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Kids & Vitamins

At a recent nutrition conference, I asked dietitians whether they give their kids vitamin and mineral supplements. I assumed that most didn't -- after all, some of these professionals had written books on getting kids to eat nutritious foods. Surely, their boys and girls wouldn't be taking a supplement..

But much to my surprise, every dietitian I spoke with confessed to buying supplements -- even if their child's diet was just a little less than perfect. "My daughter Rebecca, who's 11, makes healthy choices most of the time. I'm giving her a multivitamin for a little extra cushion," says Althea Zanecosky, R.D., a Philadelphia-based spokeswoman for the American Dietetic Association. Adds Roxanne Moore, R.D., a dietitian for the Maryland Department of Education in Baltimore and the mom of 3-year-old Cameron: "Her diet isn't bad, but I give her a multivitamin every other day just to be sure."

Picky eaters aren't the only kids taking vitamins these days. With scores of studies revealing the consequences of nutrient deficiencies in children -- not getting enough iron results in poor concentration in school; lacking in calcium lowers bone mass -- even kids with healthy diets are using supplements because their parents want to play it safe.

And the kids don't seem to mind. At the very least, products are fruit-flavored and shaped like popular cartoon characters. Some supplements even look and taste like gumballs, gummy bears, or jelly beans. From November 2001 to November 2002, sales of vitamins and minerals for kids grew almost 10% in natural product supermarkets, according to SPINS, a research firm based in San Francisco. USDA data show that roughly half of 4- to 8-year-olds -- the largest number ever -- take a nutritional supplement.

But given the recent research, is such widespread use warranted? "Probably not," says Robert Baker, M.D., a Buffalo-based member of the American Academy of Pediatrics' nutrition committee. "If you look hard enough, you'll find a flaw in most every child's diet. But most kids get enough nutrients; for them there is no benefit to a multivitamin." In fact, the AAP suggests multivitamins only for kids who come from a low-income family, follow a vegetarian diet, take part in a weight-loss program, or have an eating disorder, a disease that affects metabolism, or a poor appetite.

While most of these risk factors are clear, the last one can cause confusion. Many parents are unsure whether a child's appetite is adequate, so they give him a supplement just in case. "I understand parents' fears that their child is missing out on an important nutrient. The only problem I have with the better-safe-than-sorry approach is that some moms and dads may rely on the supplement too much rather than encouraging improvements in their child's diet," says Mary Frances Picciano, Ph.D., a senior research scientist at the National Institutes of Health's Office of Dietary Supplements in Bethesda, MD. Generally, supplements deliver vitamins and minerals, she says, while foods offer these nutrients as well as a smorgasbord of other health-promoting compounds.

So what's best for your child? We've outlined a way to find out.

1. Check up on children's vitamin and mineral needs.
Except for calcium, kids' nutrient requirements are far less than adults'. For instance, 4- to 8-year-olds need 25 milligrams (mg) of vitamin C daily -- the amount in just two ounces of orange juice. And just one peanut butter sandwich can supply more than 100 mg of a 4- to 8-year-old's 130 mg magnesium requirement. Unfortunately, you can't rely on nutrition labels to provide you with this information. Most labels use Daily Values, a measure based on the optimum amount for adults. The label on a package of rolls might state that one contains 15% of the Daily Value of the B vitamin folic acid, for example, but that's the equivalent of 30% of a 4- to 8-year-old's Recommended Dietary Allowance. The 35% of the Daily Value of thiamin contained in a serving of pasta satisfies 87% of the RDA for children 4 to 8.

How Many Nutrients Kids Really Require

The percentages of vitamins and minerals that are listed on food labels apply to adults' requirements, measured by standards called Daily Values (DV). But the Recommended Dietary Allowance (RDA) for children is usually much lower. The chart below pinpoints the amounts of different nutrients that your kids need daily. For more information about RDAs visit the Office of Dietary Supplements:

 
RDA for kids 1 to 3

Calcium -- 700 mg
Copper -- 340 mcg
Folic acid -- 150 mcg
Iron -- 7 mg
Magnesium -- 80 mg
Niacin -- 6 mg
Vitamin A -- 1,000 IU
Vitamin C -- 15 mg
Vitamin D -- 600 IU
Zinc -- 3mg

RDA for kids 4 to 8

Calcium -- 1000 mg
Copper -- 440 mcg
Folic acid -- 200 mcg
Iron -- 10 mg
Magnesium -- 130 mg
Niacin -- 8 mg
Vitamin A -- 1,333 IU
Vitamin C -- 25 mg
Vitamin D -- 600 IU
Zinc -- 5 mg

