Do kids really need a multivitamin?

Posted by Lylah M. Alphonse  April 14, 2010 12:58 PM

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When I was a kid, my parents doled out a garishly colored chewable multivitamin to my brothers and me each morning. They tasted like fruity chalk and we all fought over who got the purple or orange ones, which were infinitely more palatable than the dusty-looking pink tablets.

Now, I'm the parent, and I dole out a garishly colored chewable multivitamin to my kids each morning. They, too, taste like fruity chalk and my kids fight over the purple ones. I could give them gummy bear-shaped ones instead, but those look too much like candy to me -- I have visions of my kids sneaking off to down an entire bottle, thinking they're treats.

I was thinking about this the other morning, white plastic vitamin bottle in hand, and I wondered: Do kids really need a multivitamin at all?

While the American Academy of Pediatrics does not officially recommend a daily multivitamin for children, they do recommend at 400 IU of vitamin D a day for children who don't drink milk and also 5 to 10 mg of iron for babies who are not breast-fed. And, as Dr. Sanja Gupta points out at CNN.com, "Although a daily multivitamin might not be offering your child a tremendous amount of benefit, it certainly is not hurting them." (Corrected to add that the AAP reccommendation about iron is for babies who are not breast-fed. -- LMA)

"I'd say there's some places where multivitamins are very appropriate for children," Dr. Tieraona Low Dog, a physician and former midwife who is a faculty member at the University of Arizona, told me during a recent teleconference on dietary supplements. "It depends on the child itself, the risks they have, their own diet. Breast-fed kids may need to take supplemental iron."

Ideally, children will get the nutrients they need from their diet. But every child -- and every family's situation -- is different. Also: picky eaters abound.

"As a clinician, when I'm talking to a mom about her child, it's really about what is the birth history, what are they eating, how old they are," Dr. Low Dog points out.

Is it worth it to buy fancy formulations? Not necessarily, she says. "Flintstones, Centrum, are very appropriate. Some children may need extra DHA as well -- it's found in fish. We should have 600 to 1,200 milligrams of Omega 3s in our diet, but there are a lot of children who don't eat any fish or don't like fish."

Experts caution that taking vitamin supplements is not a replacement for going to the doctor or taking medication as prescribed. And it's worth keeping in mind that the FDA doesn't actually regulate vitamins and supplements (though U.S. Pharmacopeia, a nonprofit, non-government organization, does set some standards for them).

Parents, do you give your kids a multivitamin each day? Why or why not?

Lylah M. Alphonse is a Globe staff member and mom and stepmom to five kids. She writes about juggling career and parenthood at The 36-Hour Day and blogs at Write. Edit. Repeat. E-mail her at lalphonse@globe.com. April is Autism Awareness Month; you can read her posts about autism here.

This blog is not written or edited by Boston.com or the Boston Globe.
The author is solely responsible for the content.

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17 comments so far...
  1. My 5yo son takes his gluten-free gummy vitamins every night. But he has celiac disease, so his doctor recommends them.

    I don't know if I would bother otherwise. Foods like breakfast cereal, milk, granola bars, OJ, yogurt, etc are usually fortified with vitamins and iron. Most kids get plenty of vitamins from their food, even if they don't eat fruit or veggies.

    Posted by CCC April 14, 10 04:22 PM
  1. Vitamin D supplementation to healthy, natural levels (at least 50 ng/ml, year round) is BY FAR the most important thing anyone will ever do for their health. It is more important than quitting smoking, eating right, exercising, and losing weight...combined.

    How can this be?

    The all cause mortality risk associetd with vitamin D deficiency is 54% in certain demographics. The all cause mortality of the others listed is barely 30%- combined. NOTHING matters morethan vitamin D levels at healthy, natural levels (at least 50 ng/ml, year round).

