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Should My Child Take a Multivitamin?
By Jillian Foglesong Stabile, MD
April 06, 2023
Every parent wants their child to be healthy and happy. We are all looking for ways to ensure that our children are healthy. When you walk down the vitamin aisle at your local pharmacy, you’ll see many choices for children’s multivitamins and supplements. There are prebiotics, probiotics, calcium supplements, vitamin D supplements, sleep supplements, DHEA supplements, and many kinds of multivitamins.
It can all feel so overwhelming for a parent just trying to do what’s best for their child. So how do you know if your child needs a multivitamin, and which one should you choose?
Does my child really need a multivitamin?
The short answer to this question is no. Most healthy children do not need a multivitamin and can get the nutrients they need through their diet. Many of the common foods that children eat are fortified with vitamins and minerals such as calcium, vitamin D, vitamin B, iron, and vitamin A. There are some special exceptions to this general rule, and we’ll discuss these below, but first, let’s talk about some of the essential vitamins and where they are found.
Dietary sources of common vitamins
Most of the vitamins and minerals your growing child needs can be found in common foods. A well-rounded diet is key to getting these nutrients.
Vitamin A
Vitamin A is one of the four common fat-soluble vitamins (the others are D, E, and K). This vitamin helps support healthy eyesight and tissue repair. You can find it in many fruits and vegetables such as sweet potatoes, winter squash, greens, and tropical fruits. You can also find this nutrient in many dairy sources like cheese and animal sources like fish and liver.
Vitamin B
There are multiple B vitamins. These are water-soluble vitamins that help with blood cell development and metabolism. They are frequently found in animal protein sources such as meat, eggs, poultry, and dairy. They’re also found in enriched grains and cereals. Children on a diet restricted of animal proteins, such as vegetarians and vegans, need to pay special attention to these vitamins to ensure that they are getting enough.
Vitamin C
A lot of us reach for vitamin C when we feel a cold coming on. Vitamin C is known to support a healthy immune system. It also helps with skin and bone development. You can find vitamin C in several fruits and vegetables, like citrus fruits and spinach.
Vitamin D
Vitamin D is the second of the fat-soluble vitamins. The body uses vitamin D for bone development as well as teeth development. The body naturally makes vitamin D from sunlight, so people who live in low-sun areas can be deficient in this vitamin. Vitamin D is found in many fortified dairy products.
Babies who are exclusively breastfed should be supplemented with 400IU of vitamin D daily. Babies fed with a commercially available formula or who are over one and taking cow’s milk do not require supplementation because commercially available formulas and cows milk are fortified with vitamin D.
Vitamin E
Vitamin E is another of the fat-soluble vitamins. Vitamin E, like vitamin C, acts as an antioxidant to protect your cells. It also helps with immune system function and keeps your blood running smoothly. It is found in some nuts, greens, pumpkins, bell peppers, and avocados.
Iron
Iron is a mineral that helps with red blood cell production. Lack of iron can lead to iron deficiency anemia. Children typically get enough iron through their diet, but some things can affect iron absorption. Lead exposure can lead to iron deficiency. Your child’s doctor may recommend simple screening tests to look for iron deficiency and lead exposure. Iron-rich foods can be found in fortified cereals, beans, tofu, red meats, seafood, poultry, and eggs. You can enhance your child’s iron absorption by including foods that are high in vitamin C.
Calcium
Calcium is a mineral that is used to build strong bones and teeth. Deficiency in this mineral can lead to a condition called rickets. Rickets is extremely uncommon in developed nations. Calcium is found in dairy products, dark green leafy vegetables, broccoli, and calcium fortified products such as cereal and orange juice.
Special circumstances for vitamins in children
While most children do not need vitamin supplementation, some special exceptions exist. Children with medical conditions that affect absorption may require additional supplementation. The best way to know if your child is in this situation is to talk to your child’s healthcare provider. Other conditions that may require vitamin supplementation are discussed below.
