Updated: Sep 13, 2019
To supplement or not to supplement? Karen Sherwood takes a look at children’s vitamins.
Popping a multi-vitamin onto your child’s plate to make-up for any shortfall in nutrients seems like a sensible approach, doesn’t it? Few and far between are the parents who believe their child eats a truly balanced and wholly nutritious diet. So why not add a multi-vitamin to be sure? Well despite the comforting promises on vitamin labels, there are risks to supplement use that parents need to be aware of. The question of ‘to supplement or not’ isn’t a straightforward one.
Pills that claim to make your child smarter; make their bones stronger; give them more energy; improve their immunity – there is a supplement on offer for any concern a parent may have. The global market for dietary supplements is growing at an astounding rate. Yet regulation and testing is not as stringent as you might expect. It is often highlighted that US Federal law “does not require dietary supplements to be proven safe to FDA's satisfaction before they are marketed. For most claims made in the labeling of dietary supplements, the law does not require the manufacturer or seller to prove to FDA's satisfaction that the claim is accurate or truthful before it appears on the product.” In Hong Kong dietary supplements are classified either as pharmaceutical products, Chinese medicine or ‘general food’. A report by the HK Consumer Council found that of 76 multi- or single vitamin supplements reviewed (including supplements aimed at children), only 16 were actually registered as pharmaceutical products, despite the potential side-effects of vitamin use, prompting calls for tighter controls. Regulation does vary by country, but in general vitamin and mineral supplements are not tested and scrutinised in the way that prescription medicines are. You should therefore treat any health claims made by vitamin companies with a good dose of skepticism.
The lower levels of scrutiny applied to children’s vitamins, relative to prescription medicines, means that you may not always get what you expect either. A report by Consumer Lab in the US found that 80 per cent of children’s gummy vitamins tested did not have the same amounts of vitamins and minerals as listed on their labels. Impurities were also found. Katie Young, a Qualified Clinical Nutritionist, states that “many over the counter supplement brands contain junk ingredients, or cheaper, less absorbable forms of nutrients and some may do more harm than good. As with anything, don’t fall pray to marketing hype.” Vitamins aimed at children are often loaded with artificial colours, flavours and sugar to make them more palatable. As Katie points out, “sugar is an anti-nutrient and lowers immunity, so is counter productive.”
So if the magic multi-vitamin pill isn’t quite so magical, what should parents do? There is a whole alphabet of vitamins and minerals that are absolutely essential to a child’s health and many parents feel concerned that their child’s diet may not be adequate. Yet the advice on using vitamin and mineral supplements is constantly evolving and often frustratingly contradictory. One thing experts agree on is that parents should seek medical advice before giving their child any form of supplement.
“It is extremely important to see a professional who can determine which vitamins and minerals are needed and provide you with high-grade supplements targeted to your child’s specific needs. I know many people like to order supplements online and self-prescribe, as they may be cheaper - but you get what you pay for. You would not do this with prescription drugs and should not do this with supplements,”
Katie says. Seeking professional guidance is particularly important if your child takes other medicines as
“ you need to know if any nutrients may have contraindications with other nutrients, medications or conditions. Some supplements can interact with medication.”
Another thing most experts agree on is that when it comes to vitamins and minerals, you can certainly have too much of a good thing. There are dangerous side-effects to overdosing on vitamins, so caution is warranted. Accredited Practicing Dietitian, Violet Man, says: “Children of different ages can be different sizes and pills are based on body weight, not on age. It’s best to talk to your doctor or dietitian about the right type and correct dosage.” She highlights that excessive vitamin A can be toxic, causing loss of appetite, nausea, itching skin. Overdosing on vitamin D can lead to calcium being deposited into soft tissues, vomiting and diarrhoea. A condition called hypercalcemia can be caused by excessive calcium and vitamin D supplementation; care is needed if using either of these supplements alongside a multi-vitamin that may already contain them. Katie explains that, “some vitamins are hard to overdose on as they are water-soluble, so they are excreted easily, but fat-soluble vitamins (like vitamins A, D, E and K) are stored in the fat and may build up in the body. This is why it is important to see a professional, so you don’t overdose your child.” Most dangerous of all is overdosing on iron – about a third of the poisoning deaths amongst children in the US between 1983 and 1991 were caused by iron supplements, leading to changes in packaging and warning labels.
