Vitamin Supplementation Counseling Points for Parents

Motivations for using multivitamins and mineral supplements in children include improving health, maintaining health, or supplementing a child's diet, said Marsha Millonig, BPharm, in a session at the McKesson ideaShare meeting held this week in Orlando.

Attendees at the session, titled Vitamins A, B, C...It's Not as Easy as 1, 2, 3: An Overview of Pediatric Vitamins and Supplements, were educated on the options available to their pediatric patients.

Accounting for almost one-sixth of all dietary supplement purchases, mutivitamin and mineral supplements are taken by every age group, Millonig explained. Although children and adolescents are at the greatest risk for vitamin and mineral deficiencies, they are least likely to use supplements. While healthy children with a normal, balanced diet don't need vitamin supplements above the recommended dietary allowances, parents often will seek a pharmacist's advice on vitamins for children who are picky eaters or who don't have strong appetites, she added.

Millonig discussed some of the more common vitamins, A, B, C, and D.

• Vitamin A promotes normal growth, healthy skin, and tissue repair. Yellow vegetables and dairy products are rich in vitamin A. The recommended daily allowance (RDA) for children ages 4 to 8 is 400 micrograms per day.¹
• B vitamins promoted red blood cell formation and assist in a variety of metabolic activities, and can be found in meat, poultry, fish, soybeans, milk, and eggs. The RDA for B vitamins varies according to which type is needed, although B₁₂ is the most common. The RDA of B₁₂ for children ages 4 to 8 is 1.2 micrograms per day.¹
• Vitamin C is involved in many functions, including absorption of iron, the immune system, and wound healing. Food sources rich in vitamin C include broccoli, spinach, potatoes, and tomatoes. The RDA for children ages 4 to 8 is 25 milligrams per day.¹ One area that patients often are curious about is the effect of vitamin C on cough and cold symptoms. A 2013 Cochrane Review noted that vitamin C supplements may reduce the duration of the common cold in children by 14%, but only in those children taking them long-term—not only at the onset of cold symptoms.
• Vitamin D promotes tooth and bone formation and regulates the absorption of minerals like calcium. Because calcium is so important for bone growth, Millonig said it's one of the few supplements that she frequently recommends, even with those patients who are maintaining a balanced diet.

Megadoses of vitamins, especially vitamins A, C, and D, can be toxic, so the patient's diet and medical needs should be carefully examined to determine which vitamins and mineral supplements are needed, if any, Millonig noted during her discussion. Some vitamins and minerals can have preventive health effects and have been studied to see whether or not those effects are substantive.

Millonig also discussed the use of melatonin in helping children sleep. Although no sleep medications are approved by the FDA for pediatric use, Millonig said a survey of 700 pediatricians noted that more than 75% had recommended a nonprescription item for children who have insomnia. Children who see the most benefit from melatonin are those with autism or other developmental disorders. Melatonin was most effective for children who needed help falling asleep, rather than children who needed help staying asleep. Millonig recommended having parents seek the advice of their primary care provider, and start with 0.5-1 mg about 30-60 minutes before bedtime.

Millonig emphasized that multivitamins, minerals, and dietary supplements are not a substitute for a balanced, health diet, but are instead intended to prevent nutritional deficiencies and maintain nutritional stores. Pharmacists should always get a list of the child's medications before making recommendations, and recommend only reputable sources that have USP verification.