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To Supplement Or Not To Supplement

A guide to vitamins and probiotics for babies and toddlers

Ask ten moms and ten pediatricians which supplements your baby needs (if any), and you’ll get 20 different answers. There are as many brands as there are opinions, and, well, it’s easy to feel confused, if not overwhelmed. So we asked our trusted pediatric expert, MD Moms co-founder Dr. JJ Levenstein, to lay down the facts on the most widely considered supplements for children—Vitamin D, probiotics, iron, and multivitamins—to help our readers make their own educated decisions on supplementing their babies’ diets. As always, the MD Moms were a fountain of knowledge.

Vitamin D
Although breast milk is the ideal source of nutrients for babies, one element that does not flow very adequately from mom to baby is Vitamin D. (Mom’s bones must retain Vitamin D to stand upright, carry her young—hence nature has limited the amounts available through breast milk.) As a result, a young infant can theoretically develop Vitamin D deficiency (and weakening of the bones, a condition known as rickets). In years past, mothers would simply allow their babies to soak up the sun. But with today’s aversion to harmful UV rays, supplementing breast-fed babies with Vitamin D makes sense. The American Academy of Pediatrics increased its prior recommendation of 200 iu (international units) of Vitamin D daily to 400 units just two years ago. Many Vitamin D supplements are available in liquid form (TriviSol and DVisol are two common brands), which can easily be dropped directly into baby’s mouth or mixed with pumped breast milk. For babies fed at least 1000cc (about 30-32 ounces) of infant formula daily, Vitamin D supplements are not necessary, nor are they if your older baby has transitioned to Vitamin D-fortified milk (or Vitamin D-fortified milk equivalent).

Probiotics
Probiotics are having their moment. You’ll find the word plastered on everything from infant formulas, to eggs and bread—even drinking water. Why all the hype? Probiotics comprise a group of bacteria that are thought to be part of the normal makeup of a healthy GI tract. Infant formula manufacturers, in their quest to bring formulas as close to human milk as possible, started adding probiotics to their preparations a few years ago. Small studies have claimed that there is less colicky behavior and fewer diarrheal and respiratory illnesses in babies fed probiotic-laced infant formulas such as Nestle Good Start and Happy Baby Organics.

As for the toddler set, there are some emerging studies in Europe and China examining the effects of daily probiotic supplementation on children in daycare. The results look promising in that the European studies show fewer respiratory infections and lower rates of daycare absenteeism in the probiotic-supplemented group. Large analyses of data looking at the potentially beneficial effects of probiotic supplements on children with viral diarrhea demonstrate, at best, a one-day reduction in symptoms.

So while the verdict is still out, it makes good sense to us as pediatricians to replenish a gut that is altered by antibiotics or ravaged by diarrhea with healthy bacteria, especially if we can prescribe probiotics that include the lactobacillus family and/or saccharomyces family—the two that are showing the most consistent promise in studies of young patients. Brands that include these promising probiotics include Culturelle, BioGaia, and Jarro-Dophilus.

Multivitamins & Iron
Generally if an infant is born full term, and is either solely breast-fed or bottle-fed and thriving, multivitamin supplements are not necessary. Once baby starts solid foods, your pediatrician may recommend an iron supplement, especially if your family follows a vegetarian or vegan lifestyle. If your baby develops finicky eating habits upon entering toddlerhood, adding a nutrient supplement to your child’s diet makes sense—whether you incorporate a nutritionally rich liquid supplement (PediaSure, Boost), or vitamins/gummies laced with desiccated fruit/vegetable fiber/nutrients/antioxidants. However, if your tot is an adventurous eater and samples from a broad range of proteins, fruits, vegetables and grains, it is not necessary to give your child vitamins or iron if he/she is healthy, has normal levels of hemoglobin, and has enough energy to wear YOU out!

If you opt to supplement, take the time to read the labels. Be wary of supplements labeled as “natural” but failing to reveal ingredients. There are instances when supplements have been found to contain arsenic, mercury, or mega doses of vitamins (like A and C) that could potentially cause harm in a young child. When all is said and done, a dialog with your health care provider is the best way to sort out the myriad of choices out there.

—Dr. JJ Levenstein, MD Moms