Violet suggests that parents start by thinking of “food before supplements. Don’t think a pill can be a substitute for nutrition, a pill can’t replace all the nutrients available in vegetables and fruit. Children will absorb enough vitamins and minerals from a well balanced diet.” Getting the balance right can be hard though. Katie says “From what I see, many children do not eat enough vegetables, fruit or good quality protein today. Many children eat far too many processed foods that are devoid of nutrients – such as cookies, crackers, cakes and sweets.” Unfortunately for parents, working to improve a child’s diet is a far more beneficial strategy than popping a self-prescribed multi-vitamin into their mouth.
Aside from multi-vitamins, there are a couple of other supplements commonly used by parents. Lets start with vitamin D. Many experts (and governments) advocate giving vitamin D supplements to children, particularly during the Northern Hemisphere winter. However the research here does continue to evolve, with some of the original proponents now stating that vitamin D levels vary naturally in the population, so ‘normal’ levels are very person specific and supplements may be unnecessary. So should you give your child a vitamin D tablet just in case? “Absorption differs person to person, so without testing levels in each child it is not a yes or no answer. Many children don’t play outside much and when they do they are wearing sunblock, which blocks the absorption of vitamin D,” Katie says. Violet agrees that “its hard to obtain enough vitamin D from food alone. Due to heavy school work loads, children may not be getting enough vitamin D from sunlight, especially in winter time. They need 5-15 minutes of sun exposure two to three times a week, and longer in winter.” If you are concerned your child is not getting enough Vitamin D, and cannot increase their sun exposure, you should obtain a blood test before providing supplements. As previously mentioned, vitamin D is a fat-soluble vitamin (less easily excreted), so dosing advice should be sought.
Vitamin C supplements are another popular choice. “The scientific studies have shown that vitamin C does not reduce incidence of colds in the general population, but may reduce the duration of colds,” says Katie. Violet agrees that having adequate amounts of vitamin C (as well as zinc and probiotics) in your system can help with fighting colds but “more research needs to be done for supplementation. People should try to obtain enough vitamin C from fruit like guava, orange, kiwi and strawberries. Zinc from oysters, fish, seafood, beef, pumpkin seeds and baked beans. Probiotics like kefir, sauerkraut, natto and kimchi.” Violet also highlights that the ubiquitous chewable vitamin tablet can cause dental erosion if used regularly, due to the acidic nature of vitamin C.
There are times when supplemental vitamins and minerals are necessary. Violet states that
“if a child is ill or has had an operation and been unable to eat well, extra vitamins and minerals can help for a short term until they get back to a balanced diet. Children on any type of restricted diet can require nutritional help. Children who refuse to eat a whole food group like meat or vegetables; those with particular allergies; and those on elimination diets or gluten free diets, may need supplements.”
Whether a child should be given vitamin supplements isn’t a simple question to answer. Like most things to do with our health – there isn’t a ‘one-size-fits-all’ answer – despite what the vitamin packaging might tell us. What is clear though, is that the supplement industry is prone to wily marketing. What parent doesn’t want to make their child healthier? A lot of children (and teenagers!) are picky eaters, but that doesn't necessarily mean that they have nutritional deficiencies. Seek professional guidance if you are concerned, don’t just be swayed by clever marketing from supplement companies. Essentially, supplements should be used with care – just because they are not mandated to have child-proof lids, doesn’t mean they should be treated like candy. Thousands of children are treated in emergency rooms every year in the US because of dietary supplements, mostly due to unsupervised ingestion of a vitamin or mineral supplement. Keep them out of reach of children, handle them like medicine, and use only the best quality supplements when advised by a medical professional. Ideally, as Katie says, “let food be thy medicine.”
References for statistics: