About a third of children and adolescents take dietary supplements. Parents should be cautious though, some physicians warn, because some supplements may cause adverse drug reactions or have cardiovascular effects, including heart arrhythmia.
Although supplement usage has hovered around 30 percent in U.S. children ages 0 to 19, use of alternative medicines nearly doubled over a decade, according to a recent study published in JAMA Pediatrics. The study defines nutritional supplements as products that primarily contain vitamins and minerals and alternative medicines as herbal, nonvitamin or nonmineral supplements such as omega-3 fatty acids or melatonin.
“Many of the most commonly used supplements, including multivitamins, are implicated in preventable adverse drug events among this population,” the study says. “In addition, commonly used nutritional products (e.g., iron, calcium, and vitamin D) and alternative medicines (e.g., bodybuilding supplements) are also increasingly associated with adverse cardiovascular effects, including arrhythmias, that can lead to sudden cardiac death, a serious yet underreported problem in children and adolescents.”
The study also notes that the growing use of melatonin and omega-3 fatty acid supplements, which are often promoted as having cognitive and sleep benefits for those with attention-deficit/hyperactivity disorder, is of concern.
“Dietary supplements are not required to go through the same FDA (Food and Drug Administration) regulations and approval processes as prescription drugs,” says Dima M. Qato, PharmD, PhD, MPH, associate professor in the College of Pharmacy at University of Illinois and lead author of the JAMA Pediatrics study. “We know very little about their safety and effectiveness, especially in children.”
This lack of evidence supporting the need for supplements in otherwise healthy children without nutritional deficiencies should come as a warning to parents and guardians, Qato says, due, in large part, to potential side effects.
“Many dietary supplements have been implicated in adverse drug events, especially cardiovascular,” she says. “We simply do not know if there are any benefits for healthy children that outweigh the potential harms. The study suggests supplement use is widespread and therefore an important, yet often ignored, public health issue.”
Harmful outcomes, including interactions with prescriptions, can result from taking unsafe or ineffective supplements, says Linda Somers, RD, a pediatric clinical dietitian at Ann & Robert H. Lurie Children’s Hospital of Chicago. Because of the risks involved, there should always be a specific reason to use a supplement, she says.
Somers says she will recommend a multivitamin for children with dietary food restrictions that eliminate specific nutrients, self-selective diets, malabsorption, gastrointestinal disease or injury or those on vegetarian or vegan diets. Infants or toddlers who are exclusively breastfed or obese children, she says, may benefit from vitamin D. Some teenagers may need a multivitamin with iron due to a typical teen diet that’s high in sugar and refined starch.
Before parents give their children supplements, including multivitamins, they should have a conversation with their doctor, Somers says. She encourages doctors to educate themselves on the use of these products to help foster open communication.
This dialogue is significant, Qato adds, especially as advertising in the supplement market continues to rise, encouraging additional or continued use.
“There is increased marketing and promotion of supplements … targeting children and teenagers, particularly to improve their cognitive, sleep and mental health,” she says.
Rebecca Unger, MD, a physician at the Northwestern Children’s Practice, says the heightened use and interest in supplements stems from growing popularity and trends — not because today’s children are less healthy.
“I do not believe increased use is due to a significant change in the nutritional health of children or an increased need for supplementation,” Unger says. “I believe there has been an explosion of marketing and availability … this information is more and more accessible to families, children and adolescents.”
In today’s information-laden world, parents may be looking for easy fixes for their children’s ailments, when they should evaluate their children’s diet and lifestyle first, Unger says.
“It is important to focus on basics of healthy nutrition, physical activity and sleep habits. For example, children who do not have a neurologic problem will not likely benefit from melatonin,” Unger says. “Young athletes need to focus on hydration and adequate nutrition intake, including protein and carbohydrates, especially during intense workouts and games, but special diets and supplement use will not improve athletic performance.”
Somers adds, “Instead of focusing on the mundane path to health, we are looking for quick results, magical cures, extreme diets and exercise programs. … We need to get back to the philosophy that food is our medicine.”
“As a society, we have gotten away from the idea that healthy food and healthy lifestyle habits should be the root of our pursuit of health,” she says.