Scott Webb (Host): If our kids are eating balanced and nutritious meals and snacks, many of them really shouldn't need to take vitamins and supplements. But my guest is here today to help us to understand them, when it's appropriate to give them to our kids, what to look for on labels and much more. I'm joined today by Dr. Mira Slizovsky. She's a Board Certified Pediatrician practicing at Franciscan Health.

 This is the Franciscan Health Doc Pod. I'm Scott Webb.

Doctor, it's nice to have you here today. We're talking kids and supplements, and I've got a lot of questions for you, so hopefully you're ready. Maybe you have some notes. Let's just start here.

In your experience, what are the most common reasons parents consider giving supplements to their children? And are there specific concerns that lead them down that path?

Mira Slizovsky, MD: Supplements, first of all, it's good to establish what is it? Supplements are certain substances that we add to the diet, hoping to improve the diet, to make it perfect or to derive some other health benefits, from these substances. And they usually are something like vitamins, minerals, some herbs, probiotics, enzymes, and some other things that parents think will give their children benefits. Usually what happens is, in a perfect world, of course, diet should supply a human being with all the necessary nutrients to promote the proper growth, development and, supply proper amount of energy.

But our life is not perfect. And now society, there is a lot of concerns with the diet. Parents, usually have multiple concerns. I'd say the most common one is a picky eater. So the picky eater, usually means that the child is not eating what the parents consider to be a good diet and they want to supplement the diet.

Host: Right.

Mira Slizovsky, MD: On the other hand, some people are concerned with the lifestyle. Lifestyle is very busy. Some people realize that they do not cook at home. They provide some processed foods from the grocery store, and they hear on the media all the time that these foods are not good. So they are trying to improve the diet by adding some supplements.

Host: Right.

Mira Slizovsky, MD: Then of course there are some medical conditions and there are children with specialty dietary needs. So for these children, usually the doctors design supplements and recommend specific supplements. There's always a category of people that have food allergies. When the diet is not balanced and not good because the person has to exclude many different foods and sometimes multiple foods that the person is allergic to.

So that leads also to taking supplements, and also kind of general concerns. Some people are trying to improve cognitive and behavioral problems in their children by giving them supplements. Some want to improve immune health and gut health. And there is a lot of information about that online nowadays and in media, and most of the people do it to tell you the truth, just in case, because they're parents and they also, they always want the best for their children.

Scott Webb: Right. As I was telling you before we get started, I'm a parent too, and I definitely subscribe to the just in case, category in many cases with my kids. And it makes me wonder, are there certain age groups where supplement use is more prevalent or you just find the parents have more questions?

Is it infants, toddlers, adolescents? What are you experiencing in the office?

Mira Slizovsky, MD: I think we see use of supplement all across the all ages. In infancy, very young infants sometimes are given supplements because the parents are trying to cope with some difficulties, in raising a very young infant, neonate. They frequently don't understand exactly what is going on with a neonate.

So they think that something is wrong and something could be improved with the supplement. And they use stuff like gripe water, some concoctions. By the end of infancy at nine to 12 months of age sometimes comes a problem with iron deficiency and we test for iron deficiency at that age, and then we have to supplement the child.

The reasons for that are physiologic and also dietary reasons in our society, and the doctor usually directs that process. Then two others usually, start going to daycare. They start being very picky eaters because of their behavioral peculiarities, and they also get sick frequently in daycare.

And the parents start worrying about these problems and they want to improve behavior and improve immune system of the child. So they start giving supplements for that purpose. Then a little late in school, children start experiencing, sometimes problems with learning, with behavior in school, social life happens and the parents are trying to improve focus and mood at that age with supplements and eventually adolescence, they become masters of their own health. Now they start managing their own health. They start participating in sports on different levels, and they sometimes take performance enhancers and adaptogens and some other supplements that they consider to be right for them. So, yeah, it is common at all ages for different purposes.

Host: All ages for sure. And you know, we talked to, you mentioned earlier about how, you know, supplements are often, as indicated by the name, to supplement things maybe their kids are not getting from their diet. So let's talk about a well balanced diet. Like what does that mean exactly in practice, you know, how do we ensure that our kiddos get the adequate nutrients?

Mira Slizovsky, MD: Every time the child comes for a well visit, we always discuss diet. It's a part of a wellness visit at any age. And, balanced diet is a diet that provides the right mixture, to support growth, development and energy needs of a child at that specific age. In infancy it is kind of easy because either breast milk with certain solid foods introduction or formula, is already balanced for us by nature or by science, right?

And, you just give the appropriate quantity and usually this is good enough, it's balanced.

 Little later, we really need to design our balanced diet ourselves for our children. And, balanced diet starts with regular meals. There should be usually three meals and two snacks through the day.

Host: Yeah.

Mira Slizovsky, MD: The size of the plate, is different for different ages. But usually it is anything between six inches, little saucer for a toddler and up to 10 inches for adolescent.

Host: Yeah.

Mira Slizovsky, MD: Half of that plate usually should be covered by fruits and veggies. Fruits and veggies should be as colorful as they could be, so all the bright colors and as we hear all the time, we eat our rainbow. Right.

Host: Yeah.

Mira Slizovsky, MD: Yeah. So, we are talking about fresh or cooked vegetables, but we avoid any kind of processed juices and purees from the grocery store.

Host: Right.

Mira Slizovsky, MD: The other part of the plate should have some protein food always. And the size of protein food, roughly speaking practically, is the size of the palm of the person.So if you look at the hand, that's the right size of the meat of any kind that the family is eating, poultry, fish, egg, some protein foods. They could be present on the plate. And the whole grains. Whole grains. We are trying to avoid refined white flour. White bread, white noodles and concentrate on something which is made of whole grains on brown rice, stuff like quinoa, some other grains that are popular in different cultures.

We are trying to avoid sugary cereals. And eventually we need healthy fats. Healthy fats usually are what is called unsaturated fat, polyunsaturated fat. And, practically, I usually tell the parents that if you look at the piece of fat at room temperature and it looks solid to you, this probably is saturated fat.

If it looks semi-liquid or liquid, it's probably good unsaturated fat. So something which is in oils, in fatty fish, in nuts, is unsaturated fat.

Host: Okay.

Mira Slizovsky, MD: And this is what is better for us than saturated fat.

Host: Right.

Mira Slizovsky, MD: Okay.

Host: How about some of the key nutrients that are essential for a child's growth and development? Like which foods maybe are the best sources for those?

Mira Slizovsky, MD: So just like we discussed right now, protein foods, meat, poultry, fish, eggs. For the, as a source of protein. There could also be vegetable derived protein. Usually vegetable derived protein is, not as easy to digest as animal protein, but still is sufficient. Legumes, beans, tofu, nuts, are very high in protein.

We need of course carbs for energy. And, carbs are mostly coming from fruits, veggies, and grains. Healthy fats are coming from all, all sources and, like we discussed, the unsaturated fats are better. So oils, fatty fish, nuts. Dairy products, supply a lot of protein and fats. Fats in dairy products mostly are saturated, so they should be consumed in moderation.

Host: Yeah.

Mira Slizovsky, MD: Minerals and vitamins are coming from all of the above and vitamins, of course, the fresher the food, the more vitamins is in it.

That being said, some vitamins are easily destroyed with cooking like vitamin C and some vitamins are more stable, like vitamin D and some vitamins are water soluