"It's the bright and colorful section," the clerk at the supplement store said when I asked where I could find the children's area.
Colorful, indeed. Rows of multivitamins, fish oils, immune support capsules, calcium tablets and pills to calm children and help them sleep were displayed on the shelf in a rainbow of colors and a variety of shapes from "yummi bears" and dinosaurs to dolphins and kangaroos.
Scanning the shelves, you might wonder how many of these supplements your child should be taking. In most cases, the answer is not many – if any at all. The American Academy of Pediatrics does not recommend a daily multivitamin for most children.
"Food has what they need," says Claire Kjeld, wellness dietician with the Muliticare Center for Healthy Living in Tacoma. Exceptions are low-income kids, who often don't have access to a good variety of healthy foods, and picky eaters who may be missing whole food groups, as well as those with chronic illnesses such as cystic fibrosis and kidney diseases.
"If kids are picky eaters, they absolutely should have a multivitamin," says Lynnwood naturopath David Wood. "Even if they're not, there are a lot of trace minerals that are hard to get in the diet. Multivitamins are a little insurance policy to fill in the gaps."
The consensus among researchers for the past 50 years is that multivitamins made for children are harmless. Here are some guidelines from Kjeld, Wood and the Mayo Clinic:
• Always dispense the multivitamin to the child, and remind him that they are not candy.
• Never give children adult vitamins – even if cut in half – because children's nutritional needs are not the same as adults', especially for Vitamin D, copper and iron. • Potent prenatal vitamins, with their high iron content, are particularly bad for children.
• Watch out for binders, including talc, in multivitamin tablets. Liquid vitamins for infants, followed by chewables and then small capsules for older children, are more easily absorbed.
• Read labels to see if vitamins have added dyes and sugars.
• Wood adds that it's best to pay more for biological, rather than synthetic vitamins, especially for the B-vitamins. About 90 percent of synthetic, petroleum-based B-vitamins are filtered out by the kidneys before the liver has a chance to convert them to usable form – making expensive urine.
Even if children do not need a multivitamin, they may need added calcium and Vitamin D. The American Academy of Pediatrics recommends calcium levels ranging from 500 mg. a day for 1- to 3-year-olds (two 8-ounce glasses of milk or dairy equivalents) to 1,300 mg. a day for kids ages 9 to 18 (about four 8-oz. glasses of milk). Children who do not get that from their diet should take a supplement.
In October 2008, the American Academy of Pediatrics issued a new recommendation, increasing the Vitamin D requirement from 200 to 400 international units a day. Breastfed infants and children who drink less than 32 ounces of Vitamin-D fortified milk a day are now advised to take a supplement. Calcium and Vitamin D are often packaged together for maximum absorbency.
Most children's vitamins contain 400 iu of Vitamin D. They don't need any more than that, so if your child takes a multivitamin, he won't need a vitamin D supplement as well. However, children who eat a varied and healthy enough diet to not to need multivitamins may need a vitamin D supplement if they don't drink much milk or eat many dairy products.
Children who eat no meat or fortified cereals may need an iron supplement, Kjeld says. And those who do not live in areas where water is fluoridated may benefit from a fluoride supplement.
For all vitamins and minerals, more is not better, and experts advise against giving children mega-vitamins. "Anything that's marketed to adults shouldn't be given to kids," Kjeld says.
The biggest problem is with the fat-soluble vitamins – A, D, E and K. Small quantities are needed for good health, but the body stores the extra amounts in the liver and they can build up toxicity. Vitamin A is often prescribed to boost the immune system, but too much can cause bone loss and liver problems, while too much Vitamin D is toxic to the kidneys.
In general, Kjeld says she doesn't think children should be given any supplements, beyond multivitamins, calcium, Vitamin D and occasionally iron. "Very few studies testing the safety and efficacy of herbal supplements for children have been done," she says. "There's no regulation of supplement makers – you don't know that what they say is in the product is actually in there."