    Posted by Chuckie April 14, 10 04:39 PM
  1. Funny you should post this today because I blogged just yesterday about how my son started taking a multivitamin with iron two weeks ago after a new pedi asked if he might be anemic, and now he goes around the house SINGING, which he has never done in 11 years. I know a multivitamin can't really make that big a difference and there has to be more to his newfound levity than just a grape-flavored Fred Flintstone, but for the moment, we're just pleasantly flabbergasted. Here's my post about it (be sure to scroll down to the Apr 13 entry): http://bit.ly/RSAGy

    Posted by Nancy West April 14, 10 09:01 PM
  1. my kids are very picky eaters. i give a multi vitimin just as a backup to make sure they are getting everything. it cant hurt them.

    Posted by lala April 14, 10 09:28 PM
  1. We switched from the regular vitamins to something called catalyn, a whole food multivitamin supplement. In a regular vitamin, the vitamins come from synthetic forms cooked up in a lab. In a whole food supplement, something like vitamin c comes from a powdered, concentrated form of a food that has vitamin C. Vitamin A comes from powdered, concentrated carrots etc. In theory, whole food vitamins contain micronutrients that work together to increase absorbtion and help the vitamins interact naturally as they do in food. My kids also take fish oil daily. Their diet is pretty good but this is just a back up plan for those times when they don't eat all that well.

    Regarding a point in the article, it drive me INSANE when people say that breastfeed babies need supplemental iron, which often leads to other problems such as constipation. If a baby is exclusively fed breastmilk, he or she DOES NOT automatically need extra iron. There is plenty of natural, easily digestable iron in breastmilk (lacto-ferrin) that is designed especially to be well-absorbed by baby's perfect little digestive tract. Once you introduce synthetic iron (from formula, iron-fortified cereal etc.) to that tract, the synthetic iron can interfere with the absorbtion of the natural iron. The best thing to do is avoid synthetic iron entirely and make sure that once baby is ready to eat solids at 7+ month you include lots of naturally iron-rich foods in the diet. Anyway I know that doc quoted in the article said "may need" but I can't tell you how many women I know (me included) were told to to give our babies supplemental right from the beginning because we were breastfeeding our babies. No need for that at all unless the child shows signs of iron deficiency. OK rant over.

    Posted by Jen April 14, 10 10:32 PM
  1. Our toddler gets Flintstone toddler vitamins. It's like breakfasts' dessert, and it can't hurt. I do wish they had some Omega-3s.
    And I don't like trying to explain who Dino, Pebbles, and Bam-Bam are. Can't they make Dora the Explorer multis instead?

    Posted by Jennifer April 14, 10 11:42 PM
  1. Fintstones and Centrum may be appropriate, but they contain artificial food dyes which have been banned in Europe, but not here! As a mother of two kids who are both intolerant/allergic to red #40, I have to buy a "special formulation" and it's not cheap. However we have been very pleased with Herbalife's kids' line and my kids think they taste great - no fighting here!

    I give my kids vitamins because I know that, like me, they don't always eat the way they should. I'm not always in control of their diets, and while we try to eat right as a family, there are the rare "ice cream for lunch" and "we have to get to practice, so it's McDonald's tonight". I feel like at least they get the vitamins, so if they don't get their 9 servings of fruits and veggies in a day, or whatever, they're at least getting baseline nutrition.

    Posted by Mom of 2 April 15, 10 08:49 AM
  1. We're vegetarians. I make sure my kids get a multivitamin because getting enough of some nutrients every day can sometimes be tricky. Over the course of a week, they get all they need, but a little extra D's and B's and iron won't hurt.

    Posted by BMS April 15, 10 09:35 AM
  1. At my kids' physicals a few months ago, the doctor asked if I give them a multivitamin with iron, and when I answered, "usually", he said, "It's important.". I'm not sure if he says that to everyone, or if it was because I had already told him they don't like meat.

