Children’s Multivitamins: Are They Really Necessary?

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The case for pediatric supplementation

“Why do kids love carbs and dairy so much?” my mother asks me, exasperated after her latest thwarted attempt to get her grandchildren to eat more nutritious fare.

“We’re actually lucky,” I tell her between bites of the cold broccoli the kids left behind, “at least these kiddos eat something.”

“But how do we know they’re getting their nutritional needs met?” she asks.

It’s a good question, and one that I wish more caregivers would ask. Despite a caregiver’s best efforts, children are often deficient in the vitamins and minerals necessary for growth, development, immune function, and brain health.

How common are nutritional deficiencies?

Nutrient deficiencies are prevalent worldwide, with iron, vitamin A, folic acid, and zinc being among the most common. Though all kids are at risk, the incidence of nutritional deficiency is especially high in children from low-income regions.[1]

Almost two-thirds of the deaths of young children worldwide are related to nutritional deficiencies.

Sub-optimal nutrition affects a both a child’s physical health and cognitive development throughout life.[2],[3] The iodination of salt has thankfully reduced the prevalence of goiter,[4] but a host of other nutritional deficiencies still regularly cause health problems, including birth defects in utero;[5] developmental delays,[6] increased susceptibility to infectious diseases,[7] and compromised bone growth[8] in childhood; and overall poorer health outcomes in adulthood.[9] In fact, almost two-thirds of the deaths of young children worldwide are related to nutritional deficiencies.[10]

How did we get here?

When I was a baby, my mother fed me homemade chicken livers and sweet potato puree. One of my favorite photos in the family album features my mother holding a pickled cucumber and me, wide-eyed, eagerly reaching for it.

Times have changed: studies suggest that only about 20% of children nowadays eat the recommended daily amounts of fruits and vegetables.[11] Many children and teens are picky eaters with erratic dietary habits. Others are on restrictive diets, whether chosen for religious adherence, health reasons, or personal preference.

Only about 20% of children nowadays eat the recommended daily amounts of fruits and vegetables.

Even the children who eat plenty of vegetables, meat from ethically raised animals, and other whole foods may still be vulnerable to sub-optimal nutritional status. This is in large part due to the loss of phytonutrients in the soil. The increased concentrations of pesticides, herbicides, heavy metals, and other environmental toxins in the earth have further compromised the nutritional power of our food supply.[12]

The nutrient density of plants, nuts, and grains also varies depending on the nutritional content of the soil in which they grow. For example, a Brazil nut grown in selenium-rich soil contains 100 mcg (micrograms) of selenium, on average. The same kind of nut grown in selenium-poor soil, however, contains a mere 10 mcg of selenium – only one tenth of the nutritional content.[13] (It’s no wonder that thyroid diseases are on the rise.)

When we buy food at the grocery store, we often have no clue what country it came from, let alone what type of soil it grew in. This leaves the mindful consumer (and parent) wondering if we are really getting the fullest nutritional potential from our food.

These are but some of the reasons that health care providers sometimes recommend daily multivitamin/multimineral supplements to their pediatric patients. Nutritional support is especially important in children, as their bodies are quickly utilizing the nutrients available to promote growth and development.

Here are but some of the important nutrients that children need and can be found in a quality daily supplement:

Vitamin D3

Vitamin D has been shown to protect against acute respiratory infections, including the common cold and influenza (flu) viruses.[14],[15] Through its effects on the immune system, vitamin D also helps minimize allergic reactions, such as those seen in food intolerances, seasonal hay fever, and eczema.[16],[17] Unfortunately, four out of every 10 toddlers and children are vitamin D deficient, according to the American Academy of Pediatrics (AAP).[18]

4 out of every 10 toddlers and children are vitamin D deficient.

Understanding the importance that vitamin D plays in immune system function, bone growth, and mental health, the AAP recommends that vitamin D supplementation begin at birth with 400 international units (IU) daily and continue through childhood.[19] Ideally, vitamin D is taken as vitamin D3 because this form is far more effective than vitamin D2 at improving vitamin D status.[20],[21] Most multivitamins, however, contain less than the recommended amount of vitamin D, leaving kids vulnerable to infections. Because some vitamin D is naturally made in the body when the skin is exposed to sunlight, children living in non-equatorial countries and/or who are darker skinned are especially at risk of vitamin D deficiency and may need to supplement above and beyond what’s in their multivitamin.

Magnesium

From energy production to DNA synthesis, magnesium is involved in more than 300 essential metabolic reactions in the body.[22] Required by hundreds of biochemical enzymes, magnesium plays important roles in cardiovascular health, bone density, and metabolic function.[23] Magnesium is often a quick-and-easy solution for irritability and anxiety in kids,[24] and is the mineral of choice in cases of muscle cramping.

Magnesium’s calming effects on the nervous system may also be of particular benefit to children with hyperactivity, such as those with ADHD, and those on the autism spectrum.[25]

Iodine

Iodine is required for the synthesis of thyroid hormone, and is thus essential for normal thyroid function.[26] In fact, iodine deficiency is a leading cause of fetal and infant hypothyroidism, which results in brain damage and stunted growth.

