Do Kids Need Multivitamins?

The simple answer to this question is that no, kids (like adults) don’t need to take a multivitamin/multimineral.

As a species, humans survived for hundreds of thousands of years without supplements and we can get all that we need from food, given the right food, lifestyle, and environment.

However, there can be compelling reasons to consider a supplement to help support optimal growth and performance.

Do we get what we need from diet alone?

As adults, many of us don’t get all the essential micronutrients that we need to thrive from diet alone. This is especially true of vitamin A, B1, B6, B12, iron, magnesium, zinc and selenium. (1, 2)

Without all of these vital nutrients, we are unable to perform well or have robust good health and this is true for kids too!

Insufficient intakes of nutrients rise rapidly from infancy. From the age of 2-4 to 14-18, around 1/3 of males and over ¼ of females do not consume sufficient vitamin A, around 1 in 10 young women don’t achieve sufficiency for vitamin B1 and folate, 1 in 20 for B12, and 1 in 5 for B6. Inadequacy of essential minerals is even more pronounced, with around 80% inadequate by the age of 18 for calcium, and over 60% inadequate for magnesium. Iodine, iron, and phosphorus intakes are also particularly concerning in young women, while for boys and men, zinc insufficiency consistently rises from almost none insufficient at the age of 2-4 years, to over 2/3 of the male population insufficient by older adulthood! (2)

Why don’t we always get what we need from the diet?

We eat more processed food

The major reason for not getting all we need from diet alone is simple; we eat more refined and processed foods. In Australia, around 1/3 or more of our daily energy intake comes from ‘discretionary foods’ – "foods and drinks not necessary to provide the nutrients the body needs”, but which are rich in energy (calories) and yet, often far lower in essential and secondary nutrients beneficial to overall health. (2) We are also, over time, eating fewer nutrient-rich whole foods (like vegetables and berries). Nowadays less than half of us eat the recommended amounts of vegetables and fruit that we should to optimise health. (3)

Some foods may be lower in essential nutrients than in the past

US Department of Agriculture data shows that some fresh produce (some vegetables, fruits, and berries) may only provide around half the amounts of some vitamins and minerals that they did in the 1950s. (4) So, while we have been eating more over time, and taking in more than enough calories and ‘fuel’, we aren’t necessarily getting enough of the ‘little guys’, the vitamins, minerals and secondary nutrients that help every system of the body run optimally.

There are additional reasons why our diets are becoming more insufficient:

• Increasingly stressful lifestyles which increase our demand for micronutrients
• A longer ‘food chain’ (i.e. more time in transport and storage and less local, fresh produce) which can reduce the amounts of nutrients (especially fragile, water-soluble vitamins)
• Lack of variety in food choices and fewer people choosing wild foods (like previously popular vegetable choices such as dandelion, sow thistle etc.)

How can a multivitamin help kids?

A multi is never a substitute for healthy eating, and the focus should always be on working towards a diet mostly based on natural, unrefined foods.

Multis can help to ‘fill the gaps’ in nutrition though and are considered a safe and effective way to ensure a healthy intake of essential and beneficial nutrients. (5) In a study of school-age children, memory test scores were improved in children taking a multi. (6)

Additionally, supplementation to ensure the adequacy of various nutrients including vitamins B, C, D, and zinc and magnesium might help to:

• improve migraines (7, 8)
• improve growth rates, muscle, and blood markers of later health risks (9-13)
• improve behaviour and cognition (14-16) and
• reduce respiratory problems (17-20)

Ensuring nutrient density

The shift towards more sugar and more ‘ultra-refined’ processed foods has been detrimental to kids’ health, and our key focus should be on encouraging the receptive minds of young people to become reconnected to REAL food.

• Try to make at least 80% of what you put in your child's lunchbox (or on their plate) natural, whole, unprocessed food
• Choose natural, unrefined carbohydrate choices (such as sweet potato, yams, potato and some whole, unprocessed grains) over pasta, bread, crackers and other refined choices
• Choose water over fruit juices
• Get kids eating vegetables early! Much of our food preferences are based on what we ‘learn’ to eat early in life
• Use smoothies made with whole, unprocessed foods (such as vegetables, berries, nuts and nut butter, seeds and fruit) as an option in addition to meals to boost vegetable intake
• Consider a whole food based multinutrient supplement

There’s nothing wrong with an occasional treat, but we should always try to prioritise whole, natural, foods to provide the essential nutrients that growing and active bodies (and minds!) need.