Prematurity
Premature infants go through a lot in their very young lives. They require higher nutritional support because of their low body stores at birth. Most of their needs can be met by fortifying breast milk or using a preterm infant formula. They typically need to be supplemented with vitamin D in addition to the fortification. On discharge from the NICU, premature infants are usually sent home with a multivitamin with iron a vitamin D (for breastfed infants). Premature infants are frequently sent home with instructions for fortifying breastmilk or using a preterm formula for the extra calcium and phosphorus.
Cystic fibrosis
Cystic fibrosis is a rare genetic condition that causes thickening of the mucus in the body, including the lungs and pancreas. These patients are prone to infections, especially lung infections. In addition, they frequently have problems absorbing certain nutrients. These patients especially have difficulty absorbing fat soluble vitamins. They also need water soluble vitamins. These patients frequently have to take multivitamins that are specifically designed for patients with cystic fibrosis, and they typically require supplementation of pancreatic enzymes as well.
Food allergies
Kids with dietary restrictions due to food allergies may require vitamin supplementation. The vitamins needed really depend on the types of foods that the child is allergic to. This is best discussed with your child’s healthcare team.
Vegetarian and vegan diets
Vegetarian and vegan diets are more common. With careful planning, children with vegetarian and vegan diets can have very healthy and normal growth and development. Some studies have shown that vegan children are less likely to be obese than children with a traditional diet. The challenge with vegetarian and vegan diets is that they require careful planning and evaluation in order to determine what supplementation is needed.
Poorly planned vegan diets can lead to deficiencies in calcium, vitamin D, iron, and omega 3 fatty acids. They can also be deficient in some of the smaller nutrients such as cobalamin, iodine and selenium. Studies are ongoing with regard to vegan diets in particular, but most of the current literature shows that a well-planned diet with supplementation provides sufficient nutrients for healthy growth and development in children.
Failure to thrive
Failure to thrive is a term used to describe children who are not growing as well as expected. These children have either fallen off their curve on the growth charts or are less than the third percentile for height, weight, or BMI. Most of the time, failure to thrive is the result of inadequate calorie intake, generally from behavioral or social issues.
In some children, the failure to thrive is the result of inadequate absorption of nutrients from a chronic medical condition or from excessive use of calories from a medical condition. Children with failure to thrive need extra calories to try to catch up their growth. They may be fortified with formula or other nutritional supplements, depending on their age. These children may also require supplementation with vitamins or other micronutrients. If your child has been diagnosed with failure to thrive, discuss their nutritional needs with their healthcare team.
The majority of children do not need any additional vitamin or mineral supplementation. As we discussed above, there are specific circumstances where children may need additional nutritional support.
The best course of action in determining whether your child needs to be supplemented is to talk with your child’s healthcare provider. Will it harm your child to take a multivitamin if they don’t need to? Most of the time, not if you’re taking the vitamins in recommended doses. Overdosing on vitamins can be dangerous and can interfere with the absorption of other nutrients.
The best way to provide your child with the vitamins and minerals vital to proper growth and development is to provide and encourage a well-rounded diet with different colorful fruits and vegetables and healthy protein sources. And discuss with your child’s healthcare provider whether other supplementation is necessary based on your child's unique health conditions and needs.
Once you've talked to your child's healthcare provider about their vitamin needs, visit us at www.wellrx.com to save up to 80% on medications.
Dr. Foglesong Stabile is a board-certified Family Physician who enjoys full scope Family Medicine, including obstetrics, women’s health, and endoscopy, as well as caring for children and adults of all ages. She also teaches the family medicine clerkship for Pacific Northwest University of Health Sciences.
References:
https://www.hsph.harvard.edu/nutritionsource/vitamin-a/
https://www.hsph.harvard.edu/nutritionsource/vitamins/vitamin-b/
https://medlineplus.gov/vitaminc.html
https://www.cdc.gov/nutrition/infantandtoddlernutrition/vitamins-minerals/vitamin-d.html
https://www.cdc.gov/nutrition/infantandtoddlernutrition/vitamins-minerals/iron.html
https://www.cff.org/managing-cf/vitamins
https://pubmed.ncbi.nlm.nih.gov/34130207/
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