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What parents should know about kids and supplements

Children who eat healthy diets rich in whole grains and fresh fruits and vegetables should not need to take a daily multivitamin—but how many truly fit that description? Even in households focused on whole foods and nutritious cooking practices, kids can be finicky eaters. Or they may live in homes where a standard Western diet too often includes processed junk food.

Can a nutritional supplement take the place of eating healthful whole foods?

Nutrition research strongly suggests that the answer is no. But a combination of some whole foods and high-quality supplements may be the best many parents can expect, and it is likely to prevent nutrient deficiencies. Children, especially those from low-income households, are at risk of several deficiencies and supplementing with a good multivitamin may act as a safety net, preventing them from falling into nutritional deficit.

When should I consult a doctor?

If you are considering a multivitamin, it’s a good idea to discuss your child’s best options with your doctors. However, you should always ask your doctor about supplement use if your child is already being treated with medications or if you are concerned that he or she has a deficiency that needs correcting.

Also, remember that “natural” does not always mean “safe,” though responsible supplement manufacturers will try to provide safety information that should be followed. Some nutritional supplements and herbs can be poisonous if taken in the wrong amounts, even if they are sold over the counter or are formulated for children.

What about herbal supplements?

Herbs are not recommended for children on a daily basis, but certain remedies may be considered for specific health conditions. For example, chamomile and mint teas may soothe upset stomachs, and ginger syrup or tea may help a child who is nauseated. Consult with a qualified healthcare provider before giving your child herbal supplements.

Does my child need a multivitamin?

While well-nourished children probably do not need a multivitamin, there appears to be no harm (and probably some benefit) from taking a good one that provides the Recommended Dietary Allowance (RDA) of most essential vitamins and minerals. Several good children’s multivitamins are available, some in chewable form. A high-quality multivitamin will provide at least the RDA of its key ingredients, it will contain no unnecessary additives, and it will meet its label claims for nutrient content.

Improved performance on IQ tests has been observed in some children who take a daily multivitamin, compared with those who do not. However, the results of this research are not conclusive, and it may be that the children who benefited had iron deficiency that was corrected by the multivitamin. Children from low-income households are at the highest risk of nutritional deficiencies. Studies suggest that in these groups multivitamins may improve brain function and attention in school, fortify the immune system against infection, and prevent diseases such as anemia (caused by deficiency of iron or certain B-complex vitamins) and rickets (caused by vitamin D deficiency).

Does my child need an iron supplement?

Though less common now that breakfast cereals and breads are fortified with iron, iron-deficiency anemia is still a common nutritional problem for children and teens. Consult your pediatrician to determine if your child needs iron. Iron can be dangerous and should never be supplemented unless deficiency has been found. Some children’s multivitamins contain iron; some do not. Be sure to check the label.

• Babies & toddlers: Breast-feeding infants less than three months old do not need iron supplements and neither do formula-fed infants as baby formula is fortified with iron. Children between three months and three years old may need iron (1 mg per kilogram [2.2 pounds] of body weight per day). Some experts disagree, saying that once solid foods have been introduced the need for iron supplementation goes away, but this depends on the child’s individual diet.

• Kids: Children who eat nutritionally inadequate diets may be at risk of iron deficiency, which can cause anemia and impair brain function and intellectual performance, and require dietary intervention and supplemental iron.

• Teens: Iron-deficiency anemia may affect adolescents. Teen girls who have begun menstruating may be at increased risk.

Does my child need fluoride?

Fluoride is the only nutrient that has been proven to reduce the incidence of dental cavities or caries. The Centers for Disease Control and Prevention, the American Dental Association, the American Academy of Pediatrics, and many other organizations, recommend that children use fluoridated toothpaste, even if they live in areas with fluoridated drinking water (as long as the water contains no more than 1.2 mg per liter).

Fluoride must be used in correct amounts as too much can be toxic or permanently discolor the teeth’s enamel. Do not give your child fluoride supplements if he or she drinks fluoridated water. Your local water bureau can tell you how much fluoride is in your drinking water. Water testing kits are also available.

• Babies: Children under six months of age do not need fluoride since they do not have their primary teeth.

• Kids: Children who live in areas where drinking water is not fluoridated may need to take sodium fluoride supplements to get adequate fluoride, even if they use fluoridated toothpaste. The amount to take is determined by the child’s weight, and the supplement should be prescribed by a doctor.

Does my child need a vitamin B12 supplement?

Vitamin B12 deficiency can cause serious, irreversible nerve damage and anemia. Reliable amounts of vitamin B12 can be obtained only from foods of animal origin (in other words, fish, meat, poultry, eggs, milk, and milk products). Tempeh, seaweed, and some other foods not of animal origin may contain some vitamin B12, but the amounts are not consistently high enough for these foods to be dependable sources. So, children eating a vegan diet (one that contains no animal products whatsoever) need to take a vitamin B12 supplement. Most children’s vitamins contain enough. The RDA by age group is:

• Toddlers: Ages 1 to 3, 0.9 mcg per day

• Kids: Ages 4 to 8, 1.2 mcg per day; ages 9 to 13, 1.8 mcg per day

• Teens: Ages 14 to 18, 2.4 mcg per day (same as adults)

Does my child need a vitamin D supplement?

Children older than six months need 400 IU of vitamin D per day. Since vitamin D is produced in the skin after exposure to sunlight, supplementing is only needed if your child does not get enough exposure to sunlight, because of geographical location or lack of outdoor activity. Vitamin D deficiency can impair calcium absorption and affect bone formation. Cow’s milk is fortified with vitamin D, and most children’s vitamins provide sufficient vitamin D.

Does my child need more calcium?

Children, adolescents, and young adults (ages 11 to 25) need to get at total of 1,200 mg daily calcium. Growing children or adolescents need it to reach peak bone mass, which will decrease their later risk for developing osteoporosis. Many children’s vitamins include calcium, but it may not be enough for adolescents, especially those with increased requirements (for example, female athletes who have begun their menstrual periods).

Are essential fatty acid supplements necessary?

Essential fatty acids (EFAs) are needed for proper development, particularly of the brain, nervous system, heart, and skin. A diet that includes nuts and fish should provide ample EFAs. Some children whose diets are low in these foods may benefit from a high-quality fish oil supplement.

Fish oil supplements should be free from contaminants, such as pesticide residues and heavy metals, particularly mercury, which pollute oceans and are consumed by fish. These are sometimes removed during manufacturing. Companies with high purity standards will often advertise it.

Are there other important supplements?

Some children who have poor or restricted diets, liver disease, or other chronic medical problems (especially those that lead to fat malabsorption, such as cystic fibrosis) may need specific vitamin and mineral supplementation to prevent nutrient deficiencies. Only a qualified healthcare provider should prescribe nutrient use in conjunction with drug treatment or as a treatment for a medical condition.

Jeremy Appleton, ND, CNS, is a licensed naturopathic physician, certified nutrition specialist, and published author. Dr. Appleton was the Nutrition Department Chair at the National College of Naturopathic Medicine, has served on the faculty at Bastyr University of Natural Health Sciences, and is a former Healthnotes Senior Science Editor and a founding contributor to Healthnotes Newswire. He has worked extensively in scientific and regulatory affairs in the supplement industry and is now a consultant through his company Praxis Natural Products Consulting and Wellness Services.

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