There is not much experience treating toddlers with high doses of vitamins so you are right to be concerned. I share your concern. With my own children, I balanced my fear of side effects with my fear of the consequences of relying on food alone. The doses I advise in my blog are less than half the doses I raised my children on. The exceptions are vitamin D and vitamin B1 (thiamine). I raised my children on 800 IU and about 10 mg/day of thiamine hydrochloride. Today I would recommend 1000 IU vitamin D in the winter and plenty of sunshine without sunblock during the other seasons. I would consider adding 100 mg thiamine hydrochloride once per week.

I'm sorry that I can't claim to be more experienced. The health and welfare of children are on the line. The good news is that experience is rapidly accumulating. Keep on coming back to the blog to stay up to date.

I hope you give this a try. The facts are that the doses of vitamins recommended here carry much less risk than the steriods and viral medications your daughter is already taking. Your daughter has much to gain and little to lose by giving the vitamins a try.

Thanks again for visiting.

At 8:31 AM, Anonymous Anonymous said...

I was pleased find I am not alone regarding these puzzling symptoms. Thank you for starting this blog! My 6yr old started showing this condition about a year ago and we had him tested for anemia, which he is not. Since this "condition" occured, he has had problems with listening, extreme moodiness, irritability, defiance and he requires Melatonin to fall asleep. All these behaviors are above and beyond what one would consider normal. We are eager to try the vitamin route but have a couple of questions: 1) will it interact with the Melatonin? 2) Is it possible it can improve his behavior? 3)should we increase the dosage slightly that was offered to the parents of the 4 yr old? Again, we thank you for this helpful post!!!!

At 8:23 PM, Blogger anderrygreen said...

A very common cause of dark circles under the eyes in children is a food allergy or sensitivity - usually dairy, but wheat and gluten are also trouble makers for a lot of children. It would benefit any child that has ongoing dark circles to have allergy testing and sensitivity testing. I recommend both because my daughter tested negative for any allergies and ended up testing highly sensitive to dairy and eggs. I would have never known if I had not had the seperate testing done through Immuno labs. Try taking dairy out of the equation for a week and see what happens. It was an amazing difference in my daughter - even in behavior. When given dairy she displays symptoms of ADHD - but without the dairy - she is great. Good luck!

At 5:55 PM, Anonymous Anonymous said...

hi, im a 27 female with pale face and dark much should i take?

At 7:21 PM, Blogger Steve said...

Dear Anonymous,

Please excuse the delayed response. I didn't notice the new posts.

I am not aware of any papers warning of interactions between these four vitamins and melatonin. If your child has a bad reaction to the vitamins for any reason, stop the supplements and come back for advice. The odds are good that there won't be any problems with melatonin interactions.

Yes the vitamins can improve behavior. Improved behavior was my number one objective when I started supplements with my children.

I recommend starting with the same doses independent of age and weight. If the vitamins are ineffective, and no side effects are encountered, then it is rational to try higher doses. If the vitamins are effective and no side effects are encountered, it is even more rational to try higher doses although I'd recommend more patience.

I hope my delayed response did not stop you from getting started.


At 7:25 PM, Blogger Steve said...

Dear Anonymous 27 year Old,

Please see this post for my dosage recommendation for adults:

I hope you feel better soon,


At 7:32 PM, Blogger Steve said...

Dear Anderry,

Healthy children do not have food sensitivities and allergies. I agree that unhealthy children with allergies should avoid the foods that they are allergic to. I also recommend that they take the supplements that I recommend in the hopes that the allergies will go away.


At 4:53 PM, Anonymous Anonymous said...

It is remarkable, this very valuable opinion

At 9:20 AM, Anonymous Anonymous said...

Easily I assent to but I dream the post should prepare more info then it has.

At 12:58 AM, Anonymous Anonymous said...

Again a gentle post. Offer your crony

At 5:15 PM, Blogger Steve said...

Dear Anonymous,

I have access to a wealth of additional information and would be happy to share more of it as you request. I just need your help being more specific. Before asking me for more information, make sure you've read everything I've already posted. It is easier to browse my columns using Google than using my blog page. Type "vitamins and pale faces" into Google and then click "show all" to get a list of all the blog entries I've written about vitamins and children.

