Should your child be taking a multivitamin? A paediatrician offers advice

Vitamins are a multibillion dollar industry and whether we should be giving vitamins to our children is certainly a million dollar question. There is just so much information out there – and so many choices – that parents often find themselves wondering what would be best for their child.

Articles published by the Mayo Clinic and in the American Journal of Paediatrics state that “Multivitamins aren’t necessary for most healthy children who are growing normally. Food remains the best source of nutrients. Regular, well-balanced meals and snacks can provide all the nutrients most preschoolers need”. So, in an ideal situation where children are eating well, tolerating all food groups and growing normally, supplements aren’t necessary. Consideration needs to be given to the child who isn’t meeting these requirements through the food they’re eating.

What is the role of vitamins and minerals in the body?

Imagine an orchestra with all the complexities of each instrument being played in a unique way to produce a single symphony. Your body produces muscle, skin and bone each and every day. It also produces red blood cells that carry oxygen all over your body.

The oxygen received allows every single cell in your body to perform very complex functions. It takes at least 30 vitamins, minerals and other dietary components to get this right. The vitamins and minerals are obtained from outside of the body – ideally this would be from a well-balanced diet but, under certain circumstances, supplements may be indicated.

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Some of the major functions of vitamins and minerals are:

• Preventing birth defects Mothers who lack certain vitamins may give birth to a baby with severe abnormalities. A lack of folic acid may result in the baby having brain, spine or spinal cord defects such as spina bifida. For this reason mothers are advised to take supplements during pregnancy.
• Building immunity 3 vitamins play a huge role in the body’s ability to fight infection. Vit C is the biggest immune booster while Vit B6 supports the biochemical reactions in the immune system, and Vit E is a powerful antioxidant which fights infection.
• Building strong bones and teeth A combination of calcium, vitamin D, vitamin K, magnesium, and phosphorus protects your bones against fractures. A lack of vitamin D causes a disease known as Rickets. Children with rickets develop abnormalities of their bones such as bowed legs.
• Clotting of blood Vitamin K plays a very specific role in bone metabolism and blood clotting. A lack of vitamin K in adults is rare but common in newborns. For this reason a baby is usually given a Vit K injection at birth. This releases clotting factors from the liver and prevents bleeding disorers. A recent study conducted in Tennessee reported that there had been an increase in the number of parents who are refusing the Vit K injection at birth. These parents perceive it to be unnatural and unnecessary in full-term babies. This, however, is not fact. We know that Vit K is not transferred well through the placenta to the unborn child. Over and above this a newborn’s gut flora is immature and is not able to produce Vit K. Very little Vit K is found in breastmilk so newborns do lack Vit K. The result of this refusal has led to an increase in the number of tiny babies being brought to casualty by concerned parents. After investigation many of these babies are found to have suffered brain bleeds. This condition is very severe – it can lead to retardation and even death.
• Eye-sight– Vitamin A helps keep cells healthy and protects your vision. It is particularly important for vision in dim light. Children who lack vitamin A may in fact go blind.
• Growth and development- Maintaining normal growth and development ensures that our children progress as they should. If any baby presents with failure to thrive or a regression in their development your doctor may well suspect a Vit B12 deficiency. A baby which is exclusively breastfeeding may become Vit B12 deficient if the mother has anaemia or is following a vegetarian diet. Ultimately this may cause poor growth and in severe cases brain damage. Another cause for failure to thrive may in fact be a lack of zinc.
• Collagen production– Collagen knits together wounds, forms a base for teeth and bones and supports our blood vessels. Vitamin C is very important for the production of collagen (this is certainly not the only function of Vit C but a significant one). As a child I used to listen with horror about olden day sailors who developed Scurvy on board the ships. They had no access to fresh fruit and vegetables and developed this horrible disease which caused their gums to bleed and a rash to appear all over their skin.
• Releasing energy- There are a number of vitamin Bs and these help the body to release the energy we get from eating food so that we are able to function normally. Vitamin B1 combines with phosphorous and enables the body to metabolise carbohydrates, fats and proteins. If a child lacks Vit B they will most certainly feel tired most of the time and will most probably not enjoy physical activities.

If vitamins and minerals are so important why not give a supplement to all children?

There’s an old saying “Too much of a good thing is bad” This goes for vitamins and minerals as well.

Let’s take a closer look at some of the major vitamins and minerals in more detail. The table below may help to examine the most commonly supplemented vitamins and minerals, examine the source and then show the effects of too little or too much of each.

Name of Vitamin or mineral	Main source	Too little	Too much
Vit A	Breastmilk, infant formula, vegetable oil, liver, egg yolk, butter, green leafy  vegetables, sweet potatoes, carrots, whole grain bread, cereals	Night blindness, dry eyes, prone to infections, poor bone growth	Vomiting, jaundice, abdominal pain, night sweats, vertigo, dry cracked skin
Vit C	Breast milk, formula, citrus fruit, strawberries, pawpaw, potatoes, cabbage	Bleeding disorders, diarrhoea, Scurvy	Abdominal cramps, nausea and the possibility of kidney stones
Vit D	Sunlight, fatty fish, egg yolk, liver, infant formula	Soft bones and growth delays in children, in adults muscle weakness, bone loss and fractures	Vomiting, high blood calcium, retarded growth
Vit B1 (Thiamin)	Breast milk, formula, lean pork, potatoes, legumes, wholegrain breads and cereal	Heart failure, oedema, Beriberi
Vit B6 Pyridoxine	Breast milk, formula, liver, meat, whole-grain breads and cereal, legumes, potatoes	Irritability, anaemia, convulsions	Weakness, numbness, sensitivity to light
B12 (Cobalamin)	Breast milk, formula, cheese, fish, poultry, meat, egg yolk, liver (Vegans and Vegetarians are often deficient of B12)	Impaired brain function, anaemia
Vit K	Vegetable oils, green leafy vegetables such as spinach and kale, pork, liver	Excessive bleeding especially in newborns	This is very rare but may result in jaundice, anaemia or kernicterus in infants
Iron	Breast milk, formula, red meat, seafood, canned sardines, legumes, wholegrain breads and cereals, seeds such as pumpkin and sesame	Dizziness, headaches, weakened immune system, unusual tiredness, anaemia, fast heart rate, brittle nails, dry damaged hair and skin, restless legs, anxiety	Joint pain, diabetes, irregular heartbeat, Abdominal paid

