Amy Martin’s 3-year-old twins were sick yet again — and the Anacortes, Wash., mom was fed up. “We were just getting cold after cold,” she says.
But Martin soon became disillusioned. Making her sons eat the gummies was a hassle, and they made no appreciable difference in the frequency of her family’s colds. She still gives her sons other supplements, including vitamin D, melatonin and probiotics, but “we do wonder if we are wasting money,” she says.
Martin is one of a growing number of parents who give herbal dietary supplements to their children. Most aren’t designed or marketed for kids: According to Innova Market Insights, a marketing research group of the food-and-beverage industry, just under 5 percent of dietary supplement launches target children. But supplement use among children is much higher.
About a third of children in the United States use dietary supplements, according to a nationally representative survey of American children and adolescents. Between 2004 and 2014, participants’ use of herbal and nonvitamin supplements nearly doubled, from 3.7 percent to 6.7 percent in 2013-2014.
Fish oil, melatonin and probiotics are the most commonly used dietary supplements outside vitamins.
Researchers still know little about whether or how dietary supplements can benefit — or hurt — kids. Studies of herbal and homeopathic remedies can have design flaws, and products can lack randomized clinical trials. Parents often rely on anecdotal evidence instead of reliable medical studies. And decisions to buy and administer vitamins and other products can be swayed by advertising or a parent’s own supplement use.
According to a Centers for Disease Control and Prevention report, children with parents who use dietary supplements or other complementary health approaches are more likely to use them than kids whose parents do not.
“I am always very hesitant to recommend any supplements to patients, even when there is some evidence of effectiveness,” says pediatrician Natalie Muth, a spokeswoman for the American Academy of Pediatrics. “In many cases, there is no evidence of effectiveness.”
Nevertheless, kids’ use of herbal supplements continues to rise. So do the number of calls to poison centers. “[Supplement-related calls] have been steadily increasing since 1994,” says Susan Smolinske, director of the New Mexico Poison and Drug Information Center. That’s when legislation went into effect that allows the Food and Drug Administration to intervene only after products are already on the market.
“What that created in this essentially almost unregulated environment is an industry gone wild,” says S. Bryn Austin, a public health researcher and professor at the Harvard T.H. Chan School of Public Health. “The industry went from 4,000 products on the market when this law was passed to well over 80,000 products on the market.”
Austin warns parents that just because a product is on store shelves doesn’t mean it’s safe for children — or even that it contains what it claims on the bottle. The FDA has recalled 12 dietary supplements in 2019 alone; most of the recalls related to mislabeling or undeclared ingredients.
Austin and other researchers examined the FDA’s database of unwanted side effects of supplements in children and adolescents, known as adverse events. Of the 977 events reported between 2004 and 2015, about 40 percent involved severe medical outcomes such as hospitalization, disability or death. Supplements that promised energy, weight loss and muscle building were associated with nearly three times the risk of an adverse event than those that did not.
“The claims are not true,” Austin says. “These products are not proven to turn anyone into an Olympic athlete or the highest scorer on their team. What they are proven to do is lead to serious adverse events when the products have dangerous ingredients, which too often they do. Parents cannot look at the bottle or box and read the label and know what’s in there.”
In a study published in the journal Hepatology Communications this year, researchers analyzed the ingredients of 272 herbal and dietary supplements associated with liver injury. Fifty-one percent of them had ingredients that weren’t listed on the label.
Todd Raymond and his daughter Abby, a 14-year-old team USA weightlifter, learned about that risk firsthand last year. After a family friend with a supplement company offered to make the athlete an ambassador for his fitness-related supplements, the Raymonds scoured the ingredient list for substances that might violate anti-doping rules. “Everything looked good to go,” Todd Raymond says. Abby began taking the supplements and promoting the brand.
But during a random drug test, she tested positive for ostarine, a non-FDA-approved substance that produces results similar to anabolic steroids. She was sanctioned by the U.S. Anti-Doping Agency (USADA) and disqualified from medals, points and prizes she earned before the test.
“It was devastating,” Todd says. After product testing, the Raymonds learned that the supplements Abby had consumed were contaminated during production.
Today, Abby is 15. She has returned to competition, and the Raymonds share their story with other youth athletes through TrueSport, the USADA’s educational program.
Jennifer Royer, USADA’s TrueSport and athlete education director, says that the organization has recently seen a rise in supplement use among younger athletes.
“Because parents have access to these products at their local grocery store, they assume they’re safe, but the supplement market is unregulated and evidence suggests that the modest regulation in place does little to dissuade companies from manufacturing with ingredients that are prohibited or dangerous,” she says.
Adolescents aren’t the only group at risk. Thirty percent of supplement-related emergency room visits between 2004 and 2013 involved children age 10 or younger. The majority were kids who ingested the supplements without parental supervision.
“You should be very vigilant about keeping them out of reach until it’s time to dispense them,” Smolinske says. Child-resistant packaging isn’t required for dietary supplements that don’t contain iron.
Independent test providers such as ConsumerLab.com and certification programs such as the one offered by NSF International, formerly called the National Sanitation Foundation, can help direct parents toward higher-quality products. “You should look for trusted brands from trusted companies,” says Andrea Wong, vice president of scientific and regulatory affairs for the Council for Responsible Nutrition, a trade association representing dietary supplement manufacturers.
So how can a parent responsibly navigate the slippery world of supplements? In written statements, representatives from the FDA and the National Institutes of Health urged parents to communicate with their child’s pediatrician before giving their kids an herbal remedy or other supplement. NIH also offers a series of tip sheets online, including one with questions parents might want to ask health-care providers.
Often, Muth says, parents don’t realize a pediatrician might be able to address their kids’ health concerns in ways that don’t involve supplements.
“If a pediatrician learns that a parent is giving a child melatonin as a last-ditch effort to help a child sleep, it creates an opportunity for the family and pediatrician to troubleshoot why the child may be struggling so much,” she says. “Or, if a pediatrician knows that parents are giving their toddler a multivitamin because they are so concerned the child will become malnourished due to picky eating, it creates an opportunity to discuss strategies to help increase a child’s willingness to try new foods.”
In turn, the American Academy of Pediatrics recommends that pediatricians ask patients about which supplements kids are taking.
Smolinske’s poison center handles tens of thousands of calls a year — and she has another reason to second-guess supplements: “Because of my experiences, I worry that giving these drugs to treat a disease may delay a diagnosis or evaluation by a physician. If [parents] decide to go it on their own, they may be ignoring something that should be evaluated by a physician.”
During her career, Smolinske has seen children with brain tumors, severe anemia and other life-threatening conditions go untreated because their parent thought an herbal supplement could cure their symptoms.
“They think that Dr. Google has all the answers,” she says.