RDA for kids 9 to 12

Calcium -- 1,300 mg
Copper -- 700 mcg
Folic acid -- 300 mcg
Iron -- 8 mg
Magnesium -- 240 mg
Niacin -- 12 mg
Vitamin A -- 600 mcg RAE
Vitamin C -- 45 mg
Vitamin D -- 600 IU
Zinc -- 8 mg

DV

Calcium -- 1000 mg
Copper -- 2.0 mg
Folic acid -- 400 mcg
Iron -- 18 mg
Magnesium -- 400 mg
Niacin -- 20 mg
Vitamin A -- 5,000 IU
Vitamin C -- 60 mg
Vitamin D -- 600 IU
Zinc -- 15 mg

2. Grade your child's diet.

Once you've pinpointed the target amount, try to determine whether your child's intake is in the ballpark. The best way: Record all the meals, snacks, and drinks your child consumes on two weekdays and Saturday or Sunday; note the portion size too.

Then go to the University of Illinois Urbana-Champaign Web site at www.nat.uiuc.edu, where you can plug in the foods and portion sizes for each day. The site analyzes your child's diet and gives you a chart noting each day's total calories, protein, carbs, fat, and essential nutrients compared to the recommended amounts for a child of that gender and age. Average the results of the three days. Don't sweat it if your child misses 100% of all the nutrients on one day -- it's the average that counts.

If the program fails to detect a shortfall of any nutrient, your child doesn't need a vitamin supplement. "While giving a healthy eater a children's supplement wouldn't result in an overdose of nutrients -- even iron -- it's not necessary," says Dr. Picciano. Plus, some nutrients work best in a narrow range close to the RDA. For instance, a bit too little or too much zinc wears down the immune system. If the program identifies a problem, however, highlight the nutrients in question and move on to the next step.

 
3. Fill in nutrient gaps.

You'll have an easy time correcting a shortage in one or two nutrients. Suppose your 6-year-old meets 75% of her calcium needs. By substituting a cup of milk or calcium-fortified o.j. for a cup of soda, fruit punch, or juice, she'll exceed her calcium needs. Is iron the issue? Trade a jelly-topped bagel for a tuna sandwich or add chicken to pasta and her iron intake will rise by at least one-third. To find food sources for specific nutrients, go to www.nutrition.org/nutinfo.

But if your child is deficient in many nutrients, one or two switches are unlikely to fix the problem -- and he'll probably balk if you make sweeping changes at once. So how should you begin? Rethink the snacks you offer, suggests Elizabeth Ward, R.D., Reading, MA-based author of Healthy Foods, Healthy Kids. For instance, if your child noshes on potato chips and fruit punch, switch to trail mix and a fruit smoothie made with milk to considerably up her intake of calcium, vitamin C, and B vitamins. If she usually munches on cookies or cupcakes, replace them with banana bread (loaded with potassium), carrot cake made with whole wheat flour, or pumpkin muffins (both rich in vitamin A).

 

Then use the children's version of the USDA MyPlate.gov at www.usda.gov to determine the proper portions and how many servings your child needs from each of the food groups. If your child resists, try to win her over by letting her help out in the kitchen. Zanecosky says her daughter started eating more iron-rich foods such as scrambled eggs and chili with beans and meat when she taught her how to prepare them.

4. Reexamine her diet.

Give yourself a month to improve your child's eating habits. Then recalculate his nutrient intake using the University of Illinois software. If you still find shortfalls, consider a supplement, although you should continue trying to improve your child's eating habits, says Dr. Picciano. Which vitamin and mineral supplement is best? It depends.

If your child's diet is insufficient in calcium only, you should opt for a calcium supplement rather than a multivitamin because it contains more of the bone-building mineral. Otherwise, try a multivitamin/multimineral tablet that doesn't contain herbal ingredients and is made specifically for kids, says Thomas Badger, Ph.D., director of the USDA Children's Nutrition Research Center at Arkansas Children's Hospital in Little Rock. "Many herbal ingredients are unsafe for children, and adult tablets may contain too much of certain nutrients for kids' bodies," he warns.

Since the U.S. government doesn't verify that a supplement contains the amount of the nutrients indicated or that they are in a form the body is capable of absorbing, consider a brand that participates in the United States Pharmacopoeia's Dietary Supplement Verification Program. Companies that meet the stringent requirements can be found at www.usp-dsvp.org, and the certification mark will appear on supplement labels.