The Centers for Disease Control and Prevention (CDC) reports that 34% of American kids take at least one dietary supplement. Do they need them? Are they safe? Erin E. Alexander, D.O., a pediatric gastroenterologist and nutrition specialist at Mayo Clinic Children’s Center and mother of two, answers your most pressing questions on if — and when — your child might need to take dietary supplements. If you’d like to hear an in-depth conversation with Dr. Alexander and other Mayo Clinic experts on this topic, listen to this “Ask the Mayo Mom” podcast episode.
Mayo Clinic Press (MCP): Let’s start by saying the Food and Drug Administration (FDA) conducts very little regulatory oversight over dietary supplements, whether for adults or children. When you buy most vitamins and supplements for your child, you are buying products that are vouched for mainly by their manufacturers.
Dr. Alexander: It can feel like the Wild West. Certain products are marketed as pharmacist or pediatrician recommended, and it isn’t always clear how they get that stamp of approval. It’s tricky, so checking with your doctor before starting any supplementation is important, along with making sure the ingredients match with what you’re looking for in a supplement for your child.
MCP: Do babies need vitamins?
Dr. Alexander: Generally, no. However, breastfed infants do need vitamin D supplementation though because vitamin D is not well absorbed from milk. Infants who are primarily breastfed should receive 400 international units (IU) of vitamin D daily, which can be purchased without a prescription and is often administered as drops. Otherwise, infants who are not premature usually do not need multivitamins, as formula and breast milk are otherwise nutritionally complete. Always let your pediatrician know if you are giving vitamins to your baby.
MCP: Are vitamins safe for toddlers to take?
Dr. Alexander: Generally, when given at the appropriate doses, vitamins are safe for otherwise healthy toddlers. Still, any supplementation should be discussed with the child’s doctor.
A key element in safety is that too much of a vitamin can be dangerous and can lead to significant harm. Given that children’s multivitamins are branded to appeal to kids, there is a danger for every household that children might ingest too much of a supplement because it tastes like candy or because they’ve been told it’s “good for them.” Or, they might think similar looking adult supplements — especially candy resembling chewables and gummies — also are fun to explore. I can’t emphasize enough that people need to always keep all medicines and vitamins out of reach of children. Even though the caps say they are childproof, they often are not, as my own children have proven. It’s really important to tell your kids: “This is something only I give to you. You do not take it yourself. This is not candy. And while it tastes good, this is not a treat. It’s medicine.” And then you treat it as such.
MCP: During the fussy eating phase of the toddler years, is it appropriate to balance out any shortfall in nutrition by giving the child a multivitamin?
Dr. Alexander: As long as your child is getting most of the food groups most of the time and is growing well, you probably don’t need to give them any extra vitamins in supplement form. Ideally you want your child to get the vitamins from their diet. But in toddlers, picky eating is common, and deficiencies may sometimes occur. My own kids are 3 and 5 and are notoriously picky eaters, so I have them on an age-appropriate multivitamin with iron because that gives me some peace of mind.
MCP: Are vitamins and supplements essential if your child has a medical condition?
Dr. Alexander: There are some medical conditions that require vitamin supplementation such as liver disease and cystic fibrosis. Premature babies typically also require nutritional supplementation. In situations like these, the specifics would be recommended and prescribed by a physician.
MCP: Are there any supplements known to be harmful to kids that parents should avoid?
Dr. Alexander: Too much of any supplement, even a vitamin or mineral, can cause toxicity with harmful effects. It is important to pay attention to labels and ingredients. There is very little published data regarding safety and efficacy of supplements in children. Parents should always use caution when considering supplement use for children. This should always be discussed with the child’s pediatrician. Some products labeled as “natural” can have serious physical effects, such as hemlock.
If your child has taken a potentially toxic dose of a supplement, call Poison Help at 1-800-222-1222.
MCP: Is there a risk that a supplement could interact with a medication a child is taking?
Dr. Alexander: Supplements should be treated as medications. These supplements can interact with prescription medications, affecting the metabolism of the drug — either leading to a toxic buildup, or to the drug being processed too quickly and being ineffective. For example, St. John’s wort can cause several medications to be ineffective, such as oral contraceptives, the anti-clotting drug warfarin (Jantoven) and the heart rhythm drug digoxin (Lanoxin). Ginkgo can interact with medications such as common nonsteroidal anti-inflammatory drugs (NSAIDs) pain relievers, which can lead to dangerous bleeding. Considering the limited regulation of many supplements, there also is the possibility of contamination with dangerous chemicals.
