What vitamins are recommended for children?

Vitamin Recommendations for Children

Most healthy children consuming a balanced diet do not require routine multivitamin supplementation, with the critical exception of vitamin D (400-600 IU daily), which should be supplemented universally because dietary sources alone rarely provide adequate amounts. 1

Universal Vitamin D Supplementation

All children should receive vitamin D supplementation regardless of diet quality:

• 400-600 IU per day is the recommended dose for all children, as dietary sources alone rarely provide adequate amounts 1
• For children ages 1-3 years specifically, 400-600 IU daily maintains adequate serum 25(OH) vitamin D concentrations >50 nmol/L 2
• The tolerable upper intake level is 2,500 IU/day for ages 1-3 years, providing a substantial safety margin 1
• Breastfed infants require vitamin D supplementation starting in the first days of life, as breast milk does not provide adequate amounts 3

Newborn-Specific Requirements

All newborns must receive vitamin K at birth to prevent life-threatening vitamin K deficiency bleeding:

• Vitamin K administration is mandatory for all newborns regardless of feeding method 3
• This can be given intramuscularly or via oral protocol according to local policy 2, 3
• Infants whose mothers took medications interfering with vitamin K metabolism require specialized supplementation protocols 2

When Multivitamins ARE Indicated

Supplementation should be considered only in specific high-risk groups:

• Children on calorie-restricted diets or with inadequate dietary intake 1
• When oral and enteral feed intake is less than 100% of the Recommended Dietary Allowance 1
• A standard pediatric multivitamin (0.5-1.0 mL) is adequate for children requiring supplementation 1
• Children following strict vegetarian diets (no animal products, milk, or eggs) require vitamin B12 supplementation, as these diets provide no vitamin B12 4

When Multivitamins Are NOT Needed

Routine supplementation is unnecessary for most children:

• Healthy children consuming a balanced diet meet most micronutrient needs through food alone 1
• Whole foods should be the primary source of micronutrients rather than supplements 1
• Generally, healthy infants and toddlers can achieve recommended levels of intake from food alone 5

Critical Safety Warnings

Avoid excessive supplementation due to toxicity risks:

• Megadoses of vitamins and minerals carry potential toxicity risks 1
• Supplement use can increase the likelihood of intakes above the upper tolerable intake level for certain nutrients 1
• Excessive intakes have been documented for vitamin A (97% of toddler supplement users), zinc (60-68% of supplement users), and folate (18% of toddler supplement users) 5
• The tolerable upper intake level for zinc is only 7 mg/day for ages 1-3 years 1

Special Populations Requiring Specific Protocols

Preterm infants have unique requirements:

• Preterm infants require neonatal-specific parenteral multivitamin preparations with weight-based dosing 3, 6
• Adult multivitamin formulations must never be used in preterm infants due to potential toxicity from propylene glycol and polysorbate additives 3, 6
• Supplementation continues until infants reach at least 2000 grams body weight or 300 kcal/day caloric intake 3

Children on parenteral nutrition:

• All infants and children receiving parenteral nutrition should receive parenteral vitamins daily 2
• Vitamins should be added to lipid emulsions when possible to increase stability 2
• Routine monitoring of vitamin concentrations (except vitamin D) is not recommended unless on long-term parenteral nutrition 2

Practical Clinical Approach

Follow this algorithmic approach:

1. Start by assessing dietary intake to determine if supplementation is truly needed 1
2. Ensure universal vitamin D supplementation (400-600 IU daily) for all children 1
3. Confirm vitamin K was administered at birth for all newborns 3
4. Consider multivitamin only if: child has restrictive diet, inadequate intake, or special medical needs 1
5. Use pediatric-specific formulations only - never adult formulations 1, 3
6. Seek pediatrician guidance before initiating supplementation 1

Common Pitfalls to Avoid

• Do not assume supplements are harmless - they can cause toxicity, particularly with fat-soluble vitamins A and E, and minerals like zinc 1, 5
• Do not use supplements as a substitute for dietary improvement - whole foods should remain the primary nutrient source 1
• Do not overlook vitamin D - this is the one universal exception where supplementation is needed regardless of diet 1
• Do not give folic acid in place of vitamin B12 to children with B12 deficiency, as this may mask anemia while allowing irreversible neurologic damage to progress 4