Supplements can have an important role in your child's diet, but they're not replacements for food.
Supplements are always a hot topic with our clients. We are constantly asked what supplements we recommend for kids, and while we do have some favorites to share we want to clarify a few things first:
Vitamin D is traditionally known for promoting strong bone growth, as it helps the body utilize calcium, but newer research also suggests that optimal vitamin D status may help prevent chronic diseases like asthma, cardiovascular disease and cancer. The best source of vitamin D is sunlight. However, since sunscreen use is important for skin cancer prevention, coupled with our indoor lifestyles, most people are vitamin D deficient.
Interestingly, vitamin D is the only supplement routinely recommended by the American Academy of Pediatrics. Specifically:
What does this mean? Essentially every child should receive a vitamin D supplement throughout infancy and childhood, unless they are getting at least 32 oz of formula or milk, or if they're breastfeeding and mom is taking 6400 IU vitamin D herself. Note: we don't recommend that most toddlers drink anywhere near 32 oz of vitamin D fortified milk, so for most toddlers direct supplementation is critical.
We know that some parents are uncomfortable with supplementation and think that children should get all they need from their food. While we agree with this philosophy, vitamin D may be the exception. When children were tested for vitamin D status, over 70% were considered insufficient. Vitamin D, especially when given in very simple supplements with no preservatives, is a safe and effective way to help build strong bones and prevent chronic disease. If you decide not to supplement your child, we recommend annual vitamin D testing.
Anecdote: I (Megan) am very vitamin D deficient without supplementation. I gave my eldest 1 drop per day of Thorne Vitamin D/K2 when she was a baby, as the 6400 IU vitamin D study data was not available at the time. Her vitamin D levels at age 1 were 62 ng/mL. With my second, I made sure to take about 7500 IU a day myself and didn't supplement her much. When tested, her vitamin D levels were 32 ng/mL. This is on the very low side of "normal" per certain medical boards and is in the "insufficient" range per the Vitamin D Council. If we weren't supplementing, I am convinced my children would be severely deficient via breast milk alone. They play outside every day without sunscreen, but they still don't synthesize vitamin D well (like myself). If you don't want to supplement your child, please test their vitamin D levels to ensure they are not deficient.
When looking for a vitamin D supplement, watch ingredient lists. Look for simple words you can pronounce. There are many very simple options available - no need for tons of ingredients or preservatives. If your child takes a multivitamin (see below) that contains 400 IU vitamin D or more, you do not need a separate vitamin D supplement.
Thorne Vitamin D/K2
Age: birth +
Dosage: 1 drop
We love Thorne Vitamin D/K2 because vitamin K aids in absorption of vitamin D. This flavorless, small drop can be mixed into anything or put directly into a child's mouth or via a parent's finger. Breastfeeding moms can also put it directly on their nipple directly before a feeding.
Carlson Labs Baby's Super D Daily D3
Dosage: 1 drop
Like Thorne's vitamin D, Carlson Baby's Super Daily D3 is a liquid drop that is small and flavorless. Use it as described above.
Probiotics are such a hot topic right now, as more and more research is emerging to suggest the importance of a healthy gut flora. We plan to write an entirely separate post specific to probiotics, their uses, which strains to focus on for given issues, etc. The recommendations below are simply a few general high-quality probiotics that we use and love.
Probiotics are the live bacteria and other organisms that live in our GI tract and various parts of our body. They are responsible for fighting off invaders as part of the immune system defense and may play a role in disease prevention, gut health, skin health, and neurological function.
In general, if your baby is breastfeeding or is using a formula that contains probiotics, additional probiotics are not necessary. However, if you baby has taken antibiotics, is exposed to a lot of germs at daycare or while traveling, or has any skin or digestive upset it is generally considered safe to start a probiotic to see if it helps. If your child has any medical conditions or is immunocompromised, please talk to your doctor first.
What about probiotics for toddlers and older children? If your toddler or child doesn't have breast milk, yogurt, kefir, sauerkraut, kim chi or other fermented foods multiple times a week, a probiotic may be a good idea. This is especially the case if your child struggles with constipation (or diarrhea), eczema or skin issues, uses antibiotics, or seems to get sick often. Again, check with your doc!
Below are 5 different products we like - again, there are MANY probiotics out there, but these are the ones we've used the most. Look for at least 5 billion CFU (colony forming units) per serving and at least 4-6 different bacterial strains. Note: Florastor Kids is the exception to this and should be used during antibiotic regimens, as S. boulardii can help prevent antibiotic-induced diarrhea. The probiotic strain in Florastor is a yeast, not a bacteria, so it's not killed by the antibiotic.
Klaire Ther-biotic Infant Formula
Dosage: 10+ billion CFU per 1/4 teaspoon
Note: at the time of publication the Amazon link for this product was not working. To ensure this product arrives cold, we have included a link to a company that sends it next day on ice pack. If you are local to the Phoenix area, you can pick it up at Modern Milk.
Must keep refrigerated. Should come with an ice pack.
