Parents of our patients often ask whether we recommend multivitamins for their children. In most situations, the answer is no. This takes a lot of them by surprise. Vitamins are a good thing, right?

The explanation is actually somewhat complicated. Foods that are rich in vitamins are definitely a good thing, and many scientific studies have proven the benefits of a diet abundant in fruits, vegetables, whole grains, fish, lean meats, and low-fat milk. But the vitamins themselves, when taken in pill or liquid form, can actually be harmful.

Our bodies use nutrients most effectively when we consume them directly from natural food sources. The healthful advantages of these nutrients depend on their food “packaging” to provide their full benefit. Researchers have not been able to find any benefit from most vitamins when they are taken in pill form rather than in their natural state. None of the major medical associations, including the American Academy of Pediatrics, The American Medical Association, The American Institute of Nutrition, The American Society for Clinical Nutrition, or The American Dietetic Association, recommend routine use of multivitamins.
In addition, many vitamins can actually be harmful if taken in excess. Too much Vitamin A, for example, can cause birth defects, liver abnormalities, reduced bone mineral density, and brain disorders. Too much vitamin B6 can result in nerve damage to the arms and legs. Toxicity from these vitamins occurs almost exclusively as a result of taking vitamin supplements. Supplements of some vitamins and minerals can also block the body’s ability to absorb other essential nutrients from foods.

Many parents give their children vitamins because they believe they are helping to prevent diseases. However, this is unlikely to be true. For years many people believed in the benefits of extra Vitamin C, particularly in fighting colds. But in every careful scientific study of the effectiveness of taking vitamin C supplements, no benefit whatsoever has been found. Medical researchers have also studied whether adults taking multivitamin supplements are protected from cancer. But shockingly, many of these studies found that taking vitamin supplements actually increased the risk of getting cancer or dying from it. A recent study performed at the National Cancer Institute found that men who took more than seven multivitamins per week significantly increased their risk of prostate cancer. Several studies of adults taking extra vitamin E, beta-carotene, and vitamin A have shown an increased risk of developing cancer and an increased rate of death from all causes, without showing any overall health benefit.

And what exactly is in those vitamin pills that everyone is taking? An organization called ConsumerLab found that about half of the vitamins they tested had problems with contamination or didn’t really contain the ingredients that they claimed. One children’s vitamin contained a dangerously high level of vitamin A. Another marketed to women was contaminated with lead.

Of course, there are a few situations in which vitamin supplementation is a good thing. All newborns should receive a single injected dose of vitamin K. Vitamin K deficiency, which is common in newborns, can cause severe, sometimes fatal bleeding. Routine Vitamin K administration at birth has eliminated this once common cause of newborn death.

All infants and young children should receive some Vitamin D supplementation to help them develop strong bones. As humans, we evolved to obtain vitamin D by absorbing it directly from the sun through our skin. However, society’s greater tendency toward indoor living has greatly reduced this beneficial effect of natural sun exposure. In addition, since becoming more aware of the harmful effects of the sun, we have consciously reduced our children’s exposure, which has caused a reduction in naturally acquired Vitamin D. Since breast-milk contains very low levels of Vitamin D, all breast-feeding babies should receive it as a supplement. Formula-fed infants benefit from the Vitamin D that is added to all infant formulas, and young children receive it through readily available vitamin-D-fortified cow’s milk.

Children who suffer from serious chronic intestinal-tract ailments, such as inflammatory bowel disease, celiac disease, and cystic fibrosis, also require vitamin supplementation because their injured intestinal tracts prevent the adequate absorption of vitamins contained in food. Children on a vegan diet need vitamin supplementation to obtain the vitamins and nutrients that come only from animal-based foods such as milk, eggs, meats, and fish. Pregnant women should take a folic acid supplement, which has been proven to be a safe and effective means of reducing the risk of spina bifida in their babies.

So in general, should you be giving your child a multivitamin? In most cases we will say that that you should not. However, if you believe that your child is at risk for developing a vitamin deficiency, we’re happy to discuss with you the pros and cons of supplementation. And if vitamins are not the answer, what should you be doing to keep your child nutritionally healthy? From the start, offer only healthy food choices. Serve real food, not processed foods, with as many fruits and vegetables as possible. Most children will go through a super-picky phase or a barely-ate-a-bite-all-day phase. That’s OK, and very much to be expected! Just keep providing healthy options. Teach your child that good health comes from making healthy choices, not from a pill in a bottle.