If you read online guidance about nutritional supplements and vitamins for kids, you can easily fill an entire cabinet with recommended supplements (and empty your wallet). After eight years of managing vitamins and supplements for my four kids, I have managed to limit my supplements to four bottles. So which supplements do kids really need?

When it comes to vitamins, more does not equal better. I’ve seen children admitted to the hospital due to vitamin over-doses from well-meaning parents. Vitamins A, D, E, and K are stored in fat tissue. If you ingest too much of these vitamins you will store them, not just excrete them in your urine. One of my patients had orange hands and feet from drinking carrot juice daily. Some kids do have medical diagnoses that require nutritional supplements, such as anemia. But your pediatrician should be screening for these conditions at your child’s yearly check-up. If your child’s getting sick frequently or feeling tired, it’s best to get checked out by your pediatrician rather than blindly adding nutritional supplements.

In general, kids with well-balanced diets usually need few, if any, nutritional supplements. The problem is that most kids don’t eat well-balanced diets – not even mine. Trying to get kids to eat well is its own challenge—you can read my tips in my posts, “Food Fights—A Pediatrician’s Attempt to Get Her Kids to Eat Well” and “Food Fights—The Next Battle.”

So if your kids, like mine, have pretty good but not great diets, it’s probably a good idea to add a few supplements to their morning routine.

Here’s my list of supplements not to skip:

Vitamin D

Does your child drink a quart of vitamin D fortified milk each day? Or eat eggs and fish oil and get plenty of sun exposure? If not, they need vitamin D supplementation. This includes all infants, both formula-fed and breastfed. The American Academy of Pediatrics now recommends that children of all ages receive 400 IU (international units) of vitamin D daily. At present, 1 in 5 formula-fed infants and 1 in 20 breastfed infants are getting their full 400 IU of vitamin D each day.

Vitamin D deficiency is associated with rickets, increased risk of type I childhood diabetes, and a weakened immune system.

The primary natural source of vitamin D is sunlight, but sunlight is no longer recommended as a primary source of vitamin D due to the known skin cancer risks of excessive childhood sun exposure. Also, latitude, cloud cover, skin pigmentation and local weather affect the amount of sun exposure necessary to get enough vitamin D.

Iron

Children usually need 8-10 mg of iron per day, which most kids get by eating meats and iron-fortified cereals, breads and other grains. Iron deficiency anemia most commonly affects girls who have started their menstrual periods and babies 9 – 24 months old. All babies should have a screening test for iron deficiency at their one-year well-child check. If your baby was born prematurely, she may need to be tested earlier.

DHA supplements

Do your kids eat 2-3 servings of fish each week? If not, they probably need a DHA supplement. Breastfed babies and infants on DHA-fortified formula do not need additional supplements. DHA is a type of omega-3 fatty acid that is particularly important because it is required for optimal growth and development of the brain and eyes. Children with appropriate amounts of DHA in their diet have been found to have less aggressive activity, and there is some research that supports treating ADHD with DHA supplements. Omega-3 recommended daily intake for children varies widely, but I feel the best source is the International Omega-3 Learning and Education Consortium for Health and Medicine at the University of Connecticut.

Calcium

Most American kids don’t get enough calcium in their regular diet. The AAP recommends that kids 1-3 years old get 500mg per day (approximately 2 servings of milk), 4-8 years old get 800mg per day (approximately 3 servings of milk), and 9-18 years old get 1300mg per day (approximately 4 servings of milk). Too much milk-drinking can cause iron deficiency anemia, so drinking just the right amount of milk and not more is important.

So here is what my kids get each morning:

√ One kid’s chewable multi-vitamin primarily for iron and vitamin D, but the other elements are important for my super-picky 3-year-old with multiple food allergies. Note that most kid’s chewable multivitamins do not contain much Calcium. Most gummy vitamins do not contain much Calcium or iron.

√ One-three Children’s DHA softgels, depending on age

√ One chocolate-flavored chewable Calcium supplement that contains 500 mg of Calcium

√ My infants get D-vi-sol from birth until 4 months, when they start poly-vi-sol with iron. As soon as they can chew, I switch them to half a chewable children’s multi-vitamin, which is more palatable and easier.

The best time to take vitamins is with or after breakfast. Just taking supplements and skipping breakfast is not a healthy habit. There is consistent research that shows that kids perform better in school if they eat breakfast.

Do your kids have trouble remembering to take vitamins? Try keeping your vitamins next to your toothbrush. Make vitamins part of your morning tooth-brushing routine. For our infants, we keep vitamins with our baby bath supplies. We give vitamins nightly during baby’s bath, which also limits stains on all those beautiful baby clothes!