Ask a dozen parents whether it's a good idea to give children daily multivitamins, minerals or other supplements, and you'll get a dozen different answers.
Five of 12 local parents we surveyed say they routinely give their healthy children supplements to make sure they're hitting all of the nutritional bases or because their pediatricians suggest it.
"My two older kids (almost 6 and almost 4) each eat half of a Flintstones Complete tablet daily," says Helene Hills, a Lynnwood mother of three. "I grew up on Flintstones myself, though I am far from being a supplement pusher. I figured that half a tablet would be enough to give the kids' sometimes questionable diets a boost." Other parents in this group also administer probiotics, fish oil, Vitamin D, Vitamin C or calcium.
Another five give their children multivitamins or other supplements sporadically, especially during the winter months when it's cold and flu season, when their children may not eat as many fruits and vegetables, or when the sun does not provide much Vitamin D.
Leigh Larsen, an Everett mother of three boys, typifies the ambivalent attitude. "I usually buy one bottle of multivitamins for the winter months," she says. "When they are getting sick, I do give them Vitamin C in either a chewable or warm drink form. Our diet is balanced (not perfect) with variety, so I feel that a multivitamin is a waste of money and would be useless for the most part. Also, so many items are fortified nowadays that I wonder if they are getting too much of a mineral or vitamin."
Two of the parents don't believe in added vitamins or minerals. "We've never put our kids on any kind of supplements, preferring, rather, to give them a lot of healthy choices for snacks or meals," says Andrea Peterson, a Snohomish mother of two "fairly adventurous" eaters. "I think it really depends on the individual child's eating habits, tastes and temperament. I certainly think that vitamins/supplements are appropriate if a parent or their doctor is concerned that a child has a nutritional deficiency."
About 30 percent of American children take dietary supplements regularly, according to the National Institutes of Health, but doctors are divided over whether they're necessary. We asked Seattle Polyclinic pediatrician Dr. Jenny Lobo and Lynnwood naturopath Dr. David Wood about whether multivitamins and other supplements are helpful (sometimes), useless (often) or harmful (not usually). Both emphasize nutrition in their practices.
Dr. Lobo doesn't routinely recommend multivitamins and does not give them to her 21-month-old daughter. "If they're good eaters – eating at least some meats, fruits, vegetables and dairy products – multivitamins are unnecessary. When I ask questions about diet, parents are often surprised at how much nutrition their children are actually getting, even if they only eat three or four different fruits and vegetables."
Evidence shows that multivitamins do not help with preventing disease or reducing infection, she says. There is no point in giving them seasonally.
If parents do want to give their children multivitamins, she recommends ones that are chewable, taste good and include iron. "It's hard to harm yourself with over-the-counter vitamins, but do limit access by keeping them safe and put away when not in use." Parents concerned about fillers, sugar, preservatives or food dyes can look for pills without those ingredients.
Dr. Wood agrees that getting vitamins through diet is the best way, but says that most of his child patients get multivitamin/mineral supplements to make up for any nutrient deficiencies. Some children have allergies that cause them to miss certain food groups. "Most Americans simply do not eat a well-rounded, balanced diet. If parents aren't perfect with their food intake, can we really assume their children will be?"
The quality of the multivitamins is important, he adds. "Many patients react to artificial dyes and fillers. Also, the cheapest products often contain synthetic vitamins which may have little or no biological activity."
This vitamin, usually in the form of D3, is the current darling of the medical world, especially in cloudier climates where less is produced by sunlight striking the skin. It's involved in bone and cell growth and health, neuromuscular and immune function and reduction of inflammation.
"Virtually everyone who is unsupplemented in the Northwest is deficient. Period!" emphasizes Dr. Wood. "We prescribe Vitamin D3 to all patients all year long and adjust dosage according to follow-up lab studies." The levels may be lowered in the summer when children can get 10 to 15 minutes of unprotected exposure of the skin to the sun before applying sunscreen.
