Frequently Asked Questions
1. For children who are receiving high dose vitamin A capsules twice yearly, is there any concern about vitamin A toxicity if they also receive Sprinkles, which also contain vitamin A?
There is no risk of toxicity. The dose of vitamin A in Sprinkles is formulated to help the child meet the
daily vitamin A requirement (the Recommended Daily Allowance or RDA). As such, the use of Sprinkles as
‘home fortification’ is complementary to the high dose vitamin A capsules, not competitive. When the WHO
initiated the high dose capsules, they did not stipulate that the child receiving the supplement should not
eat food containing vitamin A. Indeed, they recommended an age-appropriate diet which would contain all
micronutrients, including vitamin A.
Sprinkles with vitamin A is formulated to help children meet their RDA for vitamin A and thus is safe to use with the high dose supplement.
daily vitamin A requirement (the Recommended Daily Allowance or RDA). As such, the use of Sprinkles as
‘home fortification’ is complementary to the high dose vitamin A capsules, not competitive. When the WHO
initiated the high dose capsules, they did not stipulate that the child receiving the supplement should not
eat food containing vitamin A. Indeed, they recommended an age-appropriate diet which would contain all
micronutrients, including vitamin A.
Sprinkles with vitamin A is formulated to help children meet their RDA for vitamin A and thus is safe to use with the high dose supplement.
2. It has been noted that some infants develop a change in their stool consistency (loose stool or constipation) and colour when they start taking Sprinkles. W
hy does this happen? Is it of any significance?
hy does this happen? Is it of any significance?
In the majority of infants and children receiving Sprinkles, there will be no change in the
consistency of their stools. The colour of the stool will change to a dark or black colour in all infants
if they are receiving the Sprinkles on a regular basis. The dark colour is a result of the ‘unabsorbed’
iron being excreted in the stool. Iron itself is dark in colour, thus unabsorbed iron will darken the stool.
Some very young infants, who have not previously been exposed to any complementary foods containing micronutrients
(i.e. who are exclusively breast-fed) may develop loose stools or even mild diarrhea. The diarrhea does not lead to dehydration, but is a valid concern to parents and health care providers. The diarrhea seems to last for about a week and then will not recur. Parents have reported to us that if they use 1/3 – 1/2 of a package of Sprinkles added to complementary foods in young infants who are starting the transition from breastfeeding to complimentary feeding, the diarrhea quickly disappears. Others use 1/3 of a package at each meal with similar outcomes.
consistency of their stools. The colour of the stool will change to a dark or black colour in all infants
if they are receiving the Sprinkles on a regular basis. The dark colour is a result of the ‘unabsorbed’
iron being excreted in the stool. Iron itself is dark in colour, thus unabsorbed iron will darken the stool.
Some very young infants, who have not previously been exposed to any complementary foods containing micronutrients
(i.e. who are exclusively breast-fed) may develop loose stools or even mild diarrhea. The diarrhea does not lead to dehydration, but is a valid concern to parents and health care providers. The diarrhea seems to last for about a week and then will not recur. Parents have reported to us that if they use 1/3 – 1/2 of a package of Sprinkles added to complementary foods in young infants who are starting the transition from breastfeeding to complimentary feeding, the diarrhea quickly disappears. Others use 1/3 of a package at each meal with similar outcomes.
We are not sure about the etiology of the loose stool, but it may be due to the change in bowel flora associated
with the introduction of iron into the diet or possibly the impact of ascorbic acid on bowel peristalsis in infants who previously had received only very small amounts of ascorbic acid in their diets (in breast milk).
Since the loose stoolhas only been observed in infants when they are beginning the process of transition from
exclusive breastfeeding to a diet of complementary feeds, it is possible that the loose stoolis unrelated to
the Sprinkles, but is more related to the change in stool pattern with the introduction of complementary
foods.
3. Can Sprinkles be used in fluid drinks like milk or juice?
class=”contentMargin22px”>Sprinkles can be used in any food products, but because the iron is coated with lipid
(to mask the metallic taste), it will float to the top of liquids and tend to stick to the side of the cup
or glass. So, although Sprinkles can be used with any fluid, some will be lost in the process.
(to mask the metallic taste), it will float to the top of liquids and tend to stick to the side of the cup
or glass. So, although Sprinkles can be used with any fluid, some will be lost in the process.
4. Can Sprinkles be provided to non-anemic infants without producing any toxicity?
Yes. The amount of micronutrients in the Sprinkles sachets is high enough to meet the needs of infants with micronutrient deficiencies (e.g. iron deficiency anemia) but not too high for those who do not have deficiencies. We have completed a research study in China with 400 preschool children, the majority of whom were non-anemic (95%). Sprinkles prevented anemia (when provided for 4 months) with absolutely no evidence of excessive iron stores. Serum ferritin values remain in the normal range in 100% of infants included in the study.