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The bottom line is that it’s possible to be deficient in almost all nutrients. This is particularly likely in children who are not eating a balanced diet, vegetarians and vegans. Vitamins and minerals are obtained from a diet that includes meat, fish, eggs, grains and vegetables.

Without a nutrient-dense diet your child may well be lacking in some of the vitamins and minerals he or she needs to grow normally, and have an adequate immune system with strong bones and teeth. This is why over-processed foods and food void of colour and freshness should make every parent shudder.

The flip side of this is that excessive supplementation may lead to unnecessary health problems. It is virtually impossible to get an overdose of vitamins and minerals from a healthy diet so these health problems would arise if a child is being given supplements over a long period of time or in a dose that exceeds the daily recommended amount.

Why would a doctor recommend a child take multivitamins?

Rachel Dawkins, M.D, director of the Paediatric and Adolescent Medicine Clinic at John Hopkins All Children’s Hospital states “So typically kids don’t need vitamins, but every kid is different and has different needs, so consult your paediatrician if you are worried. There are exceptions and under certain circumstances supplementation is necessary”

In my opinion this would include:

• Vitamin K- given at birth to prevent a life threatening condition known as VKDB.
• Vitamin D- given to exclusively breastfed babies
• Multivitamin with iron- premature infants when being discharged from neonatal ICU should be given this supplement.
• Iron supplement- Full term infants, who are exclusively breastfed should receive an iron supplement at age 4 months. Continue giving your baby the supplement until he or she is eating two or more servings a day of iron-rich foods, such as iron-fortified cereal or pureed meat. Formula fed babies get the iron from the formula.
• Children with selective diets such as vegetarianism or dairy free diets- A multivitamin specifically designed for children is recommended. The most important component of the supplements under these circumstances would be iron and calcium.
• Children with chronic medical conditions such as asthma or digestive problems, especially if they’re taking medications. You will need to follow the advice of your doctor to ensure your child is getting the correct supplements.
• Picky eaters- this is the tough one. Parents do get very stressed when children are difficult to feed. Under these circumstances a multivitamin may be given BUT it is not a long term solution. Children who are fussy are often sensory defensive and benefit from Occupational Therapy to address the problem. Supplements should never take the place of a healthy diet but a two to three month course under these circumstances may be recommended.
• Pre-schoolers- A study has shown that 47% of preschool children are likely to lack iron. If your child is not eating an iron rich diet then your doctor may recommend an iron supplement.
• Boosting immunity- this is a question that comes up time and time again. Generally children can get all they need from a healthy diet. Having said this the American Academy of Paediatrics says “Over-the-counter vitamin supplements are typically safe and come in chewable forms in case your child has difficulty swallowing. Remember, however, that higher-than-­recommended dosages of supplements can cause problems. For example, giving high doses of vitamin C in hopes of preventing colds and the flu can cause a child to have nausea, diarrhoea, and cramps.” If a parent feels that their child needs a little boost going into winter then a short course of a paediatric supplement may well help.

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Conclusion

Our modern society has left us all in a quandary. Parents are often working long hours so preparing an elaborate meal is difficult. Over and above this I read an interesting article about soil depletion. The article explains that overall, magnesium in vegetables has dropped by 24%, while carrots specifically have lost 75% of this essential nutrient.

What this means is that you’d need to eat four carrots today to get the same amount of magnesium found in one carrot in 1940. Spinach has lost 53% of its potassium and 60% of its iron, while broccoli has lost 75% of its calcium. Also our modern supermarkets have meant that fruit and vegetables are available all year round but that means that they require transportation and refrigeration. In a study conducted by Spanish researchers in 2003, it was found that broccoli kept in supermarket conditions lost 70% of a protective compound called glucosalinate and 60% of its antioxidant flavonoids over 10 days. Many of the vital nutrients that are found in fresh foods, lose their nutritional value, because of the store conditions. Unless you are able to purchase organic, seasonal food this factor is a reality.

Another problem is that advertisers are also great at convincing children that food in a box is way tastier than the meal mom has cooked. Fast foods often lack the nutrients that children require.

It is a battlefield. We all want our children to grow up strong and healthy. Ideally this should be achieved through a healthy, well balanced diet.

If this is not possible then, together with your healthcare practitioner you should consider supplements under controlled circumstances. We do not want our children suffering from health issues because we were trying to provide them with the vitamins and minerals we felt were necessary.

https://www.hopkinsallchildrens.org/ACH-News/General-News/Do-Kids-Need-Vitamin-Supplements
https://www.eatright.org/food/vitamins-and-supplements/dietary-supplements/does-my-child-need-a-supplement
https://www.healthline.com/nutrition/can-you-overdose-on-vitamins
http://pgnrc.sbmu.ac.ir/uploads/Vitamin_Excess_and_Deficiency_diab2018.pdf
https://www.stanfordchildrens.org/en/topic/default?id=kids-need-their-nutrients–1-19820
https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/expert-answers/multivitamins/faq-20058310
https://www.webmd.com/parenting/features/immune-system#1