    I don't like the artificial colors, etc. in Flintstones vitamins, so I get Nature's Plus, Animal Parade, at the Vitamin Shoppe. They are more expensive, but have natural colors and flavors and actually taste pretty good. My 7 y.o. asks for them all the time, since it's like candy.

    Posted by Mom2boys April 15, 10 10:10 AM
  1. I've asked my pediatrician, and he said that as long as my kids eat a variety of healthy foods over the course of a week, there's absolutely no reason to bother with a multivitamin. So I don't.

    Posted by akmom April 15, 10 02:56 PM
  1. Yay Jen. That's one of my peeves too. The prevalence of over iron fortified foods in our little ones is leading to lots of constipation issues. Just check out all the discussions over on the other part of this site. Or talk to the nurses at your pediatrician's office.

    Posted by SarahInActon April 15, 10 03:04 PM
  1. There is evidence out now that many children and adults are getting too much folic acid, because breakfast cereals and bread and multi-vitamins all have added folic acid. This is NOT the same as folate from natural sources such as found in fruits and vegetables. Too much folic acid has been positively linked to higher incidences of breast, colon, and lung cancer.

    Multi-vitamins CAN hurt. Eating fresh organic fruits and vegetables can't.

    Posted by victoria April 15, 10 08:36 PM
  1. New studies are pointing to potential problems with consuming too much folic acid.

    My problem with multivitamins is that they contain like 100% (or more) of the RDA for all sorts of vitamins and minerals--and my kids get lots of fortified foods and drinks already.

    Posted by m April 15, 10 08:45 PM
  1. Multivitamin supplements for children are helpful and warranted for several reasons. First, children are not clones and like adults, have different dietary needs. For example, a child with extensive food allergies would benefit significantly from a dietary supplement, especially one that is allergen-free, as he/she is probably not able to consume a good ratio of nutrients on a daily basis. Or, race often plays a factor in adequate nutrition. It has been shown that minority children, specifically African American children, suffer from Vitamin D deficiency to a greater degree than do those in other racial groups.

    Secondly, children as a general rule are picky eaters. Biologically speaking, children are predisposed to like sweet, salty, starchy foods (fast energy for little bodies) and subsequently that translates into poor eating habits and/or frustrating meal times for parents.

    Lastly, our food supply, whether organic or non, is not what it used to be. Mass farming, use of pesticides, fertilizers, etc, has diminished the nutrient quality of food (due to deplenished soil nutrient composition) across the board and as such a "balanced" diet does not yield as much nutritive value as it once did, 10 or even 15 years ago.

    Dietary supplements are just that, supplements. They are not intended to be "instead" of products. A good, balanced diet is important and supplementing helps round out the diet and fill in the holes.

    As a side note, another poster indicated that "too much folic acid has been positively linked to higher incidences of breast cancer, colon, lung, etc." This is untrue. No causative link was found. A suggestion of a possible relationship was found but relationship and causation are two vastly different things in science. Another thing to note is that the women in the study were more likely to have taken oral contraceptives, hormone replacement therapy and exercise less. Do you think those could possibly be greater factors? Hmmm.

    Posted by vitaminsaregood April 16, 10 05:40 PM
  1. How about the tradeoff between sunlight and vitamin D? There was a report a few years ago of kids in middle and upper class enclaves, exclusively breastfed for extended periods and who had never been outdoors unswathed, who were showing up with borderline cases of rickets. They've done such a good job encouraging breastfeeding and scaring people about skin cancer that they have to beat people over the head with the message that eventually the babies need other food, and ten minutes of sunshine here and there can be good for you.

    Posted by di April 16, 10 10:18 PM
  1. di I agree with what you're saying but I think it's important to emphasize that the deficiency that's been talked about is in more extreme cases. A healthy baby being breastfed by a healthy mother who herself is not vitamin D deficient (and had adequate levels of vitamin D while pregnant) should get enough vitamin D from breastmilk and moderate, appropriate exposure to sunlight to last until the baby is at least six months old. A baby being exclusively breastfed much longer than 6 months would eventually be lacking more than vitamin D. The vitamin D deficiency is more the result of lack of exposure to sunlight than an inherent deficiency in breastmilk. Those in northern climates with dark complexions and little access to regular sunlight (in a city, for example) would probably have to supplement with vitamin D but even then, the mom can take vitamin D and have it pass through her milk to the baby.

