ABC's of Missing Vitamins for Kids (Or Not)

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When Natasha Solis-Ramos asked her daughter's pediatrician about the

18-month-old's diet, he said not to worry that the active toddler was eating

only scanty servings of meat and other sources of protein.

Still, Ms. Solis-Ramos did worry, and she decided to start giving the girl a

chewy multivitamin. Soon, she plans to add a cod-liver-oil supplement

containing omega-3 fatty acids. " It's supposed to be really good for you, so

I don't see the harm in it, " says Ms. Solis-Ramos, 29 years old, a futures

broker in Chicago.

Americans have been consuming growing quantities of dietary supplements in

recent years, and now their kids are starting to do the same. Sales of

children's supplements were estimated at $1.1 billion in 2008, the first

year such sales were tracked, with multivitamins the most popular category,

according to the Nutrition Business Journal. The trade publication says

sales are growing 4% to 6% a year, with companies rolling out an array of

new products.

Good nutrition is particularly important during childhood and adolescence,

when young bodies are growing fast. Still, some pediatricians say the growth

in supplement sales suggests parents may be popping too many daily pills

into children. Some supplements taken in excessive doses, such as vitamin A,

can be dangerous. The benefits for kids of others, such as omega-3 fatty

acids, have sometimes been overhyped. *Both the American Academy of

Pediatrics and the American Dietetic Association say nutrition is best

gained through food, and routine vitamin use isn't needed if children have a

good and varied diet.*

Duffy MacKay, a vice president at the *Council for Responsible Nutrition, a

supplement-makers' group*, says most children aged about 2 to 18 should

probably take multivitamins because kids generally don't meet nutritional

recommendations through food alone. Most children's vitamins are formulated

to provide less than recommended daily values of many nutrients, to allow

for kids to get some of their needs from other sources, he says.

Some nutrients, such as calcium and iron, tend to be absorbed better from

certain foods than from supplements, because of the form in which they

occur, says Dennis Bier, director of the U.S. Department of Agriculture's

Children's Nutrition Research Center at Baylor College of Medicine in

Houston. He says foods also " supply a variety of other known and unknown

nutrients, " beyond those generally found in vitamins. The U.S. Dietary

Guidelines note that foods have substances such as carotenoids and

flavonoids, as well as protease inhibitors that may help prevent chronic

health conditions.

, 42, a mother of three who lives in Berkeley, Calif., says

she prefers her kids to get their nutrients through food. With her oldest

and middle sons, now 9 and 7, she initially pushed multivitamins and some

other supplements, including a black-elderberry extract that was supposed to

help boost their immunity during flu season.

When the boys started saying they tasted bad, she stopped. And she hasn't

given any supplements to her youngest, who is 2. Instead, she works hard to

make sure the kids get a mix of vegetables and meats, and some time in the

sun for vitamin D. " I wanted to make it more organic-food-based, rather than

supplement-based, " says Ms. , an assistant history professor at Chico

State University.

For picky eaters, some use of children's multivitamins may make sense to

fill gaps in nutrition, doctors say. Children sometimes fall short of

recommended amounts of certain essential nutrients, including potassium,

magnesium and vitamin E, as well as fiber, because they often don't eat

enough fruits, vegetables and whole grains, nutritionists say. Calcium is

also a frequent problem, particularly for preteen and adolescent girls, who

need it to help build their bones, while breast-fed babies may need iron

before they start on solid foods.

The American Academy of Pediatrics says all infants and children through age

18 need a daily dose of vitamin D that's at least 400 international units, a

standard measurement. That's the amount in four eight-ounce glasses of milk.

The group says kids who aren't getting that much should likely get a

supplement.

Kids who are vegetarians can meet their nutritional needs through food

alone, without needing supplements, says Dee Sandquist, a dietitian in

Fairfield, Iowa, and a spokeswoman for the American Dietetic Association.

But parents have to make sure they're getting enough of certain nutrients

often received from meat, including vitamin B-12 and iron. Vitamin B-12 can

be found in yogurt and cheese, while iron is available from beans and seeds,

according to government data. Vegans may have a bigger challenge, since

without dairy products they could run short on vitamin D and calcium, as

well as other needs.