MCP: If a child follows a vegetarian diet or is prone to having low iron levels — such as with teen girls who have heavy periods — should I automatically supplement the child’s diet with iron?
Dr. Alexander: Again, check with your doctor first, because too much iron can be harmful. But generally, supplementing the diet with an age-appropriate multivitamin that includes iron and vitamin C can be protective against low iron levels, which can sometimes drop low enough to result in anemia. Before going the supplement route, you also can look at providing a diet that includes iron-rich foods, such as red meats, seafood, poultry, eggs, iron-fortified cereals, tofu, beans and lentils, and dark green leafy plants. In addition, complement iron-rich foods with foods rich in vitamin C, as vitamin C helps the body absorb iron.
MCP: Should all kids take vitamin D or only those who live in places with dark winters and low levels of sunlight?
Dr. Alexander: If you’re getting vitamin D from other sources — such as cereals, orange juice, vegetables, eggs, red meat and oily fish — then you just want to make sure you’re getting enough international units (IU) in a day. The recommended daily dose varies by age, with children younger than 12 months needing 400 IU and children over 12 months needing 600 IU. If you’re not going to get that from fortified foods and sunlight, then vitamin D supplementation is a good idea. And again, talk with your doctor first as too much vitamin D can cause problems. You want to make sure you’re not overdoing it.
MCP: There’s been a lot of talk about the gut-brain connection in the last few years, leading parents to look at prebiotics and probiotics for their kids. Is there value to doing this?
Dr. Alexander: Some people are convinced prebiotics and probiotics are beneficial, but there’s not enough evidence to recommend it for everybody, especially kids. There’s definitely a brain-gut connection, but I think the most important thing is to eat fruit and vegetables and a well-balanced diet to promote healthy gut bacteria. This also promotes good health in general and is often much less expensive than probiotics. That diet could include some good gut-healthy foods such as live yogurt, kimchi, kefir, kombucha, miso and sauerkraut. With probiotic supplements, the amount of bacteria you’re getting in a capsule isn’t tightly regulated. While probiotics wouldn’t be dangerous for most people, they could certainly be harmful for children who have a weakened immune system — you don’t want to be giving these children extra bacteria.
MCP: On the topic of immunity, what are the best vitamins to supplement kids’ immune systems?
Dr. Alexander: Usually children do not need a vitamin to augment or improve their immune systems. There has been a lot of marketing around several types of vitamins, but no strong scientific evidence to recommend supplementing with any specific vitamin for this purpose. Most of these vitamins marketed for immune support are not necessarily unsafe. However, it’s best to discuss this with a child’s pediatrician.
MCP: When it comes to academic performance, there are trendy adaptogenic and nootropic gummies being marketed on claims of boosting memory, focus and performance. Many of these products feature herbs and mushrooms borrowed from Chinese medicine and Indian ayurveda. Do you see any benefits to kids taking these supplements?
Dr. Alexander: You have to be careful of anything that’s marketed as boosting focus and brain performance, especially in young developing brains. There just isn’t enough scientific data. I would not jump onto that bandwagon. Not enough is known about adaptogens or nootropics yet, and its potentially dangerous to say: “Hey, let’s give our kids these things and see what happens.” That would make me very nervous as a pediatrician and as a parent. I think anything that’s marketed as life changing, brain boosting, or make-you-rich-and-famous is just too good to be true.
MCP: What is the best way for parents to buy vitamins and supplements, if they choose to do so?
Dr. Alexander: Look at the ingredients, as it’s all about how much of each vitamin is in there. You’ll want to get age-appropriate levels of vitamins and minerals. That’s the most important thing.
MCP: Every parent has bought a multivitamin that their child hated the taste of. Is there a way around this?
Dr. Alexander: You don’t want to spend a lot of money on a vitamin that tastes bad and kids refuse to take them, but it happens. I think it’s a little bit of trial and error, which is obviously not a cheap way to figure it out as you buy one at a time until you find one that works well. But as I’m finding out with my own kids, just as soon as everybody gets used to one thing, then they say, “I’m not going to take this anymore.” There’s no right or wrong way; it’s just what works for your kids.
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