It's elemental: Increased parental concerns about picky eating, poor nutrition and optimal performance add up to increased sales of specialized children's multivitamin and mineral supplements—good news for manufacturers and retailers. But for consumers, shopping for children's supplements can present special challenges, such as finding a product their children will agree to swallow every day.

A Burgeoning Category
A, Bs, C and other nutrients are essential for growing children. Even though some pediatricians and other experts doubt their effectiveness, children's supplements are one of the fastest-growing segments of the supplements category.

"Sales of vitamins and minerals targeted to children grew 21.5 percent in natural products supermarkets for the 12 months ending May 2001 versus the prior year, outpacing the total vitamins and minerals category growth of 7.3 percent," reports Paddy Spence, CEO of SPINS, a San Francisco-based market research firm. "With sales of more than $12 million in natural products supermarkets, these products made up 5.3 percent of total category sales. In mainstream food, drug and mass outlets, the children's natural vitamins and minerals category only comprised 0.6 percent of the overall vitamins and minerals category sales."

Although consumers shop both channels, the category "reflects a crossover from mainstream shoppers," Spence says. "Parents are very willing to spend on children's health. Needing convenience and lacking education on specific elements, consumers look for targeted solutions. Crossover consumers gravitate to focused formulas like children's. Natural products retailers can give more information and education, which is critical."

Supplements use by children has future business implications for retailers and manufacturers. "It starts a pattern of incorporating supplements into lifetime patterns," says Linda Kahler, CEO of Rainbow Light Nutritional Systems, Santa Cruz, Calif. "Most consumers start taking supplements in their 30s. This is an opportunity to capture them at a young age. Do a good job, and they're captured throughout a lifetime."

Special Challenges
Finding the right supplement for a child can be difficult. Many children are unable or unwilling to swallow tablets or capsules, particularly larger ones. Even small sizes designed to be taken two or three times daily can still be tough for some kids to swallow—and for the parents who must coax them. As for chewables, it's difficult to develop palatable children's products, particularly because vitamin C is highly acidic and several other nutrients are bitter or chalky.

"It's easier for kids to take the candy-type products [that are] prominent in the mass market, [but many of these] are awful products with artificial flavors, colors and substances," Kahler says. "Natural products merchandisers are vulnerable if [they're] offering products too much like mass market. It's important to offer high-quality, healthy alternatives that deliver real health benefits. We're formulating food-based products with herbs and enzymes," she says.

But products must taste good. "You're selling to parents who know what kids want," says Carsten Smidt, Ph.D., director of pharmacology and clinical affairs at Provo, Utah-based Pharmanex, manufacturers of Jungamals and LifePak Teen. "Taste fatigue is an important issue, so we package different flavors together and provide nonchewables."

Pharmanex is focusing on mental performance, hyperactivity and obesity, and may have new children's products for these conditions soon.

Another concern is appropriate dose levels for children. "Many companies use herbs and DHA tested only in adults with results extrapolated for children, but there's no scientific support for safety and efficacy," Smidt says.

Even supplements and herbs proponents question how much good stuff is too much.

"It's frustrating to see formulas adding herbs and other ingredients because children can react to them," says Tara Levy, N.D., a family practitioner at Mount Diablo Natural Health Center in Concord, Calif., and designated spokeswoman for the California Association of Naturopathic Physicians. "I like to be very specific prescribing herbs. Some shouldn't be taken daily, and some with nutrient qualities, including oatstraw and nettles, also have medicinal effects that are best to keep separate. Adding them waters down something else. It's already hard to fit in high enough levels [of vitamins and minerals]."

Levy prescribes supplements for kids with attention deficit disorder, hyperactivity, allergies, specific deficiencies, some chronic illnesses, those with a sugar-rich diet, teens and 2- to 4-year-olds.

"There's a fine line between compliance and really wanting them," Levy says. "Tell them it's medicine, not candy, and don't give it as a reward or let them eat more. Child-safe isn't all that safe, and [products] with iron are potentially toxic."

From 1986 to 1997, the American Association of Poison Control Centers received 110,000 reports of children overdosing on iron supplements; the FDA attributed 17 percent of children's deaths to iron poisoning, often from taking someone else's pills, says American Dietetic Association spokeswoman Sheah Rarback, M.S., R.D., a faculty member at the University of Miami School of Medicine in Florida.

"There's less risk of overdose and more appropriate amounts of nutrients in children's formulas," she says.

Teens can take teen or adult products, she says, since their formulas are comparable. Many adults take children's formulas because of fond memories, difficulty swallowing pills or because they like the taste.

Supplements For All Children?
"We recommend multivitamin and mineral supplements for children with inadequate diets, chronic illness, allergies, poor growth, food intolerance, digestive problems and who are picky eaters," Rarback says. "They're extra insurance for parental concerns, but they're supplements, not replacements. Parents shouldn't be lulled into false security."

For that reason, some practitioners and organizations, including the American Academy of Pediatrics, discourage daily supplements. They concede, however, that those containing the Required Daily Allowance probably are not harmful.

Supplements vary widely, particularly in mineral content, which is bulky, says Johanna Dwyer, D.Sc., R.D., director of the Frances Stern Nutrition Center at Tufts New England Medical Center in Boston. "We used to say there was no difference between food versus synthetic sources, but we're learning. Natural vitamin E is better, calciums vary widely and folic acid is much more available as a supplement or additive than as a food."

The bigger shift is from RDAs to Dietary Reference Intakes. "Some [recommended amounts of] nutrients have changed significantly for kids at different ages, including iron, folic acid and calcium," she says.

RDAs are intended to prevent deficiencies, but DRIs identify quantities beneficial to health, explains Sandra Schlicker, Ph.D., senior program director, Food and Nutrition Board of the Institute of Medicine, National Academy of Sciences in Washington, D.C. "We don't have a position on supplements. Our job is coming up with the numbers" for optimal vitamin, mineral, antioxidant and micronutrient intakes (for reports, see the bookstore at www.nas.edu).

Doctors should diagnose and prescribe for specific deficiencies such as vitamin D for rickets, says Fima Lifshitz, M.D., director of nutrition sciences and pediatrics professor at Miami Children's Hospital in Florida, but supplements are appropriate for children with poor diets. Any woman of childbearing age should take supplemental folic acid to prevent birth defects, since most diets are deficient in that vitamin.

Children with kidney or liver dysfunction shouldn't take supplements without a physician's orders, but nearly all others will benefit, says Mark Stengler, N.D., author of the forthcoming Your Vital Child (Rodale Press). Lesser amounts based on children's lower weights and higher potencies for teens "can help prevent many health problems and optimize a child's growth, development and vitality... and can also make a difference in mental function," Stengler says.

Despite questions about added ingredients and megadoses, supplements have their place, even if their use is irregular, says Paul Lachance, Ph.D., CNS, food science and nutrition professor at Rutgers University and executive director of the Nutraceuticals Institute, New Brunswick, N.J. "Every child has bad days and weeks eating—when the dog gets the vegetables," he says.

"In reality, children have some bizarre eating habits," agrees John Milner, Ph.D., chief of nutrition science at the National Institutes of Health, Rockville, Md. "I suspect we've moved beyond supplements for deficiency prevention to a whole new arena of herbs and functional food components to change and enhance cognitive and physical performance. The dearth of information is unfortunate, because there's lots of opportunity and some benefit."

Wendy Lee Bonifazi, R.N., CLS, APR, of Fort Collins, Colo., has earned 15 national journalism awards, including a National Press Club Honor, for her coverage of health and health care.

Natural Foods Merchandiser volume XXIII/number 3/p. 92, 94