    We should all really step away from the sunscreen (slathering all of those chemicals onto the largest organ in our bodies can't be a good idea!) and just be sensible about sunlight. I send a natural sunscreen to daycare/school just to humor the teachers but unless we're going to the beach at high noon in the middle of the summer, my three boys and I go without sunscreen most of the time.

    Posted by Jen April 19, 10 12:50 AM
  1. I have never really been into taking vitamins, but as I started getting older, I wanted to take care of my healthy and keep myself going. Since I am a super healthy guy, I have to make sure I get all of my supplements, and sometimes that can be hard just from food. I found dr max powers multvitamins on sale and they sound easy and safe to use. I have had a bad experience with some vitamin brands because they will upset my stomach, be a bad form to take or not show results.

    I take one in the morning with breakfast and it has really seemed to help me stay healthy and have more energy. I like that they are all natural and not made with gelatin, and they contain both calcium and iron which I need. A bottle is reasonably priced and is a balanced formula that keeps me going and healthy.

    Posted by Pilot January 20, 11 09:39 PM
 
17 comments so far...
  1. My 5yo son takes his gluten-free gummy vitamins every night. But he has celiac disease, so his doctor recommends them.

    I don't know if I would bother otherwise. Foods like breakfast cereal, milk, granola bars, OJ, yogurt, etc are usually fortified with vitamins and iron. Most kids get plenty of vitamins from their food, even if they don't eat fruit or veggies.

    Posted by CCC April 14, 10 04:22 PM
  1. Vitamin D supplementation to healthy, natural levels (at least 50 ng/ml, year round) is BY FAR the most important thing anyone will ever do for their health. It is more important than quitting smoking, eating right, exercising, and losing weight...combined.

    How can this be?

    The all cause mortality risk associetd with vitamin D deficiency is 54% in certain demographics. The all cause mortality of the others listed is barely 30%- combined. NOTHING matters morethan vitamin D levels at healthy, natural levels (at least 50 ng/ml, year round).

    Posted by Chuckie April 14, 10 04:39 PM
  1. Funny you should post this today because I blogged just yesterday about how my son started taking a multivitamin with iron two weeks ago after a new pedi asked if he might be anemic, and now he goes around the house SINGING, which he has never done in 11 years. I know a multivitamin can't really make that big a difference and there has to be more to his newfound levity than just a grape-flavored Fred Flintstone, but for the moment, we're just pleasantly flabbergasted. Here's my post about it (be sure to scroll down to the Apr 13 entry): http://bit.ly/RSAGy

    Posted by Nancy West April 14, 10 09:01 PM
  1. my kids are very picky eaters. i give a multi vitimin just as a backup to make sure they are getting everything. it cant hurt them.

    Posted by lala April 14, 10 09:28 PM
  1. We switched from the regular vitamins to something called catalyn, a whole food multivitamin supplement. In a regular vitamin, the vitamins come from synthetic forms cooked up in a lab. In a whole food supplement, something like vitamin c comes from a powdered, concentrated form of a food that has vitamin C. Vitamin A comes from powdered, concentrated carrots etc. In theory, whole food vitamins contain micronutrients that work together to increase absorbtion and help the vitamins interact naturally as they do in food. My kids also take fish oil daily. Their diet is pretty good but this is just a back up plan for those times when they don't eat all that well.

