Supplements and vitamins for children

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Marie-Ange Demory
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On the shelves of pharmacies and parapharmacies you can find numerous supplements for children. From vitamin C to vitamin B, passing through vitamin D and fluoride, not to mention the famous multivitamins. We know vitamins are essential for the growth of children and in most cases a balanced and varied diet is enough to have enough. There are some particular situations supplementation with supplements could be really useful, but the first rule for raising healthy children is to focus on correct lifestyles.

In this article

  • proper nutrition
  • supplements you really need
  • when the diet is not balanced
  • supplements for the immune system
  • memory supplements

First rule: focus on proper nutrition

So-called micronutrients such as vitamins and minerals are very important to ensure optimal growth and development of the organism and in general their contribution can be ensured by a correct diet. After all, a food supplement is by definition a product intended for supplement the diet in particular conditions of deficiency. "So let's face it immediately: it is very difficult for a healthy child who follows a correct diet to need supplements, except for some exceptions, particularly in the first year of life". Word of Giuseppe DiMauro, family pediatrician and president of the Del Paesena Society of preventive and social pediatrics who recently dedicated an extensive document to the topic of vitamins, supplements and supplements for children.

"There is no need to wage an ideological war on supplements," he explains Alberto Ferrando, family pediatrician, president of the Association of Ligurian pediatricians and author of the book How to feed my child - but parents should learn that first of all we need to focus on a Proper nutrition to provide the child with all the vitamins and nutrients he needs. In case of deficiencies, the pediatrician will recommend a specific supplement. Before giving the child the supplement advertised on TV or on the web, it is necessary to reflect on his lifestyle because no substance can replace a correct lifestyle ".

Then there are some particular situations, as in the case of newborns, in which the integration of some vitamins is really necessary and therefore recommended by all scientific societies.


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Supplements that are useful for everyone

There are only two supplements considered essentially essential for all babies, in both cases proposed at birth: vitamins K and D.

Vitamin K

"Vitamin K is important for the production of substances that contribute to normal blood clotting" explains Lina Bollani, neonatologist at the San Matteo polyclinic in Pavia. "At birth, babies have a physiological deficiency of this vitamin because its transfer into the uterus through the placenta is limited and consequently they can undergo the so-called hemorrhagic disease of the newborn, rare but potentially serious. "For this reason the World Health Organization recommends the administration of 1 mg of vitamin K immediately after birth, by intramuscular injection. "And since breast milk is a poor source of vitamin K - continues Bollani - in breastfed children, supplementation by mouth is generally also recommended until the completion of the third month of life", as recently recommended by the Del Paesena Society of Neonatology. 

Other scientific societies, on the other hand, argue that the intramuscular injection carried out immediately after birth is sufficient, as also required by the guidelines of the American Academy of Pediatrics of 2022.

Vitamin D

As regards vitamin D, Di Mauro defines it as "one of the fundamental pillars for the solid development of the child", very important for the growth and the development of the bone mass but also muscular and for the regulation of various functions of the organism, from the immune ones to the respiratory ones. Vitamin D is found in some (few) foods, such as fatty fish, liver, egg yolk, dark green leafy vegetables and cheeses, but above all it is spontaneously produced by the body as a consequence ofexposure to sunlight. In children under one year of age the risk of shortage because very young children are poorly exposed to sunlight, also in accordance with the advice of the American Academy of Dermatology (AAD) according to which children under the age of 6 months should not be exposed directly to sunlight.

For this reason, both Sipps and other health authorities and international scientific societies recommend the administration of 400 IU of vitamin D per day for all babies born at full term from birth to first birthday, regardless of the type of feeding (whether with breast milk or formula). In the case of premature babies dosages vary slightly by weight. In children over one year and adolescents, supplementation is recommended if there are particular risks of deficiency (for example dark complexion, obesity, diseases that hinder its absorption). Sipps also recommends it for i autumn and winter months for all children and adolescents who have limited exposure to the sun during the summer.

Vitamin K and Vitamin D are therefore the only two micronutrients to be integrated in all children. 

Read also: Vitamin D and children

When the diet is particular or unbalanced

Beyond these general recommendations, the intake of a vitamin or mineral salt supplement must be evaluated by the pediatrician, on the basis of characteristics of the individual patient, of his lifestyle, of any diseases that lead to a lack of particular nutritional elements.

For example: we all know that the correct, balanced and healthy eating style par excellence is the Mediterranean diet, characterized by:

  • abundant consumption of fresh and seasonal fruit and vegetables;
  • legumes as the main protein source;
  • dried and oily fruit;
  • medium-high consumption of fish;
  • reduced consumption of meat (especially red);
  • preference of extra virgin olive oil over saturated fats of animal origin.

"A child who really eats Mediterranean it needs practically nothing"Alberto Ferrando reiterates," but how many children - and their families - really eat Mediterranean? "This is why there are some particular situations in which the pediatrician can suggest the use of supplements.


Omega 3

In the Mediterranean diet, a good source of omega 3 is represented by fish, but some children hate it because of the flavor. "If you don't bring fish to the table two or three times a week, you can find other alternative sources, primarily dried fruit (especially nuts), but not only. Vegans, for example, have taught us to uselinseed oil cold to have the omega 3 ", explains Dr. Ferrando. If none of these foods are included in the child's diet, then the pediatrician will evaluate the supplementation with a omega 3 supplement.