References

1. University of Otago and Ministry of Health. A Focus on Nutrition: Key findings of the 2008/09 New Zealand Adult Nutrition Survey. Wellington; 2011.
2. ABS. Australian Health Survey: Nutrition First Results‐Foods and Nutrients, 2011‐12. Australian Bureau of Statistics Canberra; 2014.
3. Annual Update of Key Results 2014/15. Wellington: New Zealand Ministry of Health. ; 2015.
4. Davis DR, Epp MD, Riordan HD. Changes in USDA Food Composition Data for 43 Garden Crops, 1950 to 1999. Journal of the American College of Nutrition. 2004;23(6):669-82.
5. Biesalski HK, Tinz J. Multivitamin/mineral supplements: rationale and safety – A systematic review. Nutrition.
6. Vinod Kumar M, Rajagopalan S. Trial using multiple micronutrient food supplement and its effect on cognition. The Indian Journal of Pediatrics. 2008;75(7):671-8.
7. Arora J, Jeon M, Marvasti Y, Holz E, Yuvaraj S, Morris L, et al. 133 the effectiveness of riboflavin (vitamin b2) in preventing migraine episodes in the paediatric population: a comprehensive review. Journal of Investigative Medicine. 2018;66(1):A121.
8. Kelishadi R, Farajzadegan Z, Bahreynian M. Association between vitamin D status and lipid profile in children and adolescents: a systematic review and meta-analysis. International journal of food sciences and nutrition. 2014;65(4):404-10.
9. Galescu OA, Crocker MK, Altschul AM, Marwitz SE, Brady SM, Yanovski JA. A pilot study of the effects of niacin administration on free fatty acid and growth hormone concentrations in children with obesity. Pediatric Obesity. 2018;13(1):30-7.
10. Colletti RB, Roff NK, Neufeld EJ, Baker AL, Newburger JW, McAuliffe TL. Niacin Treatment of Hypercholesterolemia in Children. Pediatrics. 1993;92(1):78-82.
11. Filgueiras MS, Rocha NP, Novaes JF, Bressan J. Vitamin D status, oxidative stress, and inflammation in children and adolescents: A systematic review. Critical Reviews in Food Science and Nutrition. 2018:1-10.
12. Gunanti IR, Al-Mamun A, Schubert L, Long KZ. The effect of zinc supplementation on body composition and hormone levels related to adiposity among children: a systematic review. Public Health Nutrition. 2016;19(16):2924-39.
13. Pimpin L, Liu E, Shulkin M, Duggan C, Fawzi W, Mozaffarian D. The Effect of Zinc Supplementation during Pregnancy and Youth on Child Growth up to 5 Years: A Systematic Review and Meta-Analysis. The FASEB Journal. 2016;30(1_supplement):671.7-.7.
14. Mousain-Bosc M, Roche M, Polge A, Pradal-Prat D, Rapin J, Bali JP. Improvement of neurobehavioral disorders in children supplemented with magnesium-vitamin B6. I. Attention deficit hyperactivity disorders. Magnes Res. 2006;19(1):46-52.
15. Huang Y-H, Zeng B-Y, Li D-J, Cheng Y-S, Chen T-Y, Liang H-Y, et al. Significantly lower serum and hair magnesium levels in children with attention deficit hyperactivity disorder than controls: A systematic review and meta-analysis. Progress in Neuro-Psychopharmacology and Biological Psychiatry. 2019;90:134-41.
16. Warthon-Medina M, Moran VH, Stammers AL, Dillon S, Qualter P, Nissensohn M, et al. Zinc intake, status and indices of cognitive function in adults and children: a systematic review and meta-analysis. European Journal of Clinical Nutrition. 2015;69(6):649-61.
17. Heydarian F, Ahanchian H, Khalesi M, Ebrahimi S. The effect of serum levels of vitamin C on asthmatic children: a systematic review. Reviews in Clinical Medicine. 2016;3(3):87-92.
18. Jat KR. Vitamin D deficiency and lower respiratory tract infections in children: a systematic review and meta-analysis of observational studies. Tropical Doctor. 2016;47(1):77-84.
19. Rajabbik MH, Lotfi T, Alkhaled L, Fares M, El-Hajj Fuleihan G, Mroueh S, et al. Association between low vitamin D levels and the diagnosis of asthma in children: a systematic review of cohort studies. Allergy, Asthma & Clinical Immunology. 2014;10(1):31.
20. Fares MM, Alkhaled LH, Mroueh SM, Akl EA. Vitamin D supplementation in children with asthma: a systematic review and meta-analysis. BMC Research Notes. 2015;8(1):23.