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Do kids need a vitamin supplement?

“Today” contributor, Mark Widome, explains that while many children take vitamins, only some really need the extra vitamins and minerals. Find out what's right for your child.
/ Source: TODAY

Many parents give their children vitamin supplements, but only a few children actually need them or will benefit from them. In his new book, “Ask Dr. Mark,” pediatrician and “Today” contributor, Mark Widome, talks about what vitamins are and what they are not. He provides guidance as to whether and when you should give your child a vitamin supplement.

WHAT ARE VITAMINS?

Vitamins are micronutrients, meaning that they are needed by the body in very small amounts, usually in amounts of less than a milligram per day. (Contrast micronutrients with macronutrients, such as proteins, fats and carbohydrates, which are required in relatively large quantities for growth and health.) Vitamins are essential micronutrients. By definition, the human body cannot manufacture its own vitamins. People must get their vitamins from the diet-or in the case of Vitamin D, from sunlight. If a person truly lacks a certain vitamin, a specific vitamin-deficiency disease or deficiency state will result.

Physicians and researchers became aware of the existence of vitamins in the late 1800s and early 1900s. Before that, it was presumed that humans and animals needed only fat, carbohydrate, proteins and minerals as the basic building blocks of a complete diet. Yet, early nutritional experiments with laboratory animals found that animals needed additional, then-unknown, factors in their diets to grow and thrive. With some experimental diets, animals would fail to thrive until a small amount of butter was added. In other experiments, adding some milk to the experimental diet resulted in health and growth. Researchers rightly concluded that there must exist additional unknown nutrients, required only in small amounts, that are nutritionally essential. The growth-promoting factor in butter was eventually named Vitamin A, and the factor in milk was named Vitamin B. It would take decades for the biochemistry of these essential nutrients and others-the vitamins-to be fully worked out. Eventually, thirteen separate vitamins were identified, and chemically characterized. Over the years, several Nobel prizes would be awarded to investigators for some of this important medical research.

Vitamin deficiency diseases, such as beriberi, scurvy, and rickets sound exotic and distant, but they were once common, occurring even in Western Europe and America. Before the appreciation of vitamins, these and other vitamin-deficiency diseases were assumed to be either infections or to be caused by toxins. Yet, it was puzzling that these diseases did not spread from person to person. Over time, researchers would piece together the evidence necessary to suspect-and then prove-that these diseases were caused by the lack of specific nutrients in the diet. Furthermore, these diseases could be rapidly cured by dietary improvement.

For historical reasons, vitamins are divided into two groups: the “fat-soluble” vitamins and the “water-soluble” vitamins. Vitamins A, D, E and K are fat-soluble. They are the ones plentiful in cod-liver oil! The several B vitamins and vitamin C are water-soluble. Most of these are plentifully distributed throughout the plant and animal world. The distinction between fat- and water-soluble vitamins is important today for children with diseases that cause them to have trouble digesting fats (certain diseases of the intestine, the liver or the pancreas.) Children with fat malabsorption will malabsorb the four fat-soluble vitamins as well. These vitamins will need to be supplemented in such children to maintain health.

WHICH CHILDREN NEED VITAMIN SUPPLEMENTS

Vitamins and other dietary supplements are heavily promoted for people of all ages. However, most healthy children generally do not need-and will not benefit from-supplemental vitamins.

The best way to assure a healthy diet is to emphasize variety: to eat foods each day from the different food groups and to offer meals with nutrients that complement each other.

Even children who are described as “picky eaters,” who are otherwise healthy, are unlikely to benefit from vitamin supplements. And vitamin supplements will not correct an otherwise unhealthy or unbalanced diet: one that has too much sugar or fat or too little protein, fiber or calcium. The way to correct an unbalanced diet is to eat a more balanced one.

Who does need vitamins? Pediatricians recommend infant vitamin drops for babies who are breast-fed, in order to make sure that they are getting adequate Vitamin D. This is particularly true in the winter months when it is unlikely that small infants are getting very much sunlight. Vitamin D is important for rapidly growing bones and prevention of rickets. Formula-fed infants (who are drinking at least 17 ounces of formula per day) do not need vitamin supplements, as infant formulas are already fortified with vitamins.

Children (and adults) who are vegan vegetarians, those eating no foods of animal origin at all, need to have supplements of Vitamin B-12, a vitamin important for blood cells. Children with certain chronic diseases, particularly those that interfere with absorption of nutrients from the digestive tract, will often need vitamin supplements as prescribed by their physicians. The same is true for children with debilitating diseases that might leave them malnourished. Vitamins, particularly B and D vitamins, may be recommended for premature babies because of their very rapid growth after they go home from the neonatal intensive care unit.

A recent recommendation from the American Academy of Pediatrics further recommends that children and adolescents of any age who drink less than a pint of milk a day may be at risk of Vitamin D deficiency. Although this deficiency may be corrected by as little as several hours of exposure to sunlight each week, it is hard to judge how much sunlight any individual person is getting. Therefore these children may benefit from a vitamin supplement.

Folic acid is a B vitamin that is important for growth and for normal red blood cells. Because the vitamin is present in many foods, deficiency of this vitamin is uncommon in childhood. However, a number of studies have shown that if women receive folic-acid vitamin supplements before and during the early weeks of pregnancy, they can reduce by half their risk of having a child with a neural-tube birth defect, such as spina bifida. Therefore, the American Academy of Pediatrics and other organizations recommend that all women capable of becoming pregnant routinely take a vitamin supplement containing folic acid.

WHAT ABOUT MINERALS?

Children with iron deficiency, as demonstrated by a blood test, should take an iron supplement until the deficiency is corrected. (Iron supplements must have child-resistant caps and be kept well out of reach of young children because an overdose of iron is very toxic.)

Calcium supplements are sometimes recommended for children who are on a milk-free diet because of milk intolerance. (Though soy-based infant formulas contain plenty of iron.)

Calcium and iron supplements may also be recommended for teenage girls and young women because of the extra iron they loose through menstruation and because adequate calcium supplies when women are young is thought to help protect them years later when they are prone to bone fractures after menopause.

In growing children, fluoride is an essential mineral nutrient for strong teeth. Most of the U.S. population gets adequate fluoride in the water they drink, but a significant minority of children has a water supply that is deficient in fluoride. For those children, the pediatrician or dentist will prescribe a daily fluoride supplement in the form of drops or chewable tablets. It is important to take no more fluoride than prescribed, because excess fluoride can cause staining on the permanent teeth.

A reminder to readers-and to viewers: The child health information here (and on the TODAY show) is meant to complement-not replace-the advice of your child’s physician. Every child is different, and individual circumstances will dictate the best advice for your own child’s situation. When you have questions about your child’s health, consult with your child’s pediatrician for individual guidance. Excerpted from “Ask Dr. Mark: Answers for Parents.” Copyright © 2003 by The National Safety Council, and available from www.nsc.org. Used by permission of NSC Press. Mark Widome is Professor of Pediatrics at the Penn State Children’s Hospital. He writes frequently on topics of interest to parents and is a regular contributor to the TODAY show.