Some physicians believe that supplements are helpful, especially if your child is missing certain foods from his diet. To find out what is best for your child, speak with your doctor and provide a supplement if recommended.

It’s important to remember that supplements are not a substitute for whole nutritious foods and should never be used as insurance against a poor diet. The body absorbs nutrients from foods much more effectively than it absorbs nutrients from supplements. If your child isn’t eating well, give him a multivitamin in addition to taking steps to improve his eating habits.

Here are some nutrient supplements – along with the appropriate circumstances – recommended for toddlers:

Vitamin D

Vitamin D allows the body to absorb and retain calcium and phosphorus, both critical for building strong bones. A vitamin D deficiency can lead to rickets, a bone-softening disease that still impacts children in the U.S., usually in the first two years of life.

Testing over the last 5 years reveals most children have some level of vitamin D deficiency. Children taking certain medications or with chronic diseases such as cystic fibrosis are at a heightened risk of deficiency.

Speak with your pediatrician about the types and dosages of vitamin D that will be most appropriate for your child. And remember to incorporate foods naturally high in vitamin D, like oily fish (trout, salmon and sardines) and eggs, as well as fortified foods, like cow’s milk, toddler milk, cow’s milk yogurt, cereal, and orange juice.

Exposure to sunlight (without sunscreen for a few minutes daily or most days) is also very important, as vitamin D is naturally present in very few foods.

Vitamin B12

Vitamin B12 keeps the body’s nerve and blood cells healthy and helps make DNA, the genetic material in all cells. Vitamin B12 deficiency can also cause a type of anemia called megaloblastic anemia that makes people tired and weak.

If your toddler eats little or no animal foods, B12 supplementation is important; make sure that you check with your child’s pediatrician about the correct dosage.

Iron

Iron, a mineral, is a key component of a protein that moves oxygen from the lungs to the tissues and is essential for growth and development, metabolic and cellular function and synthesis of hormones and connective tissue. There are two types of iron, heme and non-heme. Meat, seafood and poultry contain both types while plant and fortified foods contain only non-heme iron. We absorb more iron from heme than non-heme sources.

Toddlers 12-36 months need 7 milligrams of iron per day so their diets should be rich in lean meats, seafood, nuts, beans, vegetables, whole grains and fortified cereals. Also incorporate foods naturally high in vitamin C (like papaya, peppers, broccoli, strawberries and pineapple) because vitamin C increases iron absorption.

Liquid iron supplements are recommended for toddlers who do not meet the suggested intake. Chewable multivitamins are available for children 3 years and older.

What to Do

Offer a variety of fruits, vegetables, whole grains and protein-rich animal and plant foods throughout the week

Think about creating a balanced week of meals and food choices rather than trying to incorporate every single nutrient into every single day. If you vary the foods you offer your toddler for meals and snacks; and if he is experimenting with different textures, tastes and colors of food, then he is likely eating a balanced diet of minerals and vitamins.

If your family follows a vegan or vegetarian diet—or if your child tends to avoid animal foods generally – talk to your physician about supplements of vitamins B12 and D as well as riboflavin and calcium.

If your child is not eating dairy or eggs, he may be missing out on certain nutrients and require supplementation. For additional guidance, see How can I ensure my baby and I are meeting our needs with a vegan (or mostly vegan) diet? and How can I ensure my baby and I are meeting our needs with a vegetarian (or mostly vegetarian) diet?

Avoid ‘gummy’ vitamins for your toddler

Gummy vitamins are not only choking hazards for young toddlers, but some pediatric dentists think they may be to blame for childhood dental cavities. Gummy vitamins also confuse supplementation with sweets. Liquid vitamins may be a better bet.

Never refer to vitamins as ‘candy’

Treat vitamin supplements like medicine — keep them in a locked place or on a high shelf, follow all directions on the bottle for proper dosage based on your child’s age and weight and never let your child serve himself.

Unless specifically advised by your physician, do not supplement your toddler’s diet with liquid meal supplements or shake

These drinks are also referred to as: Nutritional shake, meal replacement shake, nutritional drinks, and protein shakes, and may be used successfully when a toddler is either underweight or failing to gain weight (or both). However, if your child is gaining weight well, these liquid drinks simply fill up the belly with calories and added sugar, making your toddler too full to eat balanced meals packed full of vitamins and nutrients.

Limit cow’s milk or toddler milk to between 16-24 ounces a day

Cow’s milk and toddler milk can make children full without giving them the valuable benefits of whole foods. Additionally, children who drink more than 24 ounces of cow’s milk a day are more likely to develop iron-deficient anemia because not only will the milk replace some of the more iron-rich foods, but it will also prevent the absorption of iron from other sources.

If your child is thirsty throughout the day, offer water between meals instead of milk and increase fruits and vegetables (which are great sources of water) as snacks. See Choosing milk and non-dairy milks for your baby and toddler for more guidance on beverages.

Brush with fluoride toothpaste and talk to your pediatric dentist or physician about fluoride supplements

Using a small rice-sized bit of fluoride toothpaste, brush your child’s teeth twice per day. Once your toddler reaches the age of three, you can increase the amount of toothpaste to the size of a pea. For more information on fluoride usage in drinking water and requirements for your child, see What are the Fluoride recommendations for my baby?