1. Morin, Karen H. DSN, RN

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Recent reports indicate that approximately one-half of adults take a supplement or vitamin on a daily basis. Balluz, Okoro, Bowman, Serdula, and Mokdad (2005) reported a combined usage rate of 56.5% for vitamins and supplements among adult respondents from 13 states. Picciano et al. (2007) indicated that 47% of men and 57% of women in the 1999-2000 National Health and Nutrition Examination Survey had used a supplement within 30 days of being surveyed. Given the common use of supplements among the adult population, one wonders what is known about infant and toddler use of vitamins and supplements.

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Two recent studies provide some insight about this issue. Briefel, Hanson, Fox, Novak, and Ziegler (2006) reported that based on adjusted prevalence estimates that are considered more reliable, "supplement use was 8% among [U. S.] infants 4-5 months, 19% among infants 6-11 months, and 31% among toddlers 12-24 months" (p. S52.e5). Only one type of supplement, usually a vitamin/mineral combination, was given to almost all participants (97%). This combination usually included "vitamins A, C, B-6, B-12, D, and E; thiamin; riboflavin; niacin; iron; and fluoride" (p. S52.e5). Rarely was a single vitamin preparation administered. Interestingly, children who were considered to be "picky eaters" or who were firstborn were more likely to be given supplements. Three independent predictors of supplement use were identified: region of the country, household composition, and sex of the infant. Infants and toddlers living in the Northeast were more likely to be given supplements than their counterparts living in the West, South, or Midwest. Supplement use decreased as the number of children increased. When supplement users were compared with nonsupplement users using the Dietary Reference Intakes reference standards, the supplement group's mean usual intake of folate, iron, potassium, and vitamins A, B-12, C, D, and E were greater. However, both groups "had mean usual intakes that were well in excess of the AI" (Adequate Intake) (p.S52.e10). In other words, both groups exceeded the amounts needed, except for vitamin A.


Examining the prevalence of dietary supplement use in infants, children, and adolescents, Picciano et al. (2007) reported prevalence rate of 30% for children. Prevalence was 12% for infants younger than 12 months of age and 38% for children between 1and 3 years. When infants were excluded from the analysis, use decreased as age increased. Moreover, "when supplements were categorized based on ingredients, 18.3% said they used multivitamin and multimineral supplements" (p. 981), similar to findings obtained by Briefel et al. (2006).


What does this mean for nurses? Given findings from these two studies, it becomes important to obtain explicit information about both supplements and food when discussing nutrition issues with parents or caregivers. However, as Briefel et al. (2006) offered, foods, rather than supplements, serve as "the optimal source of nutrients for healthy children" (p. s52.e13), particularly when evidence-based standards for supplement use in infants and children are absent. Sharing this information with parents can allay their concerns about whether to offer their infant or toddler a multivitamin supplement. There are occasions, however, when vitamin/mineral supplements are recommended. For example, the American Academy of Pediatrics has specific recommendations for iron, fluoride, and vitamin D for infants up to 12 months of age, which have been discussed in previous columns. Nurses need to be cognizant of the fact that parental reliance on fortified foods and supplementation can lead to excessive intake of vitamins and minerals. Incorporating vitamin and mineral use when discussing infant and toddler nutrition with parents should be an essential part of a comprehensive diet assessment.




Balluz, L. S., Okoro, C. A., Bowman, B. A., Serdula, M. K., & Mokdad, A. H. (2005). Vitamin or supplement use among adults, behavioral risk factor surveillance system, 13 states, 2001. Public Health Reports, 120, 117-123. [Context Link]


Briefel, R., Hanson, C., Fox, M. K., Novak, T., & Ziegler, P. (2006). Feeding infants and toddlers study: Do vitamin and mineral supplements contribute to nutrient adequacy or excess among US infants and toddlers. Journal of the American Dietetic Association, 106(Suppl 1), S52.e1-S52.e15. [Context Link]


Picciano, M. F., Dwyer, J. T., Radimer, K. L., Wilson, D. H., Fisher, K. D., Thomas, P. R., et al. (2007). Dietary supplement use among infants, children, and adolescents in the United States, 1999-2002. Archives of Pediatric Adolescent Medicine, 161, 978-985. [Context Link]