Many integrative MDs and Naturopathic Doctors love Klaire's Infant Formula because it is high potency and contains strain specific to an infant's needs. In practice, we have seen wonderful success with this product.
Klaire Children's Chewables
Age: 12+ months if cut into small pieces or crushed
Dosage: 25+ billion CFU each
Note: Again, the refrigeration piece is an issue here. We are providing links for a company that ships it on ice, next day delivery, for a pretty pricey delivery fee. If you know a physician who carries them locally, we suggest buying them directly. These probiotics have been the most potent and effective children's probiotic product we have used in my house, and we absolutely adore them - otherwise, due to the shipping issue I wouldn't even put them on the list! They're also at Modern Milk for people local to Phoenix.
Must be kept refrigerated.
These chewables are not exceptionally sweet, so it may take some time for your kiddo to like eating them. We sandwiched them with a Nordic Naturals Omega-3 Fishy (see below) at first, and after a few times taking it that way my girls both willingly ate it. You can also try dipping it in a little juice or crushing it into a smoothie.
Garden of Life Dr. Formulated Probiotics Organic Kids+
Age: 12+ months if tablet is cut into small pieces or crushed
Dosage: 5+ billion CFU each
We haven't used these chewables but are very impressed by how they're formulated! They contain vitamin D (no need for a separate vitamin D supplement) and are shelf stable - no worries with refrigeration and shipping! They also are pretty affordable for a month's supply. I really respect Dr. Perlmutter and love that this product has many research-tested strains, similarly to the Klaire products listed above. However, the dosage (5 billion CFU) is lower than Klaire.
Garden of Life Raw Probiotics Kids
Age: 6+ months (due to whole-food based prebiotic blend, we recommend waiting until around 6 months to use these)
Dosage: 5+ billion CFU per 3/4 teaspoon
Must be kept refrigerated. If purchased using this link, per the answered questions the seller guarantees potency at the time of delivery, even if not using an ice pack.
For parents who want a more whole food-based probiotic, this is a great option! It can also be found in most health foods stores and is a powder so can be used for infants and children.
Florastor Kids - best for use during antibiotics
Age: 3+ months
Florastor Kids is great to use during antibiotic use, as it's technically a yeast strain and not bacterial, so it's not killed by antibiotics. Once your child is off of antibiotics, you can switch to a bacterial probiotics (like the ones listed above Florastor). I recommend this to almost every client on antibiotics. The adult version of Florastor is the exact same dosage and strain, it's just in a capsule instead of powder and doesn't have flavoring. If you're in a pinch and need to use the adult version with your kiddo, open the capsule and put it in something strongly flavored so they don't taste the true flavor (it's kind of "yeasty"). Bonus: this product does not require refrigeration.
EPA and DHA are essential fatty acids present in breast milk, fatty fish and (in much less bioavailable quantities) flax seeds, walnuts, and chia seeds. DHA specifically is responsible for eye and brain development and serves as a potent anti-inflammatory agent in the body, potentially helping in management of asthma, ADHD, and in prevention of heart disease later in life. If your baby or child is breastfeeding or is using formula containing DHA, or if your child is eating fatty fish like salmon or sardines a few times a week, supplementation is not necessary.
However, using an omega-3 supplement probably cannot hurt and can help ensure that your child consumes omega-3 fats, which are otherwise somewhat hard to get in high doses in the diet if your child doesn't eat fatty fish. Some eggs and milk are fortified with omega-3s, but it may be more cost effective to use a supplement. We love Nordic Naturals brand, as they are incredibly transparent in their processing of fish and algae oils and remove any contaminants or heavy metals utilizing molecular distillation.
While the guidance is mixed, on average we recommend approximately 100 mg per day of DHA via the form of food or supplements. Again, if your child is breastfeeding or drinking a DHA-fortified formula, or if they eat fatty fish or DHA-fortified foods regularly, they probably do not need a supplement. However, unless contraindicated by your physician it likely does not hurt, especially after your baby weans from breast milk or formula.
Note: we focus on total DHA in this blog post, but EPA is also an essential fatty acid, and the products listed below also contain EPA.
Nordic Naturals - Baby's DHA
Age: 6+ months
Dosage: 90 mg DHA per 1 mL
Babies 6+ months and toddlers not ready for gummies (usually recommended at 2+ years) are good candidates for this liquid supplement, which supplies 90 mg DHA in a 1 milliliter dose. We recommend adding this to a food or beverage. Since it contains fish, a food product, we don't recommend starting it until 6+ months of age. It is made from cod liver oil but contains very safe levels of vitamin A.
Nordic Naturals - Baby's DHA Vegetarian
Age: 6+ months
Dosage: 260 mg DHA per 1 mL
Nordic Naturals also has a vegetarian (non-fish) version of their Baby DHA. I haven't used this product myself but know many vegetarian families - or kiddos who are allergic to fish - who use this and love it. It actually has a higher DHA dose (260 mg per mL) but is about twice the price per bottle.