Thus Sprinkles are safe to use, even in infants without micronutrient deficiencies. In fact, Sprinkles were originally designed to prevent deficiencies in non-deficient children at risk of micronutrient deficiencies.
5. Sprinkles are recommended to be used in children between 6 – 24 months of age. Can they be used in
older children, adolescents, adults and pregnant women?
older children, adolescents, adults and pregnant women?
Yes, they can be safely used for any age group, although they were developed for infants and young children.
Infants and young children cannot safely ingest tablets or pills. Syrups and drops have been used for many
years, but compliance has been documented to be poor (for iron) because of the strong unpleasant taste of
the drops; the drops tend to stain the teeth unless they are carefully placed at the back of the infants’
mouth; and for parents who cannot read, it is often difficult to measure the appropriate amount of liquid
iron which is often supplied in a bottle with a dropper calibrated in milliliters. In addition, although
general food fortification is an excellent way to prevent micronutrient deficiencies in adults, because
children ingest smaller amounts of foods than do adults, general fortification often will not meet the
micronutrient needs of young children. Thus, Sprinkles occupies a unique niche for young children. For other age groups, there are more choices for supplementation, including the use of fortified foods, pills and capsules. Nevertheless, Sprinkles can be used in these other age groups without fear of toxicity.
To date, our research emphasis has focused on infants and children under aged 5 years, however we have ongoing research involving pregnant women.
Infants and young children cannot safely ingest tablets or pills. Syrups and drops have been used for many
years, but compliance has been documented to be poor (for iron) because of the strong unpleasant taste of
the drops; the drops tend to stain the teeth unless they are carefully placed at the back of the infants’
mouth; and for parents who cannot read, it is often difficult to measure the appropriate amount of liquid
iron which is often supplied in a bottle with a dropper calibrated in milliliters. In addition, although
general food fortification is an excellent way to prevent micronutrient deficiencies in adults, because
children ingest smaller amounts of foods than do adults, general fortification often will not meet the
micronutrient needs of young children. Thus, Sprinkles occupies a unique niche for young children. For other age groups, there are more choices for supplementation, including the use of fortified foods, pills and capsules. Nevertheless, Sprinkles can be used in these other age groups without fear of toxicity.
To date, our research emphasis has focused on infants and children under aged 5 years, however we have ongoing research involving pregnant women.
6. Can Sprinkles be used to treat vitamin D deficiency rickets?
The dose of vitamin D in Sprinkles is meant to meet the RDA for vitamin D, rather than provide a therapeutic intervention. Thus, for rickets treatment, the recommended dose of vitamin D is significantly higher than the dose present in Sprinkles. However the dose of vitamin D in Sprinkles is adequate to prevent rickets.
7. Can Sprinkles be used to treat anemia or is it only appropriate as a means of preventing anemia?
Sprinkles can be used both in the treatment and prevention of anemia.
8. Sprinkles has been put forward as a home fortificant that will not change the taste or colour of
the food into which it is added. However, some parents have noticed a change in the taste and colour of the food. Can this be explained?
the food into which it is added. However, some parents have noticed a change in the taste and colour of the food. Can this be explained?
In order to mask the strong metallic taste of the iron, the iron in the Sprinkles is coated or encapsulated
with a thin coat of a soy lipid. The melting temperature for the lipid is around 60ºC. If Sprinkles are
added to food that is hotter than 60ºC, the lipid coating around the iron will melt and the food will be
exposed to the iron. The result will be that the iron can change the colour of the food and certainly will have a strong taste.
with a thin coat of a soy lipid. The melting temperature for the lipid is around 60ºC. If Sprinkles are
added to food that is hotter than 60ºC, the lipid coating around the iron will melt and the food will be
exposed to the iron. The result will be that the iron can change the colour of the food and certainly will have a strong taste.
To prevent changes in the taste and the colour of food to which Sprinkles is added, we recommend that Sprinkles be added to the food after it is cooled to a temperature below 60ºC.
9. What is the cost of Sprinkles and are they readily available to the general public?
The cost of Sprinkles is variable depending on the volume that is produced. Currently the only commercial
source of Sprinkles available is from the Hospital for Sick Children Specialty Food Shop
(http://www.sickkids.on.ca/specialtyfoodshop) and is only available in North America, however Sprinkles are available for use by governments, U.N. agencies and non-governmental organizations who provide Sprinkles on a humanitarian basis to populations in need.
source of Sprinkles available is from the Hospital for Sick Children Specialty Food Shop
(http://www.sickkids.on.ca/specialtyfoodshop) and is only available in North America, however Sprinkles are available for use by governments, U.N. agencies and non-governmental organizations who provide Sprinkles on a humanitarian basis to populations in need.