To gauge where their kids' diets may fall short, parents can check the

federal government's dietary guidelines, available at www.health.gov, which

are expected to be updated this year. Recommended allowances of vitamins for

teens 14 and older tend to be close to adult doses, but they're not always

identical.

The pediatricians' group currently doesn't recommend omega-3-fatty-acid

supplements, says Jatinder Bhatia, chairman of the pediatrics academy's

committee on nutrition. In adults, omega-3s have been tied to heart-health

improvements, but scientific proof backing alleged brain and eye gains in

kids is limited, doctors say.

*In recent months, the Federal Trade Commission has warned 13 companies

about over-hyping brain and vision benefits potentially tied to omega-3

supplements for children. Last year, Northwest Natural Products Inc. stopped

using pitches like " promotes healthy brain function " for an omega-3 gummy

after the FTC began investigating whether the company could substantiate its

claims with scientific data. An official from the company said in an email

that it and the FTC " mutually agreed upon voluntary changes. " *

When parents do give supplements to kids, they should check with doctors and

make sure products contain the right balance, physicians say. Adult

vitamins, as well as pills with large amounts of a single vitamin or

mineral, may pose a risk of overdosing, particularly as more and more kids'

foods are fortified.

*A study of 1,847 preschoolers in Belgium, published this year in the

journal Appetite, suggested that both supplement users and those who didn't

take them were often meeting their nutritional needs through food alone,

with the exception of vitamin D*. *And some kids who got supplements were

absorbing zinc above the recommended upper limit. The study said chronic

zinc overdoses may be tied to suppressed immune response and a decrease in

the body's absorption of copper, which helps in the formation of red blood

cells, among other functions. A study on U.S. kids, published in the Journal

of the American Dietetic Association in 2006, found some supplement-taking

toddlers were getting above the upper limits of vitamin A, zinc and folate.

Chronic excessive intake of vitamin A can lead to symptoms including liver

problems and reduced bone density.*

Absorbing a bit too much of some nutrients, like the B vitamins, just

results in " expensive urine, " because the excess is excreted, says Kathi

Kemper, a pediatrician at Wake Forest University Baptist Medical Center.

There's also little known risk for most people from large doses of folate,

according to the National Institutes of Health's Office of Dietary

Supplements.

Herbal supplements that don't offer nutrients, such as St. 's wort or

echinacea, are likely not a good idea for kids, says Frances Picciano,

a senior nutrition research scientist at the NIH's dietary supplements

office. Many herbs have shown no benefits in major studies in adults, while

a few have been linked to side effects. A 2007 article by a NIH researcher

in the journal Clinics in Liver Disease listed comfrey, chaparral and kava

among other herbs potentially tied to liver damage.

Children are " more vulnerable " than adults to any risks, since they are

smaller and still developing, says R. Greer, a professor of pediatrics

at the University of Wisconsin.

The Food and Drug Administration has also repeatedly warned about

supplements often marketed for body-building or weight loss that illegally

contain performance-enhancing drugs and undeclared pharmaceuticals.

Supplements are much less closely regulated than drugs, which are tested

extensively and must win FDA approval before going on the market. In the

case of supplements, " products go out and then the government chases the bad

actors, " says , an official in the FDA food center's division of

dietary supplement programs.

In one case, a multivitamin liquid called Total Body Formula that contained

well above the recommended dose of selenium caused symptoms such as vomiting

and diarrhea in at least 22 people aged 18 or younger in 2008, including one

4-year-old, according to researchers at the Tennessee Department of Health

who helped author a medical journal article on the problem. The product was

recalled. At the proper dose, selenium is used to form enzymes that play a

role in thyroid function and the immune system. A lawyer representing Total

Body Essential Nutrition Inc., which distributed the supplement, declined to

comment.

Mr. MacKay at the Council for Responsible Nutrition, the supplement-makers'

group, says the " overwhelming majority of the companies...are doing a great

job " on safety.

-

Ortiz, MS, RD

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