Cora Breuner, a pediatrician at Seattle Children's Hospital, says she does not generally recommend supplements to children younger than 13 because of the lack of studies. She incorporates naturopathic remedies into her medical practice. She most commonly uses peppermint for irritable bowel, melatonin for sleep disturbances, chamomile for colic and fenugreek to promote lactation in nursing mothers.
A recent survey of 9,400 children conducted by the Centers for Disease Control and Prevention's National Center for Health Statistics found that echinacea, fish oil/omega 3 or DHA fatty acids, combination herb pills and flaxseed oil and pills are the most common dietary supplements children take.
Echinacea is derived from coneflowers, and some studies have shown that it lowers the risk of catching a cold and shortens the length of a cold. Other studies have shown no significant effect. Wood may prescribe elderberry, echinacea, zinc, beta-carotene and Vitamin C to boost the immune system and fight infections, giving patients a prescription for antibiotics if the supplements do not work. Kjeld notes that there are lots of different plants in the coneflower family, and that there is no guarantee that the ones in a supplement will be the most effective species. Do not give your child echinacea if he is allergic to ragweed, because they are in the same plant family.
Fatty acids, especially omega 3's, have been proven to help with brain development. Nutritionists prefer that children get them through food (see our March story, What's Good about Fat? in RELATED STORIES), but supplements are generally thought to be safe. Wood warns parents to get a balanced formula of omega 3 and omega 6 fatty acids. Too much omega 6 (found in plant oils and in evening primrose oil supplements) can cause inflammation in the body and throw off kids' neurochemistry, he explains.
Flaxseed, used as a health food for thousands of years, is a current darling among nutritionists for its omega 3 fatty acids, lignans (powerful antioxidants) and fiber. Flaxseed's touted health benefits range from lowering cholesterol and stabilizing blood sugar to reducing inflammation and cancer risk. There have not been studies on flaxseed safety for children, but too much flaxseed, as with any fiber source, has been shown to cause bloating, gas, abdominal pain, diarrhea or constipation in adults.
Wood says it is safest to use these and other supplements under the direction of a health care professional, rather than taking them off the shelf, to insure that children are getting the proper balance for their body sizes and individual health needs.
Who's Taking Vitamins?
Thirty-four percent of American children ages 2 to 17 take multivitamins, according to a recent survey conducted by the Centers for Disease Control and Prevention. The results of the study were analyzed by Dr. Ulfat Shaikh and her colleagues at the University of California Davis School of Medicine and the University of Rochester School of Medicine and Dentistry in the February 2009 issue of The Archives of Pediatrics & Adolescent Medicine.
Researchers noted that healthy, high-income children with balanced diets who are physically active and have ready access to an array of nutritious foods – in other words those who need vitamins the least – were the most likely to take the supplements. By contrast, low-income children with poor diets, who need the multivitamins the most, are the least likely to take them.
Complimentary and Alternative Medicine
The use of dietary supplements is part of the larger field known as Complementary and Alternative Medicine, or CAM – treatments used in addition to or instead of traditional Western medical practices. It includes acupuncture, naturopathy, chiropractic, yoga, traditional Chinese medicine and hypnosis.
In a review of CAM therapies published in the December 2008 issue of Pediatrics, the American Academy of Pediatrics took a balanced view. It noted that CAM therapies are more often used for children with special health needs, such as asthma, attention deficit disorder, autism, cancer, cerebral palsy, cystic fibrosis, inflammatory bowel disease and juvenile rheumatoid arthritis.
"Presently, there is little research on the effectiveness of CAM therapies for many of these conditions," the writers conclude. They also acknowledge that negative studies on supplements and other alternative therapies are usually published in well-known journals, while positive studies are published in lesser-known foreign journals.
Most kids treated with CAM therapies also get conventional care, although two-thirds of parents do not inform their child's medical doctor about alternative treatments and supplements. Pediatricians should have "an open, respectful relationship and clear communication with families," the American Academy of Pediatrics report concludes.