Vitamins for Kids: Are They Necessary?

The old adage “You are what you eat” couldn’t be more true of vitamins and minerals, which are necessary for proper body functioning, but are not synthesized in adequate amounts by the body itself. Therefore, vitamins and minerals must be acquired from the environment, either from the diet – or in the case of vitamin D, from sunlight. The deficiency of any of these vitamins or minerals can cause disease.

Parents may wonder if their children are getting enough of essential vitamins and minerals in their diets and whether they should be giving a daily multivitamin. The American Academy of Pediatrics does not recommend the routine use of multivitamins for most children, as a well-balanced diet should be sufficient. If your child, however, has an unusual diet, was born prematurely, or has a medical condition that affects how well he absorbs nutrients from food, he may need vitamin or mineral supplementation.

Vitamin D

There is increasing concern about vitamin D deficiency. Children don’t get as much sun as they used to since much of the life-time risk for sun-related skin cancers is attributable to sun exposure and sunburns during childhood. Without adequate vitamin D, however, the body does not properly absorb calcium from the diet, causing softening of the bones, called osteomalacia. When the growth plates are affected, the result is rickets, often recognized by excessive bowing of the legs. Poor vitamin D and calcium intake also leads to osteoporosis later in life. In addition, there is newer research possibly linking vitamin D to immune function, cardiovascular health and asthma.

It is now recommended that all children get 400 international units per day of vitamin D. Dark-skinned children may need more than the recommended levels due to less sunlight absorption. Most children will get this amount from a well-balanced diet, and babies will get this much in about 34 ounces of standard formula. Vitamin D supplements are needed in all exclusively breastfed babies, infants who consume less than 34 ounces of formula over a 24-hour period, or any child with low sunlight exposure. Premature babies may also need additional vitamin D and calcium because they miss out on the amounts of these nutrients that get transferred from mom during the third trimester of pregnancy. Adolescents, particularly females, may also need vitamin D and calcium supplementation to achieve peak bone mass density in adulthood, which largely determines risk for osteoporosis, osteopenia and fractures in adulthood.

Children also get vitamin D from sun exposure. A total of 30 minutes per week for infants over 6 months wearing only a diaper, and two hours per week for a clothed child without a hat provides children ample vitamin D. Dark-skinned children need additional exposure to get comparable amounts of vitamin D. However, any unprotected sun exposure in children should be allowed with caution, if at all.  Infants less than 6 months should not have any significant sun exposure given the greater risk for burns and dehydration.

Iron

Iron deficiency is relatively common in children, leading to problems such as anemia. Infants get iron through breast milk or formula. After six months, additional iron is needed. Iron-fortified cereal should be among the first solid foods introduced to the baby, who needs about 4 ounces per day of iron-fortified cereal or one-half to one full jar of pureed baby meat to get adequate iron. Premature or low-birth-weight babies (under 3 pounds, 4 ounces) will need double this amount of iron. Toddlers that consume large amounts of milk may also become iron deficient, since this blocks absorption of iron.

In early childhood, iron deficiency can cause cognitive impairment and developmental delays. Adolescent girls are also at risk of low iron due to blood loss after the onset of menses. Your pediatrician can easily test for iron deficiency anemia in the office and prescribe replacement doses of iron.

Vitamin B12

Another important vitamin to consider is B12, because it is the only vitamin naturally found exclusively in meat. Those consuming a strict vegetarian diet may become deficient. For this reason, it has been added to many cereals and breads. However, if your child is a vegetarian, or if you are following a vegetarian diet and are exclusively breastfeeding, you should discuss supplementation with your pediatrician. Deficiency of B12 can also cause anemia, as well as damage to the neurological system.

Fluoride

Fluoride is an important mineral for tooth health, but too much can cause fluorosis, which is damaging to teeth. Children should use no more than a rice grain to pea size amount of fluoride toothpaste on their toothbrush twice a day. City water has additional fluoride added. Children drinking exclusively bottled or well water may need small amounts of fluoride supplementation.

When considering your child’s nutritional status, it is important to remember that foods are the ideal sources for vitamins and minerals and are preferable to commercial supplements, which are not regulated by the FDA. This underscores the importance of a rich well-balanced diet. It is essential to discuss vitamin or mineral consumption with your child’s physician, since the deficiency or excess of vitamins or minerals may cause severe health problems.

Dr. Larsen is a pediatric resident at Levine Children’s Hospital. Dr. Neuspiel is director of ambulatory pediatrics at Levine Children’s Hospital and Medical Director at CMC: Myers Park Pediatrics.