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Do Dietary Supplements Help or Hurt Children?

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Serge Bloch

More and more children in the U.S. are taking alternative dietary supplements that have scant proven benefits and could pose health risks.

According to a recent analysis, the rate of children taking alternative or herbal supplements nearly doubled, to 6.3% from 3.7%, between 2003 and 2014. The increase was fueled by melatonin, a hormone used to aid sleep, and omega-3 fatty acids, or fish-oil supplements, which often are given to children with attention-deficit/hyperactivity disorder and autism despite little evidence that they help.

All told, one-third of children and adolescents in the U.S. take loosely regulated dietary supplements, the analysis found, largely reflecting the use of multivitamins. That rate has held steady over a decade, while the use of alternative supplements has jumped.

The analysis, published in the journal JAMA Pediatrics in June, is based on a national survey of more than 4,400 families asking if anyone ages zero to 19 had used dietary supplements in the past 30 days.

The rate of children taking alternative or herbal supplements nearly doubled, to 6.3% from 3.7%, over a decade, fueled by melatonin and fish-oil supplements.

The rate of children taking alternative or herbal supplements nearly doubled, to 6.3% from 3.7%, over a decade, fueled by melatonin and fish-oil supplements.


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“What this study underscores is how commonly dietary supplements are used,” says Caleb Alexander, co-director of the Johns Hopkins Center for Drug Safety and Effectiveness and a co-author of the analysis.

Healthy children and adolescents who eat a balanced diet don’t need vitamins, experts say. “These treatments add complexity and cost to patient regimens with little or nothing to gain,” Dr. Alexander says. “Why should children and adolescents be taking things where there’s no demonstrated health benefit?”

Some experts say supplements like omega-3 and melatonin aren’t harmful but have no evident benefit for children. But others such as Dima Qato, an assistant professor and pharmacist at the University of Illinois at Chicago and co-author of the study, say there is some evidence that they have risks in adults.

Supplements aren’t tightly regulated by the U.S. Food and Drug Administration like prescription drugs are. Supplement manufacturers don’t have to demonstrate safety or effectiveness to the FDA.

Bodybuilding supplements, used by 3% of boys and 1.3% of girls, are a concern because in some cases they have been linked to cardiac problems, Dr. Alexander says.

Steve Mister, president of the Council for Responsible Nutrition, a Washington D.C.-based group representing the dietary-supplement industry, said the analysis unfairly links supplement use to harmful health effects, such as heart problems.

“What concerned us is the way they tried to turn these results into something sinister by referencing potential adverse events and suggesting that because so many children were using them that that would translate into a large amount of adverse events,” Mr. Mister says.

The American Academy of Pediatrics doesn’t recommend the routine use of dietary supplements except in breastfed babies, says Steven Abrams, chairman of the AAP committee on nutrition.

Supplements don’t compensate for bad diets, he notes. “We don’t want people to think giving a child a multivitamin makes up for a diet of only hot dogs and French fries,” says Dr. Abrams, a pediatrician at the University of Texas Dell Medical School in Austin.

They also aren’t a substitute for appropriate medical therapy. Omega-3, for example, appears to be safe, but there’s very limited data that it benefits ADHD, he notes. “The concern would be if it was used to replace appropriate medical therapy,” Dr. Abrams says.

Natalie Muth, a pediatrician in Carlsbad, Calif., says supplement use comes up a fair amount in her practice. Dr. Muth says she tells most families that in most cases supplements—including vitamins and melatonin—aren’t needed.

Rather than giving children an omega-3 supplement, for example, feed them fish early on, she says: “Eating the actual food is going to be far superior to any supplement.” For better sleep, Dr. Muth favors having a bedtime routine and educating parents and children about limiting screen time and sugary or caffeinated drinks.

“Melatonin is used occasionally, but as a last resort and with a lot of caveats,” she says. “The most important caveat being across the board for all supplements, they’re not closely regulated by anyone. You can’t be sure that what’s on the bottle is actually what you’re getting, so you’ve got to really be careful.”

Clinical trials of dietary supplements often don’t include children, says Craig Hopp, deputy director of the division of extramural research of the National Institutes of Health’s National Center for Complementary and Integrative Health. “We can’t necessarily extrapolate because we see a certain finding in an adult population,” he says.

Pieter Cohen, an associate professor of medicine at Cambridge Health Alliance and Harvard Medical School who studies supplements, says the analysis raised more questions than answers. He says the study didn’t specify how many of the supplements were recommended by a doctor.

“If it’s the case that over 90% of this is unnecessary and doesn’t provide any health benefit, then we have a whole lot of children potentially being exposed to excessive products that might have harmful ingredients in them,” he adds. “On the other hand, maybe some part of this is recommended by physicians and is evidence-based.”

He says he is especially concerned about the teenagers using bodybuilding supplements. “We have study after study showing that those products may contain a host of unsafe ingredients,” Dr. Cohen says.

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