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Probiotics for Pediatric Patients Probiotics are beneficial bacteria normally present in the digestive tract. These friendly bacteria promote gut health, help prevent an overgrowth of yeast and other pathogens, and create a positive environment for the manufacture of B-complex vitamins and vitamin K. Common strains include Lactobacillus acidophilus and Bifidobacterium bifidum. Cultured or fermented foods (such as buttermilk, yogurt, kefir, and tempeh) are also sources of these beneficial bacteria. COMMON APPLICATIONS MOST APPROPRIATE STRAIN(S) DOSAGE/FORM DIRECTIONS PRODUCT RECOMMENDATIONS Antibiotic Associated Diarrhea S.boulardi, Lactobacillus GG, and Bifidobacterium bifidum L.acidophilus B.Lactis 20 to 100 billion CFU (colony forming units) per day. Powdered form or decapsulated for younger children. Can be mixed with food (i.e. applesauce or yogurt). Stagger dose with antibiotic dosing. Duration ranges from 2 weeks to 3 months. Rule of thumb: take probiotic for at least twice as long as antibiotic therapy lasted. • Proboulardi from Metagenics • Ultra Flora Plus DF from Metagenics • Florasmart from Renew Life • ABx Support from Klaire Clostridium difficile S.boulardi and Lactobacillus GG 10 billion CFUs per day 2 capsules per day in addition to prescribed antibiotic • Jarrow S.Boulardi Gastroenteritis Lactobacillus GG Powdered form or decapsulated for younger children. 10 to 14 days at 10 billion CFUs per day • iFlora Powder by Sedona • Culterelle by Amerifit Nutrition Ear Infections Streptococcus Salivarius 1 billion CFUs 1 to 4 lozenges per day • E.N.T Biotic Lozenges by Protocol for Life Balance Irritable Bowel Syndrome Lactobacillus Plantarum 299v 225 to 450 billion CFUs per day 1 to 2 capsules per day or ½ to 1 packet per day • VSL #3 packets or capsules by Sigma Tau DISEASE STORAGE REQUIREMENTS Follow label instructions. Some products are shelf stable while others require refrigeration. POTENTIAL SIDE EFFECTS Most common side effects are gassiness and bloating, typically resolving itself after about two weeks of probiotic usage. Apothecary by Design | 84 Marginal Way, Suite 10, Portland, Maine 04101 | PH: 207-899-0886 | FX: 207-773-2942 Omega 3 Essential Fatty Acids (EFAs) for Pediatric Patients Omega-3 EFAs promote and support the health and function of our cardiovascular, central nervous and immune systems as well as our brain, retina and joints. They are typically found in coldwater fish, seeds, nuts, and their oils. The three types of Omega-3 EFAs are Alpha-Linolenic Acid (ALA), Eicosapentaenoic Acid (EPA) and Docosahexaenoic Acid (DHA). ALA is a medium-chain fatty acid derived from plant sources while the long-chain fatty acids, EPA and DHA, are predominantly sourced from fish or krill. Since our bodies require preformed long-chain fats for optimal health and the typical American eats very little fatty fish, supplementation is strongly suggested. COMMON APPLICATIONS DISEASE/APPLICATION DOSAGE/FORM (BEST TAKEN WITH A MEAL) PRODUCT RECOMMENDATIONS Breastfeeding 1 to 2 grams per day of EPA and DHA combined. Higher ratio of DHA to EPA recommended with a minimum of 300 mg of DHA. • Prenatal DHA Capsules by Nordic Naturals • Vegetarian DHA by Source Naturals • Neuromins by Natures Way Children’s Supplement ¼ tsp. liquid fish oil daily for infant (6-9 months of age). ½ tsp. daily for children 1-2 years old. 1 tsp. daily for children over 2 years. • Carlson for Kids Fish Oil • Pure Encapsulations Cod Liver Oil Lemon Body weight : • Nordic Naturals Baby’s DHA with Vitamin D3 5 to 10 lbs — 1ml 11 to 20 lbs — 2 ml 21 to 25 lbs — 3ml 26 to 35 lbs — 4ml Eczema 6 grams per day of EPA/DHA combined until improvement is seen then titrate down by 2 grams to maintenance dose of 2 grams/day • Nordic Naturals Ultimate Omega (0il or capsules) Asthma 2 grams per day of EPA/DHA combined • Carlson Very Finest Fish Oil • Metagenics EPA-DHA Extra Strength (capsules) ADD/ADHD 2 grams per day of EPA/DHA combined • Nordic Naturals DHA Junior Strawberry STORAGE REQUIREMENTS Follow label instructions. Store in dark container in the refrigerator, freezer, or cool cabinet. POTENTIAL SIDE EFFECTS May experience a fishy aftertaste or repeating. Typically is managed by ensuring product quality and refrigeration/ freezing allowing product to dissolve lower in the GI tract. Contraindicated due to clotting disorders or allergies. Apothecary by Design | 84 Marginal Way, Suite 10, Portland, Maine 04101 | PH: 207-899-0886 | FX: 207-773-2942 Vitamin D for Pediatric Patients Vitamin D promotes calcium absorption in the gut and is critical for bone growth and remodeling. It also supports immune health and plays a key role in helping to reduce the risk of cancer, diabetes and heart disease. While vitamin D is found in milk, tuna, mackerel, sardines, and some other fortified foods like cereal, up to 70% of children in our country are vitamin D deficient (according to a study in Pediatrics journal). Supplementation can help counteract decreased D levels and support disease prevention throughout life. Vitamin D supplements are recommended for children of all ages to help fight disease though doses vary. It is best to refer to the standard recommended dietary allowance (RDAs). Visit the Council for Responsible Nutrition (crnusa.org). COMMON APPLICATIONS AGE DOSAGE/FORM (BEST TAKEN WITH A MEAL) PRODUCT RECOMMENDATIONS Newborn – 2 years old 400 International Units (IU) daily • Baby D Drops from Carlson 2 – 12 years old 600-1000 IU daily • D Drops for Kids from Carlson POTENTIAL SIDE EFFECTS Contraindicated in kidney and granulomatous disease. Toxicity is a possibility so monitor blood levels including serum calcium and manage by self-correcting and decreasing dose. Apothecary by Design | 84 Marginal Way, Suite 10, Portland, Maine 04101 | PH: 207-899-0886 | FX: 207-773-2942