Is a multivitamin necessary for kids who don’t eat a lot of fruit and vegetables?


This copy is for your personal non-commercial use only. To order presentation-ready copies of Toronto Star content for distribution to colleagues, clients or customers, or inquire about permissions/licensing, please go to:
If your children aren’t consistently eating three balanced meals loaded with fruits and veggies every day, you might be tempted to supplement their diet with vitamins. But Joanna Benec, a clinical dietitian with The Hospital for Sick Children, asks you to think twice before using vitamins or supplements as a dietary safeguard. Here’s what she would like parents to know about kids and vitamins.
My preschooler doesn’t eat a lot of veggies — should I give him a multivitamin?
Most healthy children, as long as they’re growing appropriately, do not need supplemental vitamins. They get enough nutrients from the food they eat. The only exception is vitamin D (more on that below).
It’s important to keep in mind that food is more than the sum of its parts. The components in food interact together, giving you more nutritional benefits. A multivitamin can’t replicate food sources.
I understand the temptation to rely on multivitamins as a kind of safety net, but a multivitamin won’t give your child the fibre he needs, for example. Ideally, you want to keep offering a variety of foods for him to get the most nutrients and fibre. Think about serving different colours of foods at each meal, because foods of different colours provide different nutrients.
Growth is one of our best long-term indicators for whether a child is meeting their nutritional requirements. So, if you’re offering enough variety and he’s eating from all the food groups to some extent, most of his nutrients should be covered. That said, if you’re concerned about your child’s growth, you should consult with your health-care provider.
I’m currently breastfeeding my baby. Do I need to supplement with vitamin D?
Yes, definitely. Infants — breastfed or even partially breastfed — require a vitamin D supplement.
We’ve always known vitamin D is important for our bones and teeth, but we now know it’s responsible for a lot more. Vitamin D has a role in our immune and neuromuscular systems and in the prevention of disease. Even though we can get vitamin D from sunlight, that’s not really an option because we should all be wearing hats and sunscreen — especially kids. So that compromises the sun as a source of vitamin D. And there aren’t many foods rich in vitamin D.
For infants, you want to supplement with 400 international units (IU) per day — whether that’s drops or liquid.
As for formula-fed babies, the Canadian Paediatric Society says most full-term, formula-fed infants are likely getting enough vitamin D without a supplement. I would say the only caveat is if your baby is taking in less than one litre per day of formula, then he’s not getting enough. In this case, you can supplement with 400 IU of vitamin D, as that amount still falls within a safe limit.
Toddlers start getting more exposure to vitamin D in the foods they eat. For example, milk and margarine in Canada are fortified with D. It’s also added to some eggs and fish. However, I should add that kids should continue with vitamin D supplements beyond infancy into adulthood.
My 12-year-old daughter is on a vegetarian diet — is she getting all the vitamins she needs?
The position of Dietitians of Canada is that a plant-based or vegetarian diet can be healthful with lots of benefits in the prevention and treatment of certain diseases. But it does take planning.
Pre-teens and teens are going through periods of rapid growth and development, so you want to make sure your daughter is getting enough key nutrients.
You definitely want to make sure she’s getting enough iron. Look for plant-based sources of iron — such as whole grains and cereals, dark leafy greens, dried fruit, eggs, lentils and nuts. When you consume plant-based iron, it’s called non-heme iron. Non-heme iron is not as readily absorbed as heme iron, which is found in animal products. So, to help with non-heme iron absorption, you can add a source of vitamin C.
For example, if you’re having whole-grain pasta, add some tomato sauce or veggies with vitamin C — such as tomatoes, spinach or broccoli — for better iron absorption. The same goes for iron-fortified cereal: Eat a piece of fruit with the cereal.
If your daughter is excluding dairy from her diet, you want to pay attention to sources of calcium and vitamin D. Look for replacements in things like milk alternatives fortified with calcium and vitamin D.
Another key nutrient is B12, because it’s found only in animal products. You can get products fortified with B12 (such as cereals, soy milk, veggie meats), but you have to really pay attention to nutrition labels. If your child is on a vegan diet, you may want to consider a vitamin B12 supplement.
One thing to note about vegetarian diets is that they tend to have a lot of fibre, which can be quite filling. Sometimes kids may not be meeting all their energy requirements because they feel full before they consume all the nutrients in a meal. So, it’s important to include a variety of foods and track their growth over time to make sure it’s progressing well.
Even if they look like gummies, multivitamins are not candy
If you’re still keen on offering your kids multivitamins, clinical dietitian Joanna Benec wants you to be aware that not all multivitamins are created equally. Multivitamins from different companies include a range of nutrients in variable amounts. “A child can actually mega-dose on certain nutrients,” says Benec. “And nutrients can also interact with medications.”
She says the body typically excretes water-soluble vitamins, such as vitamins B and C, so you needn’t worry about the toxicity of those. However, fat-soluble vitamins, such as vitamins A, D, E and K, are metabolized with the fat in our body, and so can build up. Also, a child could megadose on iron depending on the composition of the supplement.