Sunday, March 14, 2010

How To Tell If Your Child Needs A Supplement

This article is a guest post by Maryann Tomovich Jacobsen. Maryann is a registered dietitian, mother of two and creator of, a blog dedicated to giving parents the most credible nutrition advice. Subscribe to her site and get free nutrition downloads and other member benefits.

"As long as they eat a variety of food, they should be fine," the pediatrician tells you. But those comments do little to satisfy your concerns. In fact, the two questions you had before going to the doctor just got louder:

Are my children getting all the nutrition they need to grow and thrive? And if not, do I need to supplement their diet?

The easiest way to get to the bottom of this nutrition dilemma is to answer some key questions about what your children eat on a regular basis.

1. Do they eat from all the food groups? If your children eat from all the food groups including dairy, meats, grains and fruits and vegetables (not every day but their overall pattern), then they probably don't need a multivitamin.

Many parents are concerned about a lack of vegetables. Children who eat a variety of fruit with some vegetables should be fine, especially if the fruit is rich in vitamin C like oranges, strawberries, cantaloupe and sweet potatoes. Cantaloupe and sweet potatoes are great because they contain both vitamins A and C (two key nutrients kids need). Carrots, often liked by kids, are rich in vitamin A. Of course many greens are chock full of vitamin A but children do not need to eat them to meet their needs (but, please, keep offering).

But if your child skimps on whole food groups, like all fruits and vegetables, a multivitamin may be a wise choice. For more on this see Should Children Take Multivitamins?

2. Do they eat fish twice a week? According to Evelyn Tribole, MS, RD, author of The Ultimate Omega-3 Diet, children who do not eat fish twice a week will benefit from fish-oil supplements. That's because the types of omega-3 fatty acids present in fish (DHA and EPA) are essential for brain health. This is different from the omega-3s found in plant sources like flax and walnuts (ALA), which only convert a small percentage to DHA in the body.

So how much is enough? According to Tribole, she recommends children 2-3 years old get 433mg of DHA/EPA with a minimum of 145mg of DHA, 4-6 years old get 600mg of DHA/EPA with a minimum of 200mg of DHA and 7 years and older including adults get 650mg combined with a minimum of 220mg of DHA. For pregnant women the DHA minimum is 300mg. Check the supplement facts label to see how much DHA/EPA is in each serving. For more details see: Kids & DHA: The Complete Guide for Parents.

3. Do they drink milk and get regular exposure to sunlight? According to a 2009 study published in Pediatrics, 7 out of 10 kids have lower than optimal vitamin D levels. The AAP recommends 400IU of vitamin D for breastfed children and older kids who drink less than 4 cups per day (for young children 4 cups would be too much).

What about sunlight? It's difficult to tell if your child is getting enough to get the vitamin D requirements. According to vitamin D expert, Dr Michael Hollick, being out in the sun between 10am and 3pm provides the most exposure to vitamin D. Children with dark skin, who are overweight or wear sunscreen, will not make much D from the sun. If you aren't sure, check with your pediatrician.

4. Are they vegetarians (or act like one)? Some kids are raised vegetarians and others simple eat like one. Lacto-ovo vegetarians (eats no animal products except milk and eggs) usually don't have a problem meeting their nutrition needs. But vegans (consumes no animal products) usually can't get enough B12 from plant food so they either need to supplement or consume fortified products.

Babies and toddlers are at higher risk for iron deficiency anemia. This common childhood nutrition deficiency has declined in the last 30 years due to the addition of iron to formula and cereals. And while many pediatricians test for anemia in babies, this can still be a problem in toddlers as they no longer consume iron-fortified liquids and cereal.

So if your child doesn't eat meat, fortified cereals or plant-based protein sources (soybeans, lentils, white beans, chick peas), check with your pediatrician about their iron status. Parents can help increase iron from foods by serving vitamin C-rich foods with plant sources of iron (or iron-fortified products) which increases their absorption three fold.

5. Do they get enough calcium-rich foods? As kids get older calcium can become a problem nutrient. 1-3 year olds need 500 mg per day, 4-8 year olds need 800 mg and 9-18 year olds need 1300 mg. Children under 8 usually don’t have a problem meeting needs as most dairy products such as milk, cheese (1oz) and yogurt have about 300mg of calcium. Toddlers need two cups of milk/yogurt to meet their requirements and 4-8 year olds need 2 cups milk/yogurt and 1oz of cheese to get theirs.

But when kids approach puberty their calcium needs skyrocket. This is also a time many kids drop the milk for sweetened beverages. Nondairy sources of calcium include calcium flavored soy milk (300-400mg), fortified cereals (200-1000), tofu (200-300), ½ cup spinach (150mg) and ½ cup kale (90mg)

Just as kids’ calcium needs go up, so does their ability to understand why they need to include calcium-rich foods, so talk to them about it. And if they don’t quite get to the 1300 mg of calcium with food, you can choose a chewable calcium supplement to help them get there. Their growing bones will thank you.


  1. We eat well, but being in the Northern climes, we take and recommend a Multi for kids from October-April in Minnesota for that Vitamin D :)

  2. Excellent article -- thanks for laying everything out so clearly.

  3. Glad you found the information helpful!


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