Should Babies and Kids Take a Multivitamin?
I am not a pill pusher. I don't believe in taking multivitamins as an "insurance policy," and I'm concerned about the lax regulatory oversight to which dietary supplements are subject. In my adult clinical practice, I recommend supplements only to bridge specific dietary gaps or for specific therapeutic indications -- and even then, I vet the brands I recommend to ensure they are high quality. When it comes to babies and kids, my knee-jerk reaction is to advocate strongly for meeting vitamin and mineral needs solely from food.
But becoming a parent is where theory collides with reality, and my "food first" philosophy has been challenged on more than one occasion since my twins were born three years ago. So when considering how best to approach supplementation in my own children, I did extensive research to determine: When do the benefits outweigh the risks
Multivitamin/mineral supplements are the most commonly used dietary supplement among children in the U.S., with survey data suggesting that almost half (47 percent) of 3-year-olds take multivitamins at least occasionally. Considering how widespread the use of multis is among children, however, I was surprised to discover how little actual research exists to evaluate their clinical benefit and possible adverse effects. Interpreting the results of the research that is available is complicated by the fact that multivitamin formulations vary dramatically among brands. Some multis contain just a few antioxidant vitamins (A,C,E), and some only contain B vitamins and C, with no A or E. Others contain a laundry list of vitamins and minerals, at doses that vary by brand. Some products contain iron; some don't. As all such products are lumped together as "multivitamins" in research studies, it's challenging to assess whether certain combinations of supplemental nutrients might be safer or more beneficial than others.
[Read: 8 Foods Loaded With Vitamin C .]
In the absence of thorough research on children and multivitamins, therefore, attempts to determine whether otherwise healthy kids should take multis will yield tentative conclusions, at best. With this caveat notwithstanding, I've come out against the use of multivitamins in infants across the board and in toddlers or preschoolers whose diets are not severely restricted. But I'm more comfortable with recommending multivitamins for older schoolchildren and adolescents with poor eating habits or generally restricted diets. Here's why:
One study of more than 8,000 infants found an association between early exposure to multivitamins (before 6 months) and both increased risk of asthma among black children as well as increased risk of food allergy among formula-fed children. In this cohort, there was also an increased risk of food allergy among all 3-year-olds who used multivitamins compared to their peers who did not, regardless of how they were fed as infants. Since formula is designed to be nutritionally complete for infants, and breastmilk meets all of an infant's needs for micronutrients (with the possible exceptions of vitamin D and iron -- see more about these supplements in my column next week), the limited available data suggest the risks of multivitamin use in early childhood -- particularly early infancy -- may outweigh the benefits.
With regard to toddlers and older children, a recent study that analyzed more than 7,000 kids found little role for multivitamin use among kids aged 2 to 8. Specifically, researchers found that the nutrients most lacking from young kids' diets -- calcium and vitamin D -- largely remained lacking despite multivitamin use. They attributed this to a mismatch between what young kids' typical dietary deficiencies and common multivitamin formulations. For example, many multis are heavy in B vitamins, vitamin C and zinc -- nutrients that most young children obtained adequate amounts of from diet alone. But they're light on vitamin D and calcium, which tend to be lacking from children's diets. (Interestingly, however, since these data were collected, many brands of children's multis have increased their vitamin D content.) While multis did bridge dietary gaps in some important nutrients among users, they also contributed to excessively high levels of other nutrients -- including metals like iron, zinc, copper and selenium. It is difficult to weigh the relative risks of inadequate intake of certain nutrients compared to excessive intake of others in this youngest population. But in light of the potential risks of overload -- coupled with the concerning association regarding multivitamin use and food allergies among toddlers in particular -- I remain unconvinced that the benefits of multivitamins outweigh the risks in otherwise healthy young children.
[Read: 9 Foods Packed With Potassium .]
This same study, however, suggests that multivitamins may offer a more compelling benefit among older children, as they appear more likely to provide micronutrients for which dietary intake is inadequate. Specifically, kids ages 9 to 18 were more likely than their younger counterparts to have insufficient intake of nutrients like magnesium, copper, vitamin A, vitamin C and vitamin E. Furthermore, available research has not found similar evidence of increased food allergy risk in older children using supplements compared to those who do not use supplements.
According to my fellow dietitian Elizabeth Somer, author of "The Essential Guide to Vitamins and Minerals," the absence of health-promoting nutrients in the typical American child's diet is exacerbated by the fact that "the typical American child's diet is astronomically high in disease-promoting food components," such as sugar, saturated fat and sodium. She specifically notes that "most children get no omega-3 fats like DHA on any given day as the result of low intake of fatty fish, like salmon. Yet a growing body of evidence shows its importance for developing brains and vision ... possibly improving sleep habits in school-age children." So while she advocates giving a child a multi on days s/he isn't eating well as "an inexpensive way to fill the gaps," she also cautions that "there's a reason why they're called supplements and not substitutes. You cannot feed your kids McDonald's and a multivitamin and think all your bases are covered."
[Read: Pharmacist Recommended Vitamins and Supplements .]
Certain dietary supplements may be appropriate and beneficial for certain children under certain circumstances, but it's important to recognize that the concentrated doses of nutrients in pills are not buffered in the same way as are nutrients from food. Therefore, they can be more potent. More is not always better -- even for essential nutrients, and particularly for the youngest of children whose rapid development may be influenced in unexpected ways by the presence of unusually high levels of individual nutrients at key windows of time. And just because a supplement is marketed for children, that doesn't mean the long term risks and benefits for children have been thoroughly assessed. Rather than adopt an "insurance policy" mentality with regard to multivitamin use, I recommend discussing your child's individual risk profile and needs with his pediatrician in order to make a judicious decision about which, if any, supplements are appropriate for your child. In some cases of multiple food avoidances or extremely restricted eating, a multi may indeed make sense. In other cases, single nutrient supplements -- such as vitamin D, iron and/or an omega-3 supplement -- may be more beneficial for a child. Stay tuned for my column next week, where I'll review the case for these individual supplements.
[Read: 7 Reasons to Choose a Plant-Based Diet .]
Tracey Kurland, a dietetic intern and master's degree candidate at Columbia University Teacher's College in New York City, contributed to this article.
Tamara Duker Freuman, MS, RD, CDN, is a registered dietitian whose NYC-based clinical practice specializes in digestive disorders, celiac Disease, and food intolerances. Her personal blog, www.tamaraduker.com, focuses on healthy eating and gluten-free living.