10. Who owns the intellectual rights to Sprinkles?
Intellectual property protection for Sprinkles has been granted to Ped-Med Ltd.
Ped-Med Ltd is owned by Stanley Zlotkin, the inventor of Sprinkles. The objective of maintaining the
intellectual property associated with Sprinkles is to ensure the highest standards of quality and integrity
to the Sprinkles Initiative and to ensure the safety and efficacy of Sprinkles to the end users.
The name Sprinkles is protected as a trademark. Only approved suppliers of Sprinkles are granted use of the
Sprinkles technology and use of the Sprinkles name as a quality mark to represent production under the highest
quality standards and commitment to the Sprinkles Initiative.
Ped-Med Ltd is owned by Stanley Zlotkin, the inventor of Sprinkles. The objective of maintaining the
intellectual property associated with Sprinkles is to ensure the highest standards of quality and integrity
to the Sprinkles Initiative and to ensure the safety and efficacy of Sprinkles to the end users.
The name Sprinkles is protected as a trademark. Only approved suppliers of Sprinkles are granted use of the
Sprinkles technology and use of the Sprinkles name as a quality mark to represent production under the highest
quality standards and commitment to the Sprinkles Initiative.
11. How long should Sprinkles be used? When should they be started?
The current recommendation from the World Health Organization (WHO) is that exclusive breastfeeding should
last until 6 months of age. Sprinkles may be given once complementary foods are started. Infants should
receive a minimum of 60 sachets, either once daily, or 60 sachets over 90 120 days. The provision of 60
sachets should be repeated yearly until a variety of mixed foods (containing iron and other micronutrients)
are being eaten.
last until 6 months of age. Sprinkles may be given once complementary foods are started. Infants should
receive a minimum of 60 sachets, either once daily, or 60 sachets over 90 120 days. The provision of 60
sachets should be repeated yearly until a variety of mixed foods (containing iron and other micronutrients)
are being eaten.
12. Why were Sprinkles developed?
In 1996, a group of UNICEF consultants determined that the standard iron drops were not effective,
as adherence to treatment remained poor. They called for a simple, inexpensive and potentially viable
new method to provide micronutrients (including iron) to populations at risk. The Sprinkles concept was
based on two observations from the ‘West’ where micronutrient deficiencies are rare; (a) fortification of
commercially available food provides essential micronutrients and (b) no change in the color, texture or
taste of the food ensures compliance.
as adherence to treatment remained poor. They called for a simple, inexpensive and potentially viable
new method to provide micronutrients (including iron) to populations at risk. The Sprinkles concept was
based on two observations from the ‘West’ where micronutrient deficiencies are rare; (a) fortification of
commercially available food provides essential micronutrients and (b) no change in the color, texture or
taste of the food ensures compliance.
Responding to the challenge, the Sprinkles Global Health Initiative at The Hospital for Sick Children,
University of Toronto, developed Sprinkles utilizing encapsulated iron that could be added directly to food.
13. Can Sprinkles be used in emergency rations?
Sprinkles can be added to any semi-solid complementary food. Emergency rations tend to include corn-soya
blend (CSB) or wheat-soya blend (WSB), two vehicles suitable for the addition of Sprinkles. Both these rations
produce a thick paste-like substance after cooking, to which Sprinkles may be added after cooling to provide an additional source of micronutrients. Sprinkles has been used in emergency relief aid in Indonesia and Haiti.
blend (CSB) or wheat-soya blend (WSB), two vehicles suitable for the addition of Sprinkles. Both these rations
produce a thick paste-like substance after cooking, to which Sprinkles may be added after cooling to provide an additional source of micronutrients. Sprinkles has been used in emergency relief aid in Indonesia and Haiti.
14. Can Sprinkles be used by Muslims and Jews who follow traditional food practices?
Yes. Neither alcohol nor porcine products are used in the production of Sprinkles. They are therefore both Halal and Kosher and may be used as part of a traditional Muslim or Jewish diet.
15. Can Sprinkles be used in infants younger than 6 months of age?
Sprinkles may be used in children under 6 months of age where complementary foods are being given. However, according to the WHO recommendation that infants be exclusively breastfed until 6 months of age, we do not recommend using Sprinkles before 6 months of age.
