If you’re pregnant, you’re probably taking prenatal vitamins on the advice of your obstetrician. It’s important to consult with your provider on that subject, largely because it’s such a critical period in the development of your baby-to-be. However, once your baby is born, it’s less clear what, if anything, to give in the way of nutritional supplements.
Several decades ago, when homemade, cow’s-milk-based formulas were more popular, adding vitamins to the mix was a necessity. And when agencies began to grade physicians on “quality measures,” pediatricians were often evaluated for the percentage of their patients who were on vitamins. That’s long been discontinued as a measure, and despite the persistence of ads for kids’ vitamins on TV, the benefit of giving them to an otherwise healthy child is less clear.
In order to make sense of the whether-to-give dilemma, it’s worth examining what vitamins do—and (probably) don’t do. We’ll do that, and also touch on the specific vitamins that kid doctors are most concerned about. (Although minerals are not vitamins, they’re often bundled in with them in nutritional supplements, and we’ll look at a couple of those as well.) We’ll then examine the more general question of whether to give a multivitamin, or supplement that contains many of the known vitamins and usually a few minerals.
What Vitamins Do
Think of the body as a big chemical factory. A myriad of chemical reactions keep the body functioning. While fats, proteins and carbohydrates, in addition to giving us energy and structure, provide many of the chemicals we need for these reactions, there are some we can’t make. These essential chemical compounds are known as vitamins, and we have to get them from the outside. There are two ways of doing this: through eating certain foods and through taking supplements. (Additionally, of course, Vitamin D can be made through sun exposure.)
If we’re lacking certain vitamins, the body doesn’t work as well. In some cases, certain organs are affected; for example, Vitamin A is needed for good eyesight. While most western diets (and breast milk) have enough of most vitamins to prevent deficiencies, there are certain nutrients that are a little trickier to get in. Let’s touch on a couple of these. (Some of these have been blogged on, and I’ll refer to those blogs for more details.)
Vitamin K is essential for blood clotting. While older children can make their own, usually from a combination of intestinal bacteria and diet, newborns have no such ability. For this reason, Vitamin K has been given by injection to newborns for almost 60 years. It’s got a great track record of safety; however, there’s been a trend of late for many parents to reject it. That’s a mistake due to the risk of hemorrhagic disease of the newborn, which can affect up to 12% of babies and can, in some cases, mean bleeding into the brain. Many times, the complication occurs without warning, and it can be irreversible.
Vitamin D has been increasingly thought to be an important supplement for infants. This is particularly true for breastfed infants as breast milk contains little Vitamin D. It’s long been known to help the body use calcium and phosphorus, which contributes to bone health. More recent research has focused on its potential role in preventing other diseases, such as diabetes and asthma. While this is not yet conclusive, most pediatricians recommend that infants receiving any breast milk receive a Vitamin D supplement of at least 400 international units (IU) daily.
Although not a vitamin, it’s worth talking about iron here. Iron deficiency anemia in children isn’t disappearing any time soon. Because it’s so prevalent in kids, it’s the one nutrient that pediatricians routinely perform blood tests for. Although symptoms of iron deficiency are usually pretty subtle, it affects growth and development. For this reason, many children will need an iron supplement. Giving iron to exclusively breastfed infants is also recommended by the American Academy of Pediatrics (AAP) until iron-rich foods (such as fortified cereals) are introduced.
Other nutrients are sometimes specifically recommended in certain fairly common situations. Zinc, which helps growth, development and brain function, is low in breast milk, and a supplement is sometimes desirable in breastfed babies. Vitamin B12, which is usually present in animal products, is lacking in the breast milk of vegan Moms. Fluoride helps in the development of decay-resistant teeth, particularly in areas where water isn’t fluoridated, although how much to give and when to start depends on several factors.
Giving Multivitamins (and What They Won’t Do)
In otherwise healthy children who are eating a regular diet for their age—breast milk, standard formula, and, when the time comes, solid food—the AAP doesn’t specifically recommend a multivitamin. Your provider may have her own opinion on the subject, and that’s worth talking about; most will OK multivitamins for parents who want to give them. (Keep in mind that children with medical problems may need additional supplements.)
It’s worth touching on one final vitamin-related issue. Over 33 years, in 3 states, I’ve heard the same request from parents: “Doctor, can you prescribe some vitamins to make my child eat?” There don’t appear to be good studies regarding an effect of vitamins on appetite in an infant or toddler who is healthy and growing and developing well. If you are concerned about your little one’s nutrient intake, your pediatric provider will indeed be your best source regarding the question of appetite and supplementation. But realize that the primary role of supplements is to prevent deficiency disease, not stimulate appetite. And I would guess that most providers would agree that with the possible exception of the specific nutrients discussed above, childhood obesity and its complications probably pose a greater threat to kid health in the U.S. these days than vitamin deficiency.