The Government Accountability Office investigated commonly available supplements, and found heavy metals — including lead, mercury, cadmium and arsenic — in supplements available at drugstores and health food stores.

The FDA’s authority to regulate such supplements and treatments was rescinded during the Bush administration; since then, the sale of unregulated supplements has skyrocketed.

Sometimes I am asked about the value of various herbal or homeopathic treatments for children.  In general, there is no proof that they live up to their claims, nor is there supervision to ensure that they are free of foreign substances that might be harmful.

For my patients, I am skeptical that herbal and homeopathic supplements not regulated by the FDA are of benefit to children.  Labelling a treatment as “natural” does not assure us that it is effective, or safe.

Click here to read an article about the Congressional investigation from the New York Times.

–     David Epstein, MD

But now, we read in the news that the Institute of Medicine is about to publish a rebuttal to some recommendations for super-high doses.  (Click here for the Washington Post article, or here for the New York Times report.)

In fact, as far as I can tell, there’s not much disagreement between the Institute of Medicine and the AAP’s recommendations.  IOM recommends that all infants receive 400 International Units (IU) per day, and children over 1 year should receive 600 mg; the AAP recommends 400 IU for all infants and children. The AAP and the IOM agree that there is little evidence to support recommendations for huge doses of vitamin D (2000 IU or more).

Breast milk contains little Vitamin D, so all infants who get most of their milk from breastfeeding should be given Vitamin D supplement drops (with iron if possible).  For older kids, cow milk is fortified to give 400 IU per quart; so unless the kids drink a quart of milk every day, they need other sources as well, so I recommend daily vitamin supplements for them as well.  (Any brand-name or store-brand kids’ vitamin supplement will do; look for ones that also contain iron.  I’d stay away from any supplement made in China!)

So I still recommend once-daily vitamin supplements (with iron) for all children.  Don’t be put off by the news reports this week; the IOM is simply debunking claims for mega-doses of Vitamin D.

–  David Epstein, MD

Until now!  Recently, I have seen a steady stream of recent research suggesting that vitamin supplements, especially with Vitamin D, might be useful.

People with low blood levels of Vitamin D have reported 40% more frequent respiratory infections.  The association is even stronger for those with asthma or other lung diseases. (Arch Intern Med. 2009; 169:384-390.)

Teenagers with low Vitamin D levels are twice as likely likely to have high blood pressure, obesity, and high blood sugar.  They were also more likely to have cholesterol problems.  The same finding has been previously reported in adults.  Low Vitamin D levels have direct effects on blood pressure metabolism and insulin levels, and might also be a marker for poor diet.  Vitamin D tends to be drawn into fat tissue, so people with obesity probably need higher Vitamin D intake.  (Click here for the article. 1)

And, of course, Vitamin D’s relationship to bone health is well known.  This has led to universal supplementation of milk with Vitamin D, to complement milk’s calcium supply.  Kids should be happy about this; they don’t need to swallow cod liver oil any more!

Vitamin D deficiency turns out to be surprisingly common.  61% of American children have low serum Vitamin D levels, and almost 10% are frankly deficient.  Only 4% of kids take regular children’s vitamin supplements.  (Click here to see the data. 2)

As a result, the AAP now recommends Vitamin D supplements for all children, 400 IU (“International Units”) per day.  (Click here for the AAP report. 3) (Most children’s vitamin supplements provide this amount, but check the label to be certain.)  But even this may turn out to be insufficient for some kids.  Obese children, and kids taking seizure medications, might need more.

What do I recommend?

• Infants fed with breastmilk should be given a daily vitamin supplement, starting at 1 month of age (such as Tri-Vi-Sol).  (Formula already contains vitamin supplements, so infants taking more than 16 ounces of formula per day don’t need Tri-Vi-Sol.)
• For kids over 1 year, and actually into adulthood, a regular vitamin supplement (any brand) should be given daily.  Any brand should be fine; I suggest you find a brand that also provides mineral supplementation, such as iron, zinc, and even selenium.
• Unfortunately, blood testing for Vitamin D is problematic.  Some doctors recommend keeping levels above 20 ng/ml; but others recommend levels above 20 ng/ml.  Lab testing and reporting of Vitamin D levels are not yet standardized.  And Vitamin D levels vary normally with the seasons.  So I don’t recommend blood tests except under specific circumstances.

And don’t forget to check my handout on Calcium supplements (click here).

–  David Epstein, MD

1. [PEDIATRICS Vol. 124 No. 3 September 2009, pp. e371-e379]
2. [PEDIATRICS Vol. 124 No. 3 September 2009, pp. e362-e370]
3. [PEDIATRICS Vol. 122 No. 2 August 2008, pp. 398-417]