Q. Can a nutritional supplement take the place of eating a diet rich in healthy whole foods?

A. Nutrition research strongly suggests that the answer is no. But a combination of some whole foods and high-quality supplements may be the best compromise most parents can expect, one that is likely to prevent nutrient deficiencies even if it does not provide the nutritional benefits of a diet truly rich in whole foods. Children from low-income households are at risk of several nutritional deficiencies and, for them, supplementing with a high-quality multivitamin may be the best safety net preventing them from falling into nutritional deficit.

Q. When should I consult a doctor?

• Some nutritional supplements and herbs can be poisonous if taken in the wrong amounts, even if they are sold over the counter or are formulated for children.
• Always consult a qualified doctor if you have questions about the safety or efficacy of supplements for your child.

Q. What about herbal supplements?

• Herbal supplements for children are not recommended on a daily basis, but instead may be considered to help address specific health concerns. For example, chamomile and mint teas can be useful for upset stomachs, and ginger syrup or tea may help a child who is nauseated.
• Consult with a qualified doctor to determine if herbal supplements are right for your child.

Q. Does my child need a multivitamin?

• While most well-nourished children probably do not need a multivitamin, there appears to be no harm (and probably some benefit) from taking a good one. A high-quality multivitamin will provide at least the RDA of its key ingredients, it will contain no unnecessary additives, and it will meet its label claims for nutrient content. Consult with a doctor if you have questions about how to choose a high-quality multivitamin.
• A multivitamin usually provides the Recommended Dietary Allowance (RDA) of most essential vitamins and minerals. Several good children’s multivitamins are available, some in chewable form.
• Children from low-income households are at the highest risk of nutritional deficiencies. Studies suggest that, in these groups, multivitamin supplementation can improve brain function and attention in school, fortify the immune system against infection, and prevent nutritional deficiency diseases such as anaemia (caused by deficiency of iron or certain B-complex vitamins) and rickets (caused by vitamin D deficiency).
• Improved performance on IQ tests has been observed in some children who take a daily multivitamin, compared with those who do not. However, the results of this research are not conclusive, and it may be that the children who benefited were marginally deficient in iron and had that deficiency corrected by the multivitamin.

Q. Does my child need an iron supplement?

• Iron-deficiency anaemia is the most common nutritional deficiency disease among children and adolescents. It is less common now that breakfast cereals and breads are fortified with iron. But adolescents, particularly adolescent girls who have begun menstruating, may be at increased risk of developing iron deficiency.
• Breast-feeding infants less than three months of age do not need iron supplements.
• Formula-fed infants do not need iron supplements because baby formula is fortified with iron.
• Children between the ages of three months and three years may need iron supplementation in the amount of 1 mg per kilogram (2.2 pounds) of body weight per day. However, some experts disagree, saying that once solid foods have been introduced the need for iron supplementation goes away. This depends on the child’s individual diet.
• Children who eat nutritionally inadequate diets may be at risk of iron deficiency, which can cause anaemia and impair brain function and intellectual performance. Such children require dietary intervention and/or supplemental iron.
• Some children’s multivitamins contain iron; some do not. Be sure to check the label to see how much iron is in the multivitamin. Do not give your child iron if he or she does not need it as too much iron can be dangerous. Consult your pediatrician to determine if your child needs iron.

Q. Does my child need fluoride?

• Fluoride is the only nutrient that has been proven to reduce the incidence of dental cavities or caries.
• Children who live in areas where drinking water is not fluoridated may need to take sodium fluoride supplements to get adequate fluoride, even if they use fluoridated toothpaste. The amount to take is determined by the child’s weight, and the supplement should be prescribed by a doctor.
• Do not give your child fluoride supplements if he or she drinks fluoridated water. Too much fluoride can cause dental fluorosis, which permanently discolors the enamel of the teeth.
• The Centres for Disease Control and Prevention (CDC), the American Dental Association, the American Academy of Family Physicians, the American Academy of Pediatrics, and many other similar organizations recommend that children use fluoridated toothpaste, even if they live in areas with fluoridated drinking water (as long as the water contains no more than 1.2 mg per litre).
• Children under six months of age do not need fluoride since they do not have their primary teeth.
• Fluoride must be used in precisely correct amounts as too much can be toxic.
• Your local water bureau can tell you how much fluoride is in your drinking water. Water testing kits are also available.

Q. Does my child need a vitamin B12 supplement?

• Vitamin B12 deficiency can cause serious, irreversible nerve damage and anaemia. Reliable amounts of vitamin B12 can be obtained only from foods of animal origin (in other words, fish, meat, poultry, eggs, milk, and milk products).
• Tempeh, seaweed, and some other foods not of animal origin may contain some vitamin B12, but the amounts are not consistently high enough for these foods to be dependable sources.
• Therefore, children who consume a vegan diet (one that contains no animal products whatsoever) need to take a vitamin B12 supplement. Most children’s vitamins contain sufficient vitamin B12 to meet this requirement.
• The RDA for children ages 1 to 3 is 0.9 mcg per day; for children ages 4 to 8, the RDA is 1.2 mcg per day; for children ages 9 to 13, it is 1.8 mcg per day. Adolescents (ages 14 to 18) require the same amount as adults: 2.4 mcg per day.

Q. Does my child need more calcium?

• Calcium is needed to help a growing child or adolescent reach peak bone mass, which will decrease their later risk for developing osteoporosis.
• Unfortunately, poor dietary choices—particularly among adolescent girls—may lead to lower-than-recommended calcium intake.
• Many children’s vitamins include calcium, but it may not be enough for adolescents, especially those with increased requirements (for example, female athletes who have begun their menstrual periods). Children, adolescents, and young adults (ages 11 to 25) need to get 1,200 mg of calcium per day from all sources.

Q. Does my child need a vitamin D supplement?

• Vitamin D is produced in the skin after exposure to sunlight. If sunlight exposure is adequate, there is no requirement for additional vitamin D.
• People who get little exposure to sunlight, either because of living conditions or geographical location, may be at risk of developing a deficiency of vitamin D, which is needed for proper bone formation and to prevent rickets.
• Cow’s milk is fortified with vitamin D, and most children’s vitamins provide sufficient vitamin D.
• Children over six months of age need 400 IU of vitamin D per day.

Q. Are essential fatty acid supplements necessary?

• Essential fatty acids (EFAs) are needed for proper development, particularly of the brain and nervous system. They also contribute to the health of the heart and skin. A diet that includes nuts and fish should provide ample EFAs. Some children whose diets are low in these foods may benefit from a high-quality fish oil supplement.
• Fish oil supplements should be free from contaminants, such as pesticide residues and heavy metals, particularly mercury. These contaminants, which pollute our oceans and are consumed by fish, can be removed from the oil during the manufacture of a supplement. It's hard to know which products have had these removed, but companies with high purity standards will often advertise it.

Q. Do some children need additional vitamin or mineral supplementation?

• Some children who have poor or restricted diets, liver disease, or other chronic medical problems (especially those that lead to fat malabsorption, such as cystic fibrosis) may need specific vitamin and mineral supplementation to prevent nutrient deficiencies.
• Only a qualified doctor should prescribe nutrients to treat a medical condition.