Children and Dietary Supplements:
What the Science Says

Use of Herbs and Other Dietary Supplements by Children

The 2007 NHIS asked selected adult respondents about use of complementary health practices by children in their households. Overall, approximately 12 percent of children use some form of a complementary health approach.

• Natural products such as herbs/botanicals (vitamins, multivitamins, and minerals were not included in the survey) were the most frequently used complementary health practice among children.
• The most common natural products used were Echinacea, fish oil/omega-3s, combination herb pills, and flaxseed oil.
• Other practices often used by children included chiropractic and osteopathic manipulation, yoga, massage, and meditation.
• Complementary health practices were most often used for back or neck pain, head or chest colds, anxiety or stress, other musculoskeletal problems, and attention-deficit hyperactivity disorder (ADHD)/attention-deficit disorder (ADD).

Other studies have demonstrated that the reasons for use of herbs and dietary supplements by children vary widely with age and health status:

• According to one study, up to 10 percent of infants are given botanical supplements or teas, like chamomile or mint, usually for fussiness or stomach problems.
• Between 21 and 42 percent of children take multivitamins, according to another 2012 study. Children aged 2 to 8 were the most likely to take vitamins. However, they were also the only age group who had nutritionally adequate diets whether they took multivitamins or not.
• Products that claim to enhance sports performance, energy levels, or weight loss are popular among adolescents.
• A 2008 study found that more than half of children with chronic medical conditions use some form of complementary health practice, usually along with conventional care.

Safety of Dietary Supplements in Children

Most complementary health products and therapies, including herbs and other dietary supplements have not been tested rigorously for safety or efficacy in children. Although many dietary supplements come from natural sources, "natural" does not necessarily mean "safe." Dietary supplements can have side effects that differ from adults.

Two of the main safety concerns for dietary supplements are

• The possibilities of product contamination—supplements have been found to contain hidden prescription drugs or other compounds, particularly in dietary supplements marketed for weight loss and athletic performance or body-building.

• The possibilities of drug interactions—herbs and other dietary supplements may interact with medicines or other supplements, or they may cause problems during surgery, such as bleeding-related complications. For example, research has shown that St. John's wort interacts with drugs such as antidepressants in ways that can interfere with their intended effects.

Also, federal regulations for dietary supplements are less strict than those for prescription and over-the-counter drugs. Some dietary supplements may be of poor quality or contain contaminants, including drugs, chemicals, or metals.

Notably, the U.S. Food and Drug Administration (FDA) has issued recalls and safety alerts on some products popular with teens that claim to enhance sports performance, energy levels, or weight loss. In addition, the FDA has a rapid public notification system to provide information about tainted dietary supplements.

Given these concerns and the relative paucity of rigorous studies, particular caution is needed in considering use of complementary therapies in young people.

Discussing Complementary Health Practices With Your Patients

Most parents do not tell pediatricians or other health care providers that their child is using a complementary health product or practice, including dietary supplements. As a health care provider, it’s important that you: 

• Ask the parent/guardian of your patients about any complementary health practice being used or considered.
• Include a question about use of complementary health practices on medical history forms.
• Ask the parent/guardian of your patients to bring a list of all therapies they give their child, including prescription, over-the-counter, herbal supplements, and other complementary health practices.
• Have your nurse, nurse practitioner, or physician assistant initiate the conversation.

Childhood Vaccinations/Immunizations

A 2010 study funded by NCCAM and published in the Maternal and Child Health Journal revealed that children in Washington State who received care from complementary health providers were substantially less likely to get recommended immunizations and were more likely to be diagnosed with a vaccine-preventable disease. The cause for the association is unknown. For example, it is possible that the study’s results reflect an increased tendency of parents who are already vaccine-hesitant to seek out complementary health professionals, a direct influence of complementary health providers on parents’ attitudes, or another explanation.

Nonetheless, NCCAM urges parents to follow the CDC’s vaccination recommendations in order to safeguard their children against vaccine-preventable diseases. NCCAM also encourages all health care provider organizations—both conventional and CAM professional organizations—to engage their membership in immunization awareness and promotional activities to increase support for and adherence to childhood immunizations.