Vitamin deficiencies are quite uncommon nowadays, and will usually show up early on the periodic routine blood tests we do.  Indeed, the advent of recommendations for such routine bloodwork in the early 1980's brought with it an era (which lasted 20 years) in which it was felt there was no need for routine vitamin supplements at all in healthy, well nourished children or adolescent boys.  During that era, only menstruating adolescent (and adult) females were thought to need routine supplements (mainly for iron and, in more recent years, calcium).  Recently, however, a number of discoveries have started to call into question this wisdom .  The first was the increasing awareness that osteoporosis in the elderly has it's roots in childhood - that calcium stores built up in childhood last a lifetime, and that it's hard to catch-up on your calcium stores once you are an adult.  The second has been the increasing awareness of the importance of a number of trace elements (e.g. Zinc) which heretofore were not on our "radar screen".  Third, we now know that a number of vitamins with anti-oxidant properties can prevent atherosclerosis (the main cause of heart attacks &  stroke later in life), and that this too has it's roots in childhood.  Fourth, the recent discovery that Folate can prevent Spina Bifida has led to calls for all women to take supplements from an early age (so that getting extra Folate is automatic, not something you need to do special in preparation for pregnancy).  Finally, while we have always known that Vitamin D is crucial for calcium absorption, until recently we thought that sunlight and fortification of milk would be enough to ensure everybody had enough (the skin manufactures Vitamin D when exposed to sun).  Recent data suggests this may not always be true, and it's hard to predict which specific children aren't getting enough sunlight or milk from history alone.

All of the above has led to a change in our recommendations regarding Vitamins.  We now recommend that ALL CHILDREN receive a supplemental multivitamin daily.   This should start at 2 weeks age for breastfed babies, and at time of weaning from formula to regular milk in bottle-fed babies (a baby who receives both breast and bottle can be considered bottle-fed for these purposes if they get more than 500cc, or 16oz, of formula per day).   Supplementation should continue through adolescence.   Any of the many standard brands (Poly-vi-sol, Centrum, One-a-Day, Flintstones, many others...) available over the counter without a prescription are fine, as long as you follow the package guidelines for age-appropriateness & dosing.  Usually this will be drops for infants & toddlers, and chewable tablets for preschoolers and school age children.  When children reach the middle school years, they may begin taking adult multivitamin tablets.  All of these products will provide adequate amounts of all the necessary vitamins and minerals (except Fluoride) for all children except girls >9y.  Girls in the teen and pre-teen years need more Calcium than the standard multivitamin will provide.  We recommend that in addition to a multivitamin, they also take a separate Calcium Supplement (Citracal, Caltrate, many others...) in a dose of 800mg daily.

Finally, a word about combined Fluoride-multivitamin products (Tri-vi-flor, Poly-vi-flor).  We do not recommend or prescribe these for two reasons.  First, they contain a less complete vitamin and mineral set than most of the OTC multivitamins.  Second, Fluoride is best given alone, at bedtime, separate from the multivitamin (which should be given with a meal earlier in the day).  Therefore we prefer prescribing Fluoride as a separate medication.