Vitamins for children

Which vitamin practices are routine in children?

Routine practices differ by country; the table below gives each organization’s own wording in a separate row.

The organizations answer the same question with different scope: in Türkiye the official program covers vitamin D (alone) and iron; in the UK the recommendation for children is a supplement of A, C, and D together. These do not substitute for each other; the pediatrician decides which is appropriate for a child. Details of the programs and current distribution information are in the relevant guides:

Detailed guideVitamin D in infants: the Ministry of Health program and rickets→ Detailed guideIron: functions, daily requirement, excess, and interactions→

The Scientific Board guideline states that for prophylaxis in the 0–12 month period, vitamin D doses higher than 400 units and high doses given by ampoule are unnecessary, and that these approaches pose a risk for vitamin D intoxication. ^[1] The NHS also states that two separate supplements should not be given at the same time; for example, cod liver oil also contains A and D and is therefore not given together with vitamin drops, and if it contains enough vitamin D, a single supplement is sufficient. ^[3]

Does a picky eater need a multivitamin?

The narrative review by Samuel and colleagues (Nutrients, 2018) summarizes studies examining whether childhood picky eating is associated with measurable differences in nutrient intake and growth. According to the review, picky eaters consume fewer vegetables; no consistent difference is seen in other food groups, energy, macronutrients, and fiber intake. Although some studies found that picky eaters take in less of certain vitamins and minerals, the amounts consumed generally exceed recommended values. No consistent relationship has been observed between picky eating and growth status; the difference is most pronounced in studies of picky eating defined by multiple criteria. The authors state that a common definition and longitudinal studies are needed. ^[4] The review was funded by Nestlé Research; two of the authors are Nestlé Research employees. The results should therefore be read together with independent studies.

These findings do not show that picky eating alone is an indication for a multivitamin; however, in a child with a clear deficiency of a specific nutrient or restricted diet, the decision is made with the pediatrician and a dietitian. The NHS states that it recommends only supplements containing A, C, and D for infants and young children, that other products with different vitamins and ingredients exist on the market, and that a pharmacist can be consulted on which is suitable. ^[3]

What is in multivitamins made for children?

Dwyer and colleagues examined 288 multivitamin-mineral products labeled for children aged 1 to 4 years that were present in the NIH Dietary Supplement Label Database in 2018 in the US (a cross-sectional label analysis). The products contained an average of 10.1 vitamins and 4.59 minerals. Of the 281 products containing vitamin D, 56% provided at least half of the daily value; 4% of the 144 products containing calcium and none of the 60 products containing potassium did so. The amount recommended on the label exceeded the tolerable upper intake level (UL) in 49% of the 197 products containing folic acid, 17% of the 283 products containing vitamin A, and 14% of the 264 products containing zinc. Most products contained most of 16 other vitamins and minerals already determined in national surveys to be abundant in children’s diets; the authors recommend that the contents be re-evaluated so as to aim at filling gaps and avoiding excess. ^[5]

This study examines products on the US market from their labels; it does not represent products in Türkiye and does not measure the amount children actually consume. However, it shows why reading labels matters: carrying a children’s product label does not mean the content will stay below the upper limit.

Gummy vitamins: sugar, content, and accidental overdose

Merks and colleagues examined the label content of 103 gummy supplements on the Polish market in 2022 that declared themselves to be aimed at children. Sucrose (table sugar) was present in 56.3% of the products and glucose syrup in 52.4%; 19 products (18.5%) had synthetic or semi-synthetic colorants. The authors conclude that the content of gummy children’s supplements has a high proportion of simple carbohydrates, sweeteners, and artificial colorants, and state that detailed guidelines are needed for product composition. ^[6] This is a declaration analysis: it does not measure the amount of sugar and does not directly reflect the Turkish market.

Any iron-containing product, whatever its form, carries a separate risk. The NIH reports that about one-third of child poisoning deaths reported in the US between 1983 and 1991 were from accidental ingestion of iron supplements; after the FDA in 1997 required unit-dose packaging and a warning for products containing more than 30 mg of elemental iron per dose, only one child death attributed to ingestion of iron tablets was reported between 1998 and 2002. The unit-dose packaging requirement was lifted by a court decision in 2003, and the label warning remained mandatory for solid-form products. ^[7] The label warning cited by the NIH states that accidental iron overdose is one of the leading causes of fatal poisoning in children under 6 and advises storing the product out of children’s reach. ^[7]

What are the upper limits for children?

The UL expresses the upper limit of daily intake from all sources and is lower in children than in adults. The following values come from the sources on this page:

• Iron: According to the NIH, the UL is 45 mg in adults; in infants, children, and adolescents it is between 40 and 45 mg depending on age (40 mg for ages 0–13, 45 mg for age 14 and older; details in the iron guide). ^[7]
• Vitamin D: The Ministry of Health Scientific Board states that for prophylaxis in infants aged 0–12 months, doses higher than 400 units and high doses given by ampoule carry a risk of intoxication. ^[1]
• Folic acid, vitamin A, and zinc: In the analysis by Dwyer and colleagues, these three were the nutrients reported to exceed the UL on children’s multivitamin labels: 49% of products containing folic acid, 17% of those containing vitamin A, and 14% of those containing zinc. ^[5]

Full tables of upper limits for vitamin A, vitamin D, and zinc in children are given by organization on the relevant pages.

Detailed guideVitamin D: what it is, deficiency, the 25(OH)D test, and evidence for supplements→ Detailed guideVitamin A: retinol, beta-carotene, excess, and pregnancy→ Detailed guideZinc: overview, deficiency, and upper limit→ Detailed guideIodine: daily requirement, iodized salt, pregnancy, and excess→

Height-boosting and “prevents disease” claims

According to the text of the Ministry of Agriculture and Forestry, food supplements registered for the purpose of supporting the daily nutritional requirement may not be offered for sale as if they were weight-loss, weight-gain, height-boosting, sexual-performance-enhancing, disease-preventing, treating, or curing products, as this is contrary to legislation; products sold with these claims should not be consumed for those expectations. ^[8] This framework applies to children’s products as well: packaging or advertising statements that a children’s vitamin will make a child taller or prevent diseases are not claims to be expected from a legal supplement product. The review also notes that no consistent relationship was observed between picky eating and growth. ^[4]

Assessment of a child’s height and weight is done by the pediatrician.

What is known and what is not?

Known: In Türkiye there are vitamin D programs for infants and iron support programs for ages 4–12 months. ^[2] In picky eaters, intakes have been reported to generally exceed recommended values; the UL is exceeded on some children’s multivitamin labels; accidental ingestion of iron-containing products can be fatal.

Not known: Data comparing the risk of accidental overdose in children between gummy and other forms; national measurements of the content of children’s multivitamins in Türkiye and of children’s actual intake; randomized studies testing the health outcomes of multivitamins in picky-eating children.

This guide does not recommend personal doses. The type, amount, and duration of any supplement given to a child are determined with the pediatrician; the instructions on the product label and the warning to store it out of children’s reach are considered together.

Detailed guideWhen to take vitamins? Meals, time of day, and medicine intervals→ Detailed guideIs a multivitamin necessary? Evidence from PHS II, COSMOS, and USPSTF→ Detailed guideVitamins in pregnancy: what changes, what to avoid?→