Does Your Child Need a Multivitamin?

Let me preface this by disclosing that I am not a “supplements naturopath”—my modus operandi is to focus on correcting a patient’s lifestyle. However, I am not averse to supplementation, particularly if—upon consideration of available evidence—it is indicated.

Many years ago, as a student working in a health store in Toronto, I was asked by the storeowner to offer customers samples of a children’s multivitamin. I did so, unaware at the time that the issue was so controversial! More than one parent indignantly declined, declaring that their pediatricians claimed children did not require nutritional supplementation.

Are kids getting enough nutrients?

The intent of multivitamin/mineral use is to compensate for nutritional shortcomings in a person’s diet. The obvious first question in determining whether your child needs a multivitamin is this: are they consuming all the nutrients they require from the food they are eating?

A 2006 report prepared by the Region of Waterloo Public Health and the University of Waterloo determined that 68% of grade six students in the Waterloo Region of Ontario were not meeting the fruit and vegetable consumption recommendations laid out in Canada’s Food Guide. The same study found that consumption of “meat and alternatives” (e.g. tofu) was inadequate in 46% of students, an important factor in the associated findings of inadequate intake of iron and zinc in 11% and 31% of students respectively.

Another study, published that same year in the Journal of the International Society of Sports Nutrition, determined that 0% of (adult) subjects were able to meet their micronutrient (i.e. vitamins and minerals) Recommended Daily Allowances (RDA’s) through diet alone.

The most recent Canada Food Guide no longer recommends serving numbers but instead recommends favouring plant-based sources like whole vegetables, fruits, protein foods, and grains in abundance. Another good guideline is The Kids' Healthy Eating Plate, developed by Harvard University.

The Dietary Guidelines for Americans recommend daily amounts via cups/ounces (as opposed to servings) that gradually increase between the ages of 2 to 13.

• Vegetables: 1-1.5 cups up to 2-3.5 cups, respectively
• Fruit: 1-1.5 cups to 1.5-2 cups, respectively
• Protein: 2-4 ounces up to 5-6.5 ounces, respectively

Does your child meet these guidelines? If not, consider supplementing their diet with a multi-vitamin/mineral.

Tracking your child's nutritional intake

Take the time to learn and understand how to consistently eat a balanced, nutrient-rich diet. Include in this a refresher on what constitutes standard food-serving sizes.

Keeping a food journal is also a good idea, giving you access to the data you need to build a consistently healthy, balanced diet for you and your family (be sure to note: do they actually eat it?).

Choosing a good children's multivitamin

As with all things in life, quality in nutritional supplements is wide-ranging, and as a rule, you get what you pay for.

What determines the quality of a nutritional supplement?

• Does the product contain the full spectrum of nutrients required for health, and in adequate quantities?
• Does the product contain well-absorbed, well-tolerated, optimally bioactive forms of the nutrients it contains? It’s a little known fact that minerals and vitamins are available in differing forms. For instance, magnesium carbonate may result in a net loss of magnesium from the body when compared to magnesium glycinate, which is more efficiently absorbed and better tolerated.¹
• Certain nutrients (e.g. vitamin A, iron), are potentially toxic when consumed in excess. Does the product contain excessive amounts of potentially toxic nutrients?

The Comparative Guide to Nutritional Supplements¹ assesses and rates the quality of over 1,300 multi-vitamin/minerals on the above and 14 other criteria, offering an overall score out of five stars. The majority of inexpensive store brands earned very poor ratings (one star representing a fairly typical score).

Finding a high quality supplement for your child

• Shop for a “children’s” multivitamin/mineral, which will include potentially toxic nutrients in amounts appropriate for children’s smaller bodies
• Visit a health store for a higher-quality range of options than a national drug or grocery store chain
• Be willing to invest in a quality product—even a seemingly expensive product will typically amount to approximately $1.00 daily.

Vitamins and minerals forms to look for

• Calcium as not only calcium carbonate, but calcium citrate, which is more easily absorbed and more bioavailable
• Folate as with methyltetrahydro-folate and not folic acid
• B12 as  methylcobalamin instead of the relatively inferior cyanocobalamin form
• Vitamin E in the form of d-alpha tocopherol instead of the d/l-alpha tocopherol form

You also want to ensure that a variety of minerals are present in the multivitamin—not only calcium and iron.  Zinc, magnesium, selenium are all important as well.  

Non-therapeutic ingredients to avoid in multivitamins

• A lot of sugar. The exact amount is not included on the label, but confectioner’s sugar, corn syrup solids (which are 100% sugar) and dextrose monohydrate (sugar) are three of the first seven ingredients listed.
• Sorbitol, which may cause digestive upset.
• Several food colourings, including Red 40 and Yellow 6, both of which contain the carcinogen benzidine.

If you review the full ingredient list, you will note that I did not include aspartame, the most plentiful ingredient listed, as a point of concern. Although controversial, there has been no overwhelming evidence that aspartame is unsafe and the American Cancer Society has so far concluded, "The results of epidemiologic studies (studies of groups of people) of possible links between aspartame and cancer (including blood-related cancers) have not been consistent."

It is important to note that it may be difficult to find a multivitamin that meets all the criteria mentioned. All forms of these vitamins and minerals will be safe for your child; the difference is in the bioavailability and absorption rate. Prioritize finding a product that does not include the non-therapeutic ingredients such as food colourings and excess sugar first, and then move on to considerations of the most bioavailable forms of the vitamins and minerals contained.

Rumours about the risks of multivitamins

Over the past decade or so, several studies have been published that have demonstrated a correlation between multivitamin/mineral use and rates of cancer development.

Although receiving much publicity, the relationship here is fairly weak, statistically not such that a causal relationship would be the appropriate conclusion, based on current data.

If you are concerned that your child is not eating in a way that ensures adequate nutrition, use a multivitamin/mineral—there is very little data to support the notion that using nutritional supplements to correct nutritional deficiencies (as opposed to using “mega-doses” of nutrients) is harmful. Even the authors of studies arriving at conclusions critical of multivitamin/mineral use concede that their use is indicated to correct nutritional deficiencies. Consult your health practitioner to advise you about your child's specific needs and dosing.

References

1. MacWilliam L. Comparative Guide to Nutritional Supplements™. 5th professional ed. Northern Dimension Publishing; 2014. pp. 53-72, 90-103.