Vitamins and supplements
(including vegetarian, vegan and omnivorous diets)
Whether your child’s diet includes some animal-based foods or is exclusively plant-based, we’re happy to offer guidance on optimizing their nutrition and growth throughout childhood. To start with, here are some key nutrients to consider for each diet type, add the usual RDA (listed below) unless otherwise specified. This can often be accomplished with a combination of foods and supplements:
Disclaimer: these are general recommendations for children under our care with typical dietary intake. Please confirm with us during your child’s well check to consider their medical history as each child’s needs may be unique.
Vegetarian diets:
Iron
Vitamin D
Probably B12 (consuming dairy and eggs fairly consistently is sometimes enough).
+/- Zinc (while also found in dairy, whole grains/cereals, legumes, and nuts, absorption may be more limited - see below). A diverse vegetarian diet with regular dairy intake may not need a supplement, but a more limited/picky one might).
Protein: most kids with a broad diet will get ample protein for growth. However, a more restricted vegetarian diet can suffer from protein deficiency. In addition to dairy and eggs, make sure their diet includes a combination of legumes, whole grains, nuts, seeds, and a broad variety of vegetables. Of the plant-based proteins, soy is the most complete, but a broad vegetarian diet can meet this requirement in other ways too.
Omega 3: either fish oil (if not opposed) or via flaxseed, chia seeds, walnuts, algae, canola oil, soy
Vegan diets:
Iron
Vitamin D
B12
Zinc (while also found in whole grains/cereals, legumes, and nuts, limited absorption can affect availability, and without dairy it’s better to play it safe and add this).
Calcium: Kids need a lot of calcium while growing, and supplements usually contain only 15-20% of the RDA, so that’s reasonable to add here in addition to calcium-rich foods (see info below). Don’t forget to keep up with Vitamin D, which is critical for calcium absorption.
Protein: with a little diligence, most vegan kids with a broad diet will get ample protein for growth. However, a vegan diet is at higher risk for protein deficiency. Make sure their diet includes a combination of legumes, whole grains, nuts, seeds, and a broad variety of vegetables. Of the plant-based proteins, soy is the most complete, but a combination of other foods (eg legumes and grains) can also offer complete proteins.
Omega 3: flaxseed, chia seeds, walnuts, algae, canola oil, soy
Omnivorous diets:
Vitamin D
Omega 3: via fish or fish oil (alternatively, flaxseed, chia seeds, walnuts, algae, canola oil, soy)
Usually, no other supplements are needed if diet is otherwise broad/varied, unless a deficiency has been discovered.
Partial vegetarians (eg dairy, eggs and infrequent meat):
Vitamin D
Iron (either daily or every other day)
Omega 3: via fish or fish oil (alternatively, flaxseed, chia seeds, walnuts, algae, canola oil, soy)
Recommended Daily Allowances and Details
Iron
Values are given in elemental iron.
7-12 months: 11 mg
1 to 3y: 7 mg
4 to 8y: 10 mg
9 to 13y: 8 mg
14-18y female: 15 mg
14-18y male: 11 mg
19-50y female: 18 mg
19-50y male: 8 mg
Tips for iron:
Taking with Vitamin C at the same time (via foods or supplement) helps absorption.
The above RDA were based on absorption with a non-vegetarian diet. The RDA for vegetarians is technically 1.8 times higher, but for supplementation purposes these values will do fine, especially if combined with vitamin C.
Limit cow’s milk consumption to no more than 16-20 oz per day as this blocks iron absorption.
While some forms of iron claim better tolerance or taste, it’s usually not relevant at RDA levels, so focus on selecting a product that is easy to find with all the nutrients you need, in a taste your child prefers. Side effects like constipation are rare at this dose and more commonly seen with much higher treatment doses. But if your child has side effects, or you’re curious about the differences, see “forms of iron” below.
Keep iron out of reach of children, overdose is very dangerous.
Forms of iron, for those interested:
The most common forms are iron salts like ferrous sulfate/gluconate or ferric sulfate/citrate. Of these, ferrous salts are better because they are more bioavailable than ferric salts. Other forms include heme iron polypeptides, carbonyl iron, iron amino-acid chelates, and polysaccharide-iron complexes, and these may have fewer GI side effects than iron salts. But for small RDA doses, you’re not likely to notice a difference. Most iron forms when consumed with vitamin C or vitamin C containing foods do just fine.
B12 (cobalamin)
Important notes:
Only the active form of B12 (cyanocobalamin) counts toward B12 needs, and the nutrition facts found on packaging often doesn’t specify whether it’s active or not. So while foods like tempeh, spirulina, and seaweed contain B12, it’s mostly inactive, and that can even compete with active forms for absorption, potentially reducing B12 more than increasing it. The most reliable vegan sources are B12-fortified cereals, meat substitutes, milk alternatives, and fortified nutritional yeasts.
Expect B12 supplements to be higher than the RDA (often in the 6 to 9 mcg/day range). This is to ensure adequate intake and because, unlike calcium, higher doses don’t seem to cause adverse effects.
With these caveats in mind, the RDA is listed here in mcg per day:
1-3y: 0.9 mcg
4-8y: 1.2 mcg
9-13y: 1.8 mcg
14-18y: 2.4 mcg
Calcium
Important notes:
Don’t take these at the same time as iron or zinc supplements, because they can interfere with absorption.
Even most vegan diets will only need a partial boost as long as they’re keeping up with vitamin D and contain plenty of calcium-rich foods such as collards and kale, nuts and seeds, or calcium-fortified foods like plant-based milks, fortified tofu/cereals/etc with most meals. So don’t expect supplements to have the complete RDA, they’re often around 15-20%.
With these caveats in mind, here are the RDA levels in mg/day (again, anywhere from 15-20% of RDA for a broad palate to as much as 50% or more if your child’s diet is really restricted):
1-3y: 700 mg → consider 100-350mg + calcium-rich foods
4-8y: 1,000 mg → consider 150-500mg + calcium-rich foods
9-18y: 1,300 mg → consider 200-650 mg + calcium-rich foods
Zinc
Zinc is found in meats, dairy, and plant-based foods, though plant-based sources may not be absorbed as well. Soaking/sprouting beans, grains, and seeds can help increase absorption. Here are the RDA levels in mg/day; usually you can get a good amount of the RDA from food, similar to calcium, so just a boost here is usually all that’s needed.
1-3y: 3 mg
4-8y: 5 mg
9-13y: 8 mg
14-18y females: 9 mg
14-18y males: 11 mg
Healthy Schedule
After birth (within 24 hours)
Newborn visit (day 3-5 of age, home visits encouraged)
2 weeks
2 months
4 months
6 months
9 months
12 months
15 months
18 months
24 months
30 months
Yearly thereafter