Vitamin B12

More and more often today, for ethical, environmental and health reasons, many parents prefer eliminate the meat from their own diet and that of their children. In this case Vitamin B12 supplementation is essential. "In children who are vegetarian, vegan or who eat very little meat, B12 must be supplemented to avoid permanent neurological disorders" explains Ferrando.

Whether the child is on a vegetarian or vegan diet is also important evaluate iron and zinc levels, but even here with a balanced diet and with the right attention we should not run into deficiencies. As Dr. Ferrando "the scientific literature indicates that a well-planned plant-based diet (not improvised) and supplemented with B12 is absolutely healthy and allows normal growth ". 


If the child refuses vegetables

Unlike vegetarian and vegan children, we find children who refuse vegetables outright and just don't want to taste them. "In this case it might even be worth considering a multivitamin"suggests Ferrando. However, reiterating that the first thing to do is always try to improve the quality of the power supply. "In my experience, I have seen children who at 4 do not distinguish lettuce from carrot or who eat exceptionally vegetables and fruit, this is not good and you cannot think that a supplement solves everything".

Vitamin D in case of obesity

In case of obesity the main scientific societies recommend the supplementation with vitamin D, as also indicated by the consensus of the Paesena Society of Pediatrics. In these cases it is suggested the administration of 1000-1500 UI / die of vitamin D in the period between the end of autumn and the beginning of spring. As Dr. Ferrano, and as the guidelines on childhood obesity also indicate, "in addition to supplementing with vitamin D, it will also be necessary to work on the child's lifestyle to ensure physical but also mental health".

If the child eats little

A particular situation occurs with the child who is a bit lacking in appetite: in this case some pediatricians may suggest the use of multivitamins, and sometimes it is the parents themselves who take the initiative in this regard. In reality, there are no data that indicate any particular usefulness of this practice.

If the child is often tired

If the child is exhausted, tired, fatigued, it is necessary to investigate what are the causes underlying this condition. "Before giving a supplement to the child, parents should evaluate lifestyle of child. If he goes to bed late, if he watches too much TV or his cell phone, the solution is not a supplement for fatigue, but a change in habits ", explains Dr. Ferrando.

In any case, in general the "do it yourself" by the family is absolutely to be avoided, not only with drugs but also with supplements and supplements. In the long run, excessive doses of vitamins or minerals can lead to overdose and intoxication conditions, with more risks than benefits.

Fluoride: by mouth or in toothpaste?

Among the various vitamins and supplements suggested, it is sometimes also recommended oral fluoride supplementation from six months of age, to reduce the risk of caries. In reality, according to the document of the Del Paesena Society of preventive and social pediatrics, this does not necessarily mean that this is really useful. If there are no particular risk factors, good oral prophylaxis is sufficient, i.e. frequent and thorough brushing of the teeth with toothpaste containing fluoride. 

However, as indicated by the ministerial guidelines, oral supplementation can be useful in children at high risk of caries who do not practice good local prophylaxis.

Supplements to strengthen the immune system: do they work?

Another type of well-sold supplements, especially in the last year due to Covid-19, are those that serve to strengthen the immune system of children, but do they really work?

Better to clarify it right away: there are no magic pills that prevent children from getting sick (and maybe doing it repeatedly) in the bad season. "A healthy lifestyle, with good nutrition, adequate rest, lots of outdoor activities and protection from passive cigarette smoke constitute the first line of defense against seasonal ailments of children "remembers Ferrando. The Sipps document also clearly states this: there is no evidence that vitamin or mineral supplements serve to protect healthy children, who do not have particular deficiencies, from infectious diseases. That said, it is true that especially vitamin C and vitamin D deficiencies could be associated with a increased risk of recurrent infections (for example recurrent otitis). In children who often get sick, the pediatrician can therefore evaluate the opportunity of supplementation with vitamins.

And the same goes for the period of convalescence: infectious processes and episodes of disease in general easily "consume" vitamins and micronutrients such as zinc and iron. For this reason, the doctor could decide to propose an integration to help recovery, as indicated in the consensus of the Del Paesena Society of Preventive and Social Pediatrics and the Del Paesena Federation of pediatricians.

There is no evidence, however, that - always in the absence of specific deficiencies - supplements and supplements can serve something as "tonic", that is to help overcome a generic fatigue at particular times of the year such as spring or the autumn.

Read also: Children and Covid-19: are vitamins and supplements really needed?

Supplements for memory and academic achievement

This too would be a dream: a pill to do better in school! In reality there are no miraculous substances in this sense and the Sipps document specifies that "in healthy children of school age, in the absence of specific deficiencies or risk conditions, the supplementation of any specific nutrient in order to improve memory is not recommended. and academic performance ".

That said, the document itself is a reminder of how important it is ensure adequate levels of certain substances - vitamin B12, iron and DHA fatty acids - during fetal development and early childhood to ensure "the optimal development of the central nervous system and its performance also at the cognitive level". It means that you have to be careful about the situations they can expose you to deficiency of these substances, such as a vegetarian or vegan diet or even the time of weaning from breast milk. "Up to six months there are no problems with regard to iron intake. After this date, however, breast milk becomes deficient and that is why it is advisable to introduce foods that can guarantee a correct intake of this substance. If this is the case. it does not happen, for example because the baby eats very little outside of feedings, integration is worth considering"Di Mauro underlines. Recalling that in general the importance of iron should not be underestimated:" It is the other fundamental pillar of growth and development, together with vitamin D ".

Read also: Napping is good for children's memory

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