Q: I see vast aisles of kids’ vitamins in stores, but I don’t really understand what they’re for. Are kids supposed to take vitamins? And if so, what kind?
A: Why would children’s bodies need extra vitamins that we don’t get through food? We don't know for sure why this is, but it is likely that our foods and lifestyles have changed dramatically over the past few thousand years, which has created new nutritional needs and deficiencies. We continue to discover new information about micronutrients needed by the body all the time. For this reason, there are situations in which pediatricians recommend supplemental vitamins for children.
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The first vitamin supplement children receive is in the newborn nursery. Immediately after birth, we strongly recommend and administer a vitamin K supplement to all babies. Vitamin K helps improve blood clotting and has essentially eliminated hemorrhagic disease in newborns, which used to cause some children to die from massive bleeding in the first month of life.
The next vitamin supplement that is recommended is vitamin D. Vitamin D has relatively low levels in breast milk, and formula was designed with less vitamin D content than we currently recommend. For this reason, most infants need supplemental vitamin D. This is most commonly given using Tri-Vi-Sol, or a generic version of infant vitamin drops, which actually include three common vitamins. Infants should get 1 ml or 400 international units of vitamin D. Technically, even formula-fed infants should get supplemental vitamin D based on the current amounts recommended. It is likely that formulas will increase the amount of vitamin D soon if the current recommendations hold.
Lastly, iron is a mineral that is often too low in otherwise well children. If children are breastfed, this deficiency can occur in the late first year of life. If children are given formula during infancy, the deficiency more commonly happens by 18 to 24 months of life. Up to 20 percent of infants and young children can have iron deficiency, and iron is a necessary factor not only in making blood cells, but also in other body functions like cognition. One easy was to prevent this deficiency is to introduce a lot of iron-rich foods starting at 6 months old. This can include meats and vegetables that until recently generally weren’t recommended as early food. Also, infant rice cereal in the US is generally iron fortified to help prevent deficiency. Many parents and pediatricians also recommend using an iron-containing vitamin during this part of life in order to prevent deficiencies. Your doctor may test your child’s hemoglobin at 1 year of age as a way to check iron status, but unfortunately that test is not as helpful for detecting low iron as previously thought.
Outside of the situations above, use of multivitamins for children is likely not necessary; however, a single multivitamin a day at the appropriate dose is also likely not harmful. Giving children with restrictive diets, multiple allergies, or behavioral or developmental problems that restrict what they eat a multivitamin everyday can help assure that they get most of the important micronutrients. But remember that vitamins are not a substitute for a well-balanced diet that mimics the currently recommended USDA colorful food plate, with emphasis on five fruits or vegetables a day.
If you have questions about whether vitamins might be right for your child, please don't hesitate to ask your health-care provider.
Dr. Mike Steiner is a pediatrician in the division of General Pediatrics and Adolescent Medicine at UNC and North Carolina Children’s Hospital.