    Regarding a point in the article, it drive me INSANE when people say that breastfeed babies need supplemental iron, which often leads to other problems such as constipation. If a baby is exclusively fed breastmilk, he or she DOES NOT automatically need extra iron. There is plenty of natural, easily digestable iron in breastmilk (lacto-ferrin) that is designed especially to be well-absorbed by baby's perfect little digestive tract. Once you introduce synthetic iron (from formula, iron-fortified cereal etc.) to that tract, the synthetic iron can interfere with the absorbtion of the natural iron. The best thing to do is avoid synthetic iron entirely and make sure that once baby is ready to eat solids at 7+ month you include lots of naturally iron-rich foods in the diet. Anyway I know that doc quoted in the article said "may need" but I can't tell you how many women I know (me included) were told to to give our babies supplemental right from the beginning because we were breastfeeding our babies. No need for that at all unless the child shows signs of iron deficiency. OK rant over.

    Posted by Jen April 14, 10 10:32 PM
  1. Our toddler gets Flintstone toddler vitamins. It's like breakfasts' dessert, and it can't hurt. I do wish they had some Omega-3s.
    And I don't like trying to explain who Dino, Pebbles, and Bam-Bam are. Can't they make Dora the Explorer multis instead?

    Posted by Jennifer April 14, 10 11:42 PM
  1. Fintstones and Centrum may be appropriate, but they contain artificial food dyes which have been banned in Europe, but not here! As a mother of two kids who are both intolerant/allergic to red #40, I have to buy a "special formulation" and it's not cheap. However we have been very pleased with Herbalife's kids' line and my kids think they taste great - no fighting here!

    I give my kids vitamins because I know that, like me, they don't always eat the way they should. I'm not always in control of their diets, and while we try to eat right as a family, there are the rare "ice cream for lunch" and "we have to get to practice, so it's McDonald's tonight". I feel like at least they get the vitamins, so if they don't get their 9 servings of fruits and veggies in a day, or whatever, they're at least getting baseline nutrition.

    Posted by Mom of 2 April 15, 10 08:49 AM
  1. We're vegetarians. I make sure my kids get a multivitamin because getting enough of some nutrients every day can sometimes be tricky. Over the course of a week, they get all they need, but a little extra D's and B's and iron won't hurt.

    Posted by BMS April 15, 10 09:35 AM
  1. At my kids' physicals a few months ago, the doctor asked if I give them a multivitamin with iron, and when I answered, "usually", he said, "It's important.". I'm not sure if he says that to everyone, or if it was because I had already told him they don't like meat.

    I don't like the artificial colors, etc. in Flintstones vitamins, so I get Nature's Plus, Animal Parade, at the Vitamin Shoppe. They are more expensive, but have natural colors and flavors and actually taste pretty good. My 7 y.o. asks for them all the time, since it's like candy.

    Posted by Mom2boys April 15, 10 10:10 AM
  1. I've asked my pediatrician, and he said that as long as my kids eat a variety of healthy foods over the course of a week, there's absolutely no reason to bother with a multivitamin. So I don't.

    Posted by akmom April 15, 10 02:56 PM
  1. Yay Jen. That's one of my peeves too. The prevalence of over iron fortified foods in our little ones is leading to lots of constipation issues. Just check out all the discussions over on the other part of this site. Or talk to the nurses at your pediatrician's office.

    Posted by SarahInActon April 15, 10 03:04 PM
  1. There is evidence out now that many children and adults are getting too much folic acid, because breakfast cereals and bread and multi-vitamins all have added folic acid. This is NOT the same as folate from natural sources such as found in fruits and vegetables. Too much folic acid has been positively linked to higher incidences of breast, colon, and lung cancer.

    Multi-vitamins CAN hurt. Eating fresh organic fruits and vegetables can't.

    Posted by victoria April 15, 10 08:36 PM
  1. New studies are pointing to potential problems with consuming too much folic acid.

    My problem with multivitamins is that they contain like 100% (or more) of the RDA for all sorts of vitamins and minerals--and my kids get lots of fortified foods and drinks already.

