Giving children multivitamin pills has become a fad nowadays. But do you know what multivitamins really are? Are there any risks associated with giving multivitamins? Do children really need them?
What are multivitamins?
Various vitamins and minerals are essential for the growth and development of children. Multivitamins are preparations that contain all the necessary vitamins and minerals in different quantities. They are usually available in different forms such as pills, capsules, liquids or powders.
What are the risks?
Foods like milk and milk products, and fruits juices are packed with various vitamins and minerals. A child consuming these on a regular basis remains in good health and does not need multivitamin supplementation. Giving such children additional multivitamins can be anything but healthy. It can result in an overdose of nutrients and cause toxicity.
When should you give multivitamins to children?
Multivitamins should only be given to children when:
- Their growth and development are delayed.
- They are suffering from certain chronic diseases and allergies.
- They are on a restrictive diet, like a vegan diet.
- They have some chronic ailment.
- They live in a depressed or deprived environment. Like in, such as an orphanage or broken homes.
Parents should always consult a doctor before giving multivitamins to children to get the dose right.
Here’s a list of the common vitamins and minerals that constitute multivitamins, their natural sources, benefits, daily requirement and deficiency symptoms.
There are two types of vitamins, fat soluble and water soluble.
Vitamins A, D, E and K are fat-soluble vitamins, and if given in excess can cause dangerous side effects.
Vitamin A: Vitamin A is necessary for the development of proper vision. It is mostly found in yellow and orange-coloured fruits and vegetables, cod liver oil and egg yolk. It is not given as a supplement unless there are signs of deficiency like night blindness and dry conjunctiva. It is marketed under the brand name Aquasol A, and is available in the form of injections or capsules.
Vitamin D: Deficiency of vitamin D has been reported in the majority of Indian children. This vitamin is essential for calcium metabolism, bone mineralisation and normal functioning of hormones like the parathyroid hormone. Egg yolk, fish and tropical plants are good dietary sources of vitamin D. Its deficiency can result in stunted growth and rickets, which is a condition of weak bones.
The Indian Academy of Paediatrics recommends daily supplementation of 400 IU/day of vitamin D in children less than one year old and 600 IU/day for children above one year of age. The American Academy of Family Physicians also recommends the intake of 400 IU/day of vitamin D by babies who are exclusively breastfed or consume less than 1 litre of fortified milk formula per day. Arbivit, Dsol, D3 Must are a few brand names of vitamin D supplements.
Vitamin E: Vitamin E is given only to children with select conditions like prematurity to assist with fat absorption. It is also given along with other vitamins when some diseases of the liver and retina are detected in premature newborns. Vitamin E supplements are available as Evion drops of 50 mg/ml concentration. The daily requirement is 5–15 mg per day, depending on age.
Vitamin K: It is essential for normal clotting mechanism, which is necessary to prevent loss of blood due to injuries. It is produced naturally in the intestines by the bacterial flora. But a newborn's intestines cannot produce vitamin K. Hence, it is given as an injection when a baby is born. Green leafy vegetables are a good source of vitamin K.
Vitamins B complex and C are water-soluble vitamins. If taken in excess, these vitamins are expelled from the body with urine.
Vitamin B complex: Vitamin B complex consists of eight vitamins that have a range of benefits such as preventing memory loss, reducing stress, ensuring healthy skin and hair, and more. Vitamin B complex is found in cereals, nuts, green leafy vegetables, egg, lean meat and liver. Its deficiency can cause conditions like beriberi, pellagra, glossitis, stomatitis, diarrhoea, anaemia, knuckle pigmentation, and in severe cases, convulsions and abnormal behaviour like depression, crying spells etc.. Vitamin B supplements are available in the form of syrups like Bevon, Polybion and Visyneral.
Vitamin C: It is essential for normal development of bones, strengthening the immune system, and absorption of iron. It is also an antioxidant. The dietary sources of vitamin C are citrus fruits and amla. Its deficiency can cause scurvy, weak bones, recurrent infections and bleeding of gums. Vitamin C supplements are not recommended unless the child shows signs of deficiency, as daily supplementation can lead to the formation of kidney stones. Vitamin C supplements are sold under various brand names such as Limcee tablets.
Calcium and phosphorus:
These two minerals are necessary for the normal development of bones and teeth, strong muscles and brain, and clotting of blood. They are found in cereals, legumes, fish, nuts, milk and milk products. Babies born prematurely or those with low birth weight, and children who do not drink enough milk suffer from a deficiency of calcium and phosphorus.
The daily requirement of calcium is 100 mg/kg/day. To meet a child’s calcium needs, various supplements are available with different amounts of elemental calcium like Ostocalcium, Shelcal, Calcimax, etc. These supplements are available both in the form of syrups and tablets. Some calcium supplements may also contain vitamin D. Remember, calcium syrups should not be taken along with iron syrups as this can affect its absorption.
Iron is necessary for the formation of haemoglobin, which is essential for transporting oxygen throughout the body, and for various other metabolic processes. Iron deficiency results in anaemia, irritability, poor growth and development. In some cases, iron deficiency may also lead to Pica, an eating disorder characterised by the urge to eat inedible items like mud.
The natural sources of iron include green leafy vegetables, jaggery, liver, beetroot, etc. The required daily dose is 2–6 mg/kg/day of elemental iron. Various iron supplements are available such as Vitcofol and Orofer. Iron supplements should not be consumed immediately after drinking milk or after eating green leafy vegetables as they inhibit the absorption of iron by the intestine.
There is no substitute for a good, balanced diet for your child. It is a myth that multivitamins can replace a healthy meal, as natural food is the best source of all the required nutrients. However, if you notice symptoms of vitamin or mineral deficiency in your child, consult his paediatrician at the earliest.
Remember, do not give multivitamins and supplements to your child without consulting a specialist, as doing so may not be without risks.
The author is a paediatrician at Nanavati Super Speciality Hospital, Mumbai.