Dr. Lobo agrees that many people in the Northwest may have some Vitamin D deficiencies, especially if they have darker skin that does not absorb as much sunlight. However, she says the threshold for Vitamin D deficiency is lower for children than it is for adults, and research is still ongoing on the effectiveness of supplementation.
The only proven result of inadequate Vitamin D in children is rickets, a disease characterized by a failure of bone tissue to properly mineralize, resulting in soft bones and skeletal deformities. The American Academy of Pediatrics recommends Vitamin D drops for breast-fed infants, advice Dr. Lobo followed with her daughter. Infant formula and cow's milk are usually fortified with Vitamin D.
Safe upper intake levels of Vitamin D for children range from 1,000 IU (international units) for babies to 4,000 IU for age 9 and older, according to the National Institutes for Health.
Vitamin C is best absorbed from fruits and vegetables, especially citrus fruits. It was historically used for treating scurvy, a disease causing malaise and lethargy, followed by formation of spots on the skin, spongy gums and bleeding from the mucous membranes. Some pediatricians still prescribe a multivitamin or Vitamin C to children who don't eat many fruits or vegetables to prevent the disease.
"The biggest misconception is that Vitamin C increases immunity; there are no tests to support that," Dr. Lobo says. Some research indicates that it might reduce the duration of the common cold, even though it doesn't help prevent it. "It's hard to overdose on Vitamin C," Dr. Lobo adds. "They just pee out the extra."
Children who are vegetarian or vegan may need supplements of Vitamin B12, found in fish, meat, poultry, eggs, milk, other dairy products and fortified grains, Dr. Lobo points out. A lack of this vitamin can cause anemia in the short-term and damage to nerve tissue after years of deficiency.
Do not take Vitamins A, D or E in more than the recommended doses because – unlike vitamins B and C – they are not rapidly cleared from the body. "It is important that parents not assume that if a little is good, a lot is better," Dr. Wood says.
Most children's multivitamins also contain common minerals, such as calcium, iron, magnesium or zinc. Other mineral supplements are generally not needed unless a child is a picky eater or has a diet limited by allergies, Dr. Wood says.
"I may put patients on a good soluble calcium supplement if they are dairy-intolerant," Dr. Wood says. "Parents can instead choose calcium-fortified foods such as rice milk, orange juice, almond milk or soy milk to equal the amount that a milk/cheese-based diet would provide." The guideline is two to three servings a day of dairy products a day for children and three to four servings by the teen years, Dr. Lobo says. This is especially important for bone formation in girls. Calcium carbonate is the easiest form to find and is safest on the stomach, she says.
She points out that infants receive enough iron in breast milk for the first four to six months of age. If they are not eating iron-fortified cereal by then, breastfed infants will need an iron supplement to prevent anemia.
Several of the parents we surveyed give their children fish oil supplements, containing essential omega-3 fatty acids (abbreviated as EPA and DHA), citing its benefits in brain health and development. Omegas-3s are found in breast milk, and are now added to infant formula.
Dr. Wood calls EPA/DHA "one of my favorite prescriptions" for brain and cardiovascular health and reduction of inflammation all over the body. He advises parents to buy oil from cold-processed fish that is checked for lipid peroxides (sign of rancidity) and heavy metals. On the other hand, Dr. Lobo doesn't routinely recommend omega-3s or fish oil because "it's hard to know, from current research, how much benefit it has for children."
Several parents also routinely give their children probiotics – "friendly" bacteria and yeast that help our digestive system function properly. They're most useful after antibiotic use or a diarrhea illness or for children with colitis, irritable bowel syndrome or gas and bloating, the doctors say.
Both advise parents to be thoughtful about what they give their children, and to rely on their health care provider to guide them. This is especially true of herbal supplements with vitamins or minerals in them, which are not regulated by the FDA and may contain lead or other dangerous chemicals.
"Supplements are called that because they supplement the diet," Dr. Wood concludes. "The diet is first and foremost in protecting health."
Wenda Reed is an award-winning health writer and frequent contributor to Seattle’s Child who endured cod liver oil as a child (thereby dating herself).