Although newborn screening tests have helped us quickly identify and treat severe iodine deficiency in infants, inadequate iodine intake later in childhood and adolescence can still lead to sub-optimal thyroid activity and impaired cognitive function, as is seen in learning disabilities.[27]

Thanks to the fortification of salt with iodine and increased global awareness, iodine deficiency is overall decreasing worldwide, but curiously increasing in the Americas. This is likely due to our (justified) avoidance of sodium – and thus lower intakes of iodized salt.[28] Thankfully, seaweed and seafood are rich in iodine, and the mineral is commonly included in prenatal and multivitamin supplements.[29]

B vitamins

By simply flipping through a biochemistry textbook, it quickly becomes clear that the B vitamins are essential cofactors for countless reactions in the body. B6 (pyridoxine), B9 (folate), and B12 (cobalamin) in particular are important for the production of the neurotransmitters essential for brain health and neurological function.[30] The B vitamins are also critical for energy production, detoxification, and heart health. B vitamin deficiency can manifest as anemia, fatigue, difficulty learning/focusing, depression, and digestive trouble.[31],[32],[33]

Because they are all water-soluble nutrients, the body cannot store B vitamins; we thus require a daily intake of them to ensure optimal health.[34]

Vitamin A

Vitamin A is also known as “the anti-infective vitamin” for its important role in supporting the immune system.[35] This fat-soluble nutrient augments the protective forces of the skin and mucus membranes lining the airways, digestive tract, and urinary tract – the surfaces that comprise the body’s first line of defense against foreign pathogens and infections.[36]

Vitamin A is so vital for immune function that a deficiency of the nutrient is considered a “nutritionally acquired immunodeficiency disease.”[37] In a comparison of children who contracted the measles virus, the children who were even slightly deficient in vitamin A were shown to be at higher risk of developing diarrhea, enduring respiratory complications, and had higher mortality rates than those with adequate vitamin A intakes.[38]

Children who were even slightly deficient in vitamin A were shown to be at higher risk of developing diarrhea, enduring respiratory complications, and had higher mortality rates from measles than those with adequate vitamin A intakes.

Vitamin A deficiency has also been associated with thyroid and skin disorders.[39]

It’s important to keep vitamin A supplements in childproof containers, as high doses of the vitamin (10 times the recommended daily allowance, or RDA) can cause toxicity. While vitamin A supplementation is important in pregnancy to ensure the proper development of the fetus’ eyes and to reduce the risk of congenital blindness,[40],[41] doses of over 10,000 international units (IU) of supplemental vitamin A daily in pregnant mothers may harm the unborn child.[42] Thankfully, the amount of vitamin A found in pediatric and prenatal multivitamins is typically well within the safe range.

Zinc

Dietary zinc deficiency in children can cause impaired growth and development, as well as increased susceptibility to infections.[43]

According to the World Health Organization (WHO), 13% of all lower respiratory tract infections (such as pneumonia and flu) in children age five and younger may be related to zinc deficiency.[44] A 2016 meta analysis of six trials found that zinc supplementation reduced the risk of pneumonia by 13% in this age group as well.[45]

Zinc supplementation reduced the risk of pneumonia by 13% in children age five and younger.

By supporting the production of antibodies in the mucus membranes, zinc can also help stave off intestinal infections and diarrhea in children[46],[47],[48] and mend a leaky gut.[49]

It’s important to note that taking large quantities of zinc on a regular basis can interfere with copper bioavailability; choosing a multivitamin with both zinc and copper is an easy way to avoid nutritional imbalance.

Multivitamins for height and growth

A randomized controlled trial (RCT) conducted in healthy 4 to 13-year-old children attending public school in Thailand sought to identify some of the benefits of multivitamin supplementation.[50]

The 70 school children participating in the study were randomized to receive either zinc bisglycinate (20 mg elemental zinc) plus a multivitamin (containing 1,000 IU vitamin A; 200 IU vitamin D; 10 mg B1; 3 mg B2; 1 mg B6; 10 mcg B12; 40 mg B3) or placebo daily, five days weekly, for a duration of six months.

The children who received zinc and multivitamins grew more in height than those in the placebo group.

The children who received zinc and multivitamins grew more in height than those in the placebo group. This difference was significant by only two months of supplementation, and was especially pronounced in preadolescents.

Choosing the right multivitamin

While high-quality nutritional supplements can conveniently help maintain nutritional status quo within the body, not all products are created equally. It’s therefore important to use well-formulated products from reputable brands.

It can be tricky to find a good quality children’s multivitamin that does not contain sugar (or even worse, high fructose corn syrup) or artificial colorings. Gummy vitamins can feed a child’s sweet tooth, making them crave more sugars throughout the day. Sweet gummies can also cause dental problems.

Whereas some children do just fine with “regular” B vitamins, those with genetic mutations and special needs sometime require that vitamin B12 and folic acid be in their methylated forms in supplements. Thankfully, more medically focused supplement companies include higher-quality forms of these B vitamins, as well as vitamin D3, in their children’s multivitamin supplements.

It’s also important to remember that a nutritional supplement is designed to be just that – a supplement: something that completes or enhances something else when added to it. Although some of us – not to mention our kids! – prefer fizzy drinks and gummy vitamin “treats” to actual food, we’re likely to get limited health outcomes from adding even the best of multivitamin/mineral supplements to a poor quality diet. Likewise, fortified products like breads and cereals are not as nutritionally dense as a balanced, nutritious diet consisting of a variety of whole, “real” foods.[51]

The best bet is likely to feed your child(ren) a balanced, nutritious diet, supplemented by a high-quality multivitamin.

Check out this article to learn about the value of multivitamin supplementation in adults.

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