In the meantime, there's much to gain and almost nothing to lose by trying the vitamins I recommend for your children.


At 6:14 AM, Anonymous Anonymous said...

I inclination not agree on it. I think nice post. Particularly the title-deed attracted me to review the sound story.

At 3:29 AM, Anonymous Anonymous said...

Genial post and this mail helped me alot in my college assignement. Say thank you you on your information.

At 7:37 PM, Blogger Steve said...

Dear Anonymous,

Thanks so much for your post. I'm delighted that my views are being assessed by students in term papers. This is how the world is supposed to work. I'm also delighted that the internet has connected me with individuals interested in nutrition from around the world. I'm so grateful to those of you who learned English as a second language for making the effort to communicate with me. Sadly, my language skills are poor and I can only communicate in English.


At 7:33 PM, Blogger Unknown said...

Dear Steve,

It has been YEARS since you wrote this post, but in a desperate Google search for "4-year-old pale face red circles under eyes" your blog was the first article that turned up.

I have two daughters only 18-mos apart. Our older daughter has had a pale face and red circles under her eyes from the moment she grew from a baby into a toddler. She is not one I would call "sickly" as she is rarely ill, but she is often tired and quite content to play calmly. On the other hand, she's often happy to bounce around in the outdoors for hours on end without stopping for a break even once. Yet, no matter if she's spent all day energetically playing outside or if she's had a quiet indoor play day, she still has a persistent pale color and red/purple coloring on her lower eyelids. I feel so sad for her when other adults ask if she's sleepy when I know she's not-- it's just the circles.

Our our younger daughter has perfect coloring and has never struggled with paleness. She tags along with her sister everywhere she goes. They do everything together: They eat the same foods, play the same games, share a bedroom. They were both breastfed and then moved on to the same foods and vitamins-- All consistent! Yet one clearly has better coloring than the other.

Will you please advise me on how to move forward? (Recommended vitamins/dosages?) I am desperately seeking answers for our little girl. She is such a great kid, and if I can help her feel better in any way, I'm open to it.

Many thanks!

At 10:30 AM, Blogger Steve said...

Dear Stephanie,

I'm sorry that my blog remains the only place for concerned parents to turn. Some day pediatricians will be trained to help parents optimize the nutrition of their toddlers.

The column is old, but the advice is still good. The chewable vitamin C, time-release niacin, chewable multivitamins, and plentiful sunshine remain a very good place to start. Please reread the column carefully. The advice for a place to start is independent of age, weight, and sex. Please be watchful for any negative changes and don't hesitate to contact me with any concerns about possible side effects.

I hope you give the vitamins a try - your daughter has much to gain and the risk of harm is as low as it gets.

Good luck. I'll keep your daughter in my thoughts.


At 1:18 AM, Blogger huzaima ahmed said...

My Sister's Daughter is having pale face and dark circles under her eyes.we followed your advice but it does not work it still is the same. could you please help us with a natural face sauce made home or something we can put on her face.

At 1:26 AM, Blogger huzaima ahmed said...

My sister's daughter is having dark circles near her eyes.her daughter gets shy to go school because her friends tease.we also gave her multivitamins for 8 to 10 months. but no change appeared through those days.we are still giving vitamins as you recommended.will you please tell us what to do.should we apply a natural made sauce made home.and also she gained some very small pimples nears her eyes.please help us.

At 2:17 PM, Anonymous Anonymous said...

This is a strong evidence that your child is harbouring parasites.

Watch for grinding teeth, bedwetting, stomach pains,constipation, loose stools, check stools for undigested food looking items.
Good luck getting a diagnosis, the stool test globaly are not picking them up. WE are facing a global threat with ongoing parasitic infections and they are on the climb. Also asthma symptoms, IBS.

At 11:37 PM, Anonymous Anonymous said...

Thank you so much I'm afraid w niacin because I red tour blow long time ago and I did not see this info now I will start again the vitamin treatment he is 9 and I'm very frustare it the way my son lookswhen iI gave him niacin his legs were red and iI got scared and I stoped please tell me if I keep up of not Thank you so much Steve


Post a Comment

<< Home