Ideal world: An eager, hungry 6-year-old sits at his perfectly portioned plate comprised of a vegetable, a fruit, a whole grain and a protein, and accompanied by a glass of milk.

Real world: A picky, finicky 6-year-old stares at his plate on which you’ve hurriedly thrown a pile of pasta (you know he’ll eat it), a few green beans (that he will avoid like the plague), apple slices (that he eats first) and a glass of milk that he refuses to finish.

Among us, there are a few lucky parents whose children eat well-balanced meals every meal, every day. The majority of us struggle with picky eaters, food refusals, busy schedules or a combination of all three. We might get a well-balanced meal in a few times a week, but every day for every meal is a pipe dream!

The majority of children do manage to get most of what their bodies need to grow and thrive despite their less-than-perfect meals. However, if your child has specific food refusals, a restrictive diet or extreme pickiness, then you may need to give them vitamin or mineral supplements. Megavitamins—large doses of vitamins—are not good for children as some vitamins and minerals can be harmful to children in large doses. As much as possible, try to maximize the nutrients in your child’s diet. Look for fresh, whole foods and variety when trying to get more vitamins and minerals into your child’s diet.

Vitamin Deficiencies in Children

Some common difficulties in feeding children can make supplementation necessary, including:

• The meat-avoiding toddler: Young toddlers are notorious for avoiding meat. Most drink a lot of milk and eat a variety of fruits, some palatable vegetables but turn their noses up at the idea of meat. Lean meats are an important source of B vitamins and iron as well as proteins. Low iron is associated with fatigue, and cognitive and behavioral problems. Iron is especially important during periods of rapid growth and development for its role in building muscles and healthy red blood cells. B vitamins are essential for energy production and a healthy nervous system. Symptoms of deficiency include irritability and short attention span. Non-meat dietary sources of iron and B vitamins that are great for toddlers include hummus, fortified cereals, beans, dark leafy greens and peanuts. These same deficiencies are often seen in vegetarian diets. If you are concerned your child is not getting adequate iron and B vitamins in his diet, an iron supplement or children’s multivitamin with iron can be given daily.
• The soda-drinking teen who avoids dairy: Teenagers have some of the worst diets. Busy schedules often lead to nutrient-poor fast food meals. Many teens have diets high in fat and carbohydrates and low in fruits, vegetables and dairy. Often teens opt for sports drinks and sodas over milk and water. Calcium and vitamin D are frequently identified nutrient deficiencies in all children of all ages that often worsen in teenagers. Dairy is a major dietary source of calcium and vitamin D, both of which are vital for healthy bones and teeth. Deficiencies of vitamin D and calcium can result in brittle bones, muscle weakness, slow growth and fractures. Children who do not have adequate dairy in their diet can find calcium and vitamin D in fortified orange juice, kale, salmon, tofu and eggs (D only). Vitamin D and calcium should be supplemented for children at risk for low dietary intake of these important nutrients.
• Infants: Breastmilk and formula (less than 32 ounces a day) alone do not provide enough vitamin D for infants prior to starting fortified baby foods. Vitamin D supplementation is recommended for all breastfed infants and formula-fed infants taking less than 32 ounces of formula a day.
• Extreme picky eater: Many children with autism and some neurotypical children have very restrictive diets often comprised primarily of carbohydrates and sometimes meats. These children are at risk for deficiencies in many vitamins and minerals including vitamin A and C. Diets high in carbohydrates and low in fruits and vegetables do not provide adequate fiber, either. Vitamin A promotes normal growth and development and healthy skin and eyes. Vitamin C is essential for a healthy immune system as well as healthy muscle, skin and connective tissue systems. Low vitamin C can result in frequent infections and poor healing of wounds. Fiber is important for heart health and for colon health. Children who lack adequate fiber in their diets struggle with constipation. Vitamin A and C are found in fruits and vegetables. Foods high in fiber include whole fruits, beans, raisins and some cereals. Children who do not get enough fiber in their diets or who struggle with constipation can benefit from a daily fiber supplement. Children with diets low in fruits and vegetables need a daily multivitamin.

Well-balanced, consistent nutrition is extremely important for growth and development starting from birth and continuing into adulthood. Healthy eating patterns incorporating low-fat dairy products, plenty of fresh fruits and a rainbow of vegetables, lean proteins and whole grains should start early in childhood. Model healthy eating for your child. Aim to get your child’s nutrients through foods, but supplement nutrients when needed after talking to your pediatrician.