    Posted by m April 15, 10 08:45 PM
  1. Multivitamin supplements for children are helpful and warranted for several reasons. First, children are not clones and like adults, have different dietary needs. For example, a child with extensive food allergies would benefit significantly from a dietary supplement, especially one that is allergen-free, as he/she is probably not able to consume a good ratio of nutrients on a daily basis. Or, race often plays a factor in adequate nutrition. It has been shown that minority children, specifically African American children, suffer from Vitamin D deficiency to a greater degree than do those in other racial groups.

    Secondly, children as a general rule are picky eaters. Biologically speaking, children are predisposed to like sweet, salty, starchy foods (fast energy for little bodies) and subsequently that translates into poor eating habits and/or frustrating meal times for parents.

    Lastly, our food supply, whether organic or non, is not what it used to be. Mass farming, use of pesticides, fertilizers, etc, has diminished the nutrient quality of food (due to deplenished soil nutrient composition) across the board and as such a "balanced" diet does not yield as much nutritive value as it once did, 10 or even 15 years ago.

    Dietary supplements are just that, supplements. They are not intended to be "instead" of products. A good, balanced diet is important and supplementing helps round out the diet and fill in the holes.

    As a side note, another poster indicated that "too much folic acid has been positively linked to higher incidences of breast cancer, colon, lung, etc." This is untrue. No causative link was found. A suggestion of a possible relationship was found but relationship and causation are two vastly different things in science. Another thing to note is that the women in the study were more likely to have taken oral contraceptives, hormone replacement therapy and exercise less. Do you think those could possibly be greater factors? Hmmm.

    Posted by vitaminsaregood April 16, 10 05:40 PM
  1. How about the tradeoff between sunlight and vitamin D? There was a report a few years ago of kids in middle and upper class enclaves, exclusively breastfed for extended periods and who had never been outdoors unswathed, who were showing up with borderline cases of rickets. They've done such a good job encouraging breastfeeding and scaring people about skin cancer that they have to beat people over the head with the message that eventually the babies need other food, and ten minutes of sunshine here and there can be good for you.

    Posted by di April 16, 10 10:18 PM
  1. di I agree with what you're saying but I think it's important to emphasize that the deficiency that's been talked about is in more extreme cases. A healthy baby being breastfed by a healthy mother who herself is not vitamin D deficient (and had adequate levels of vitamin D while pregnant) should get enough vitamin D from breastmilk and moderate, appropriate exposure to sunlight to last until the baby is at least six months old. A baby being exclusively breastfed much longer than 6 months would eventually be lacking more than vitamin D. The vitamin D deficiency is more the result of lack of exposure to sunlight than an inherent deficiency in breastmilk. Those in northern climates with dark complexions and little access to regular sunlight (in a city, for example) would probably have to supplement with vitamin D but even then, the mom can take vitamin D and have it pass through her milk to the baby.

    We should all really step away from the sunscreen (slathering all of those chemicals onto the largest organ in our bodies can't be a good idea!) and just be sensible about sunlight. I send a natural sunscreen to daycare/school just to humor the teachers but unless we're going to the beach at high noon in the middle of the summer, my three boys and I go without sunscreen most of the time.

    Posted by Jen April 19, 10 12:50 AM
  1. I have never really been into taking vitamins, but as I started getting older, I wanted to take care of my healthy and keep myself going. Since I am a super healthy guy, I have to make sure I get all of my supplements, and sometimes that can be hard just from food. I found dr max powers multvitamins on sale and they sound easy and safe to use. I have had a bad experience with some vitamin brands because they will upset my stomach, be a bad form to take or not show results.

    I take one in the morning with breakfast and it has really seemed to help me stay healthy and have more energy. I like that they are all natural and not made with gelatin, and they contain both calcium and iron which I need. A bottle is reasonably priced and is a balanced formula that keeps me going and healthy.

    Posted by Pilot January 20, 11 09:39 PM
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