February 5, 2013
The American Academy of Pediatrics (AAP) provides limited recommendations regarding vitamin and mineral supplements in infancy, childhood and adolescence. A 2008 position statement of the AAP advocates that all infants, children and toddlers receive a vitamin D supplement of 400 international units per day to prevent rickets and possibly ward off cardiovascular and immune diseases in the future (Wagner and Greer, 2008). A 2010 statement recommends an iron supplement for preterm infants fed breastmilk until one year of age and exclusively breastfed, full-term babies from the age of four months until iron-rich solids are introduced (Baker and Greer, 2010). The statement also notes that iron supplements may be considered for toddlers who do not attain enough iron from their diet. These iron recommendations aim to minimize the potential effect of iron-deficiency anemia on intelligence and other developmental outcomes. Other than guidelines for vitamin D and iron, and agreement with the recommendation of the U.S. Public Health Service that all teens and women of child-bearing age take a folic-acid supplement to protect against neural tube defects in a developing fetus, the AAP leaves the decision of whether or not to begin supplements up to parents and the pediatrician on a case-by-case basis (American Academy of Pediatrics Committee on Genetics, 1999).
In response to less-than-ideal eating habits in kids—from the two-year-old who refuses nearly everything to the slightly more accepting school-aged child and the teenager who strictly adheres to a junk-food diet—parents have long-relied on multivitamins as a type of "insurance" from major nutritional deficiencies and shortcomings. Research suggests that these vitamins may not be the "magic pill" they have been purported to be.
In a study published in the July 2012 issue of the Journal of Pediatrics, researchers evaluated the nutritional status of 7,250 children, ages two to 18 years. The researchers found that:
- Nearly half of children from two to eight years of age took multivitamins. Both the children who took and those who did not take the supplements had lower-than-recommended intakes of calcium and vitamin D.
- Other than calcium and vitamin D, children aged two to eight typically had nutritionally adequate eating plans whether or not they took supplements. In fact, many of these children who took supplements consumed excessive amounts of many nutrients.
- Children older than eight years who took supplements were less likely to have inadequate intakes of magnesium, phosphorus and vitamins A, C and E compared to their peers who did not take supplements.
- Teens aged 14 to 18 were of particular concern due to high levels of nutritional inadequacy and low rate of supplement use. Still, half of teens who took supplements did not meet the recommended intakes of magnesium, a mineral important for hundreds of biochemical reactions in the body, including energy production, protein synthesis and muscle contraction.
- Supplement use increased risk of excessive intakes of iron, zinc, vitamin A and folic acid in all age groups and vitamin C, copper and selenium for children aged two to eight years.
Ultimately, the study authors concluded that multivitamins could be better formulated to meet—but not exceed—the nutritional needs of children and adolescents.
While many parents may rely on multivitamins for peace of mind when a picky eater refuses all foods with any nutritional value, this study reinforces that a pharmacologic formulation does not replace a nutritionally balanced diet. Some parents may still want to rely on a multivitamin to supplement their child’s diet while they continue to set the stage for a child to adopt a more balanced, nutrient-dense way of eating. (Check out My Teenagers Are Picky Eaters. What Can I Do to Incorporate Healthier Foods into Their Diets and the ACE Fit Fact Skip the Food Fights: 10 Ways to Get Kids to Eat Healthier for tips on getting started.) But they should not count on the vitamin to replace the nutrients from food.
Ultimately, many factors determine whether or not a multivitamin or other nutritional supplement will improve the health of any individual child. The decision whether or not a child should take a nutritional supplement is best made together with a child, parent and pediatrician.
American Academy of Pediatrics Committee on Genetics (1999). Folic acid for the prevention of neural tube defects. Pediatrics, 104,2, Pt 1, 325-327.
Bailey, R.L. et al. (2012). Do dietary supplements improve micronutrient sufficiency in children and adolescents? Journal of Pediatrics, 161, 5, 837-842.e3.
Baker, R.D. and Greer, F.R. (2010). Diagnosis and prevention of iron deficiency and iron deficiency anemia in infants and young children (0-3 years of age). Pediatrics, 126, 5, 1040-1050.
Wagner, C.L. and Greer, F.R. (2008). Prevention of rickets and vitamin D deficiency in infants, children and adolescents. Pediatrics, 122, 5, 1142-1152.
By Natalie Digate Muth
Natalie Digate Muth, MD, MPH, RD, FAAPNatalie Digate Muth, MD, MPH, RD, FAAP is the Healthcare Solutions Director for the American Council on Exercise, a board-certified pediatrician and Fellow of the American Academy of Pediatrics, a Diplomat of the American Board of Obesity Medicine, registered dietitian and board-certified specialist in sports dietetics, and ACE-certified health coach. She is the author of "Eat Your Vegetables" and Other Mistakes Parents Make: Redefining How to Raise Healthy Eaters" and the upcoming textbook "Sports Nutrition for Health Professionals". She has been ACE certified since 1998.