Up to what age are multivitamins (MVs) recommended for children?

Multivitamin Recommendations for Children

Multivitamins are generally not recommended for healthy children beyond 18 years of age who have a balanced diet and normal growth. 1, 2

Age-Based Recommendations

The need for multivitamin supplementation varies by age:

Infants and Young Children (0-12 months)

• Vitamin D supplementation of 400 IU/day is recommended for infants 1
• Vitamin K (0.5-1 mg) should be administered within the first hour after birth 3
• For breastfed infants, vitamin D supplementation is particularly important due to low levels in breast milk 3
• Iron supplementation may be advisable in certain circumstances (e.g., premature infants) 2

Children (1-18 years)

• Multivitamins are unnecessary for most healthy children with balanced diets 2
• Specific vitamin supplementation may be indicated in certain circumstances:
  • Vitamin D (400-600 IU/day) if dietary intake or sun exposure is inadequate 1
  • Iron supplementation for children at risk of deficiency 2

Special Populations Requiring Supplementation

Multivitamins or specific vitamin supplementation is recommended for:

1. Children with chronic kidney disease (CKD):

   • Children with CKD stages 2-5 should receive supplementation if dietary intake doesn't meet 100% of Dietary Reference Intake (DRI) 1
   • Children with CKD stage 5D (dialysis) should receive water-soluble vitamin supplements 1

2. Children receiving parenteral nutrition:

   • Specific vitamin dosing recommendations exist for children on parenteral nutrition 1
   • For example, vitamin D (400-600 IU/day) for children and adolescents on parenteral nutrition 1

3. Children with inadequate dietary intake:

   • Those with restricted diets, food allergies, or selective eating patterns 2
   • Children from low-income households with limited access to nutrient-dense foods 4

Common Nutrient Deficiencies in Children

Research indicates several common nutrient gaps in children's diets:

• Vitamin D and dietary fiber are generally below recommendations for toddlers and young children 5
• After age 2, iron intake is often below recommended levels 6
• Vitamin E intake is below adequate intake in 50-75% of toddlers 6

Practical Guidance for Parents

• Focus on providing fresh foods and minimally processed foods with little or no added sugar, salt, or fat 2
• Parents should model healthy food choices and dietary practices 2
• Follow the principle of "the parent provides, the child decides" - parents offer healthy options, children choose what and how much to eat 2
• Avoid practices that lead to overeating (feeding to soothe, excessive portions, forcing children to "clean their plates") 2

Monitoring Considerations

• For children on supplements, consider the combined nutrient intake from both diet and supplements to avoid exceeding upper limits 4
• In the United States, approximately 34% of children and adolescents use dietary supplements, with multivitamin-minerals being the most common (23.8%) 4
• The use of two or more dietary supplements increased from 4.3% during 2009-2010 to 7.1% during 2017-2018 4

In summary, while multivitamins are commonly used, they are generally unnecessary for healthy children with balanced diets after 18 years of age. Specific vitamin supplementation should be targeted to address identified deficiencies or for children with medical conditions that affect nutrient absorption or requirements.