Nordic Naturals - Nordic Omega-3 Fishies
Age: 2+ (cut up into small pieces if using for younger toddlers)
Dosage: 1 gummy
I use these "fishy candies" with my girls (2 and 5) and offered them once they stopped breastfeeding at least a few times a day. My girls love sushi and fatty fish, but I find myself not serving it as often as I should. They absolutely adore these gummies, which come in individualized foil packs to keep them fresh and soft.
A multivitamin may be indicated if your baby/child is tested iron deficient or has a higher risk for iron deficiency anemia (obviously the multivitamin/multimineral should contain iron in this case), The reason we would recommend a multivitamin if more iron is needed is because multivitamins often taste better than straight iron supplements, and since vitamin D is also a necessary supplement, offering one multivitamin that contains iron and vitamin D is easier (and cheaper) than offering two separate supplements.
A multivitamin may also be indicated if you are worried about your child's nutrition status due to limited food intake. We don't routinely recommend a multivitamin, but if your child taking one helps you relax about their intake and makes you feel more comfortable with how they're eating, then they may be indicated. Make sure that any multivitamin you give your child contains at least 400 IU vitamin D. We did not include multivitamins without adequate vitamin D in this list.
We do not recommend routine supplementation of multivitamins/iron for infants (babies under 12 months) unless specifically indicated by your physician for iron deficiency or a risk of iron deficiency related to prematurity or other medical issues.
If you're using a different multivitamin, make sure to check its ingredients. Watch for artificial colors/flavors, hydrogenated oils, and lots of preservatives. Many of the big brand vitamins recommended for infants contain unnecessary preservatives and coloring agents.
Honest Company Baby and Toddler Multivitamin Powder Packs
Age: 6+ months
Dosage: 1 pack for babies 6-12 months, 2 packs for children 12+ months per bottle instructions (although 1 pack will still supply toddlers with ample key nutrients like vitamin D and iron)
The Honest Company Baby and Toddler Powder Packs are a dietitian's dream - they contain methylated B vitamins (more bioavailable for those with specific gene mutations), digestive enzymes, adequate vitamin D, iron (which is hard to get in many kids multis), and a blend of veggies and fruits. The catch? You have to figure out how to get a little pack of powder into your tot. Many parents find mixing it with yogurt or in a little diluted juice helps. Technically, after your child turns one you're supposed to offer 2 packets, but I would still use 1 unless your child's diet is severely limited or they have been tested to be very iron-deficient anemic.
Renzo's Picky Eater Multi - Dissolvables
Age: 2+ per bottle instructions, can be used for children 12+ months as nutrient doses are safe
Dosage: 1 dissolvable for 1-3, 2 dissolvables for 4+
Note: does not contain iron
Despite not loving the name (make sure not to tell your kiddo they're a picky eater!), I do love that these vitamins are dissolvable and sugar-free (they're sweetened with sugar alcohols, which are safe for kids and adults). I also love that they contain methylated folate, which may be important for those concerned about the MTHFR gene mutation (more research is needed). They do not, however, contain iron.
Smarty Pants Kids Complete Gummy Multivitamin
Age: 3+ per bottle instructions, can be used for younger toddlers if cut into small pieces, as gummies are a choking hazard for younger kids
Dosage: 4 gummies
Note: does not contain iron
For kids that love gummies, these Smarty Pants vitamins may be a good solution. They do contain sugar in sticky form, so we recommend having your tot brush their teeth after taking them. We love that they have plenty of vitamin D (600 IU) and methylated folate, but like most gummies they do not contain iron. (If a child were to open a bottle and eat multiple gummies, iron taken in great excess could be toxic.) They also have 44 mg DHA in a 4 gummy serving, which is better than nothing but is on the low side of DHA. This would be a great option for a kiddo who doesn't eat a lot of variety and needs a gummy but is also getting some DHA in another form, like via breast milk, fatty fish, a separate DHA supplement, or fortified foods.
Zarbees Naturals Baby Multivitamin with Iron
Age: 6+ months (can be used in toddlerhood, especially for toddlers who are iron deficient or at risk for iron deficiency due to low iron intake in their diet)
Dosage: 2 mL via provided syringe
This is one of the more simple-ingredient multivitamins with iron for infants, and from what my clients report it is well tolerated and liked by most babies. I like that it has 400 IU of vitamin D plus a great dose of iron (10 mg).
Zarbees Naturals Toddler Multivitamin Gummy
Age: 2-4 (if using for one-year-olds, cut gummy into very small pieces)
Dosage: 2 gummies
Note: does not contain iron
Many parents like this sweetened-with-honey gummy, which provides many key nutrients for toddlers, but not iron. The dosage (two gummies) is also smaller than other gummy products.
I hope this post helped you dissect the complicated world of supplements and find a product that works for you!
In case you were wondering, I personally give my girls Thorne Vitamin D/K2 (1 drop), Klaire Children's Chewable probiotic (1 chewable), and Nordic Naturals Omega-3 Fishies (1 gummy) - see below for details. We also mix up the probiotics after a few bottles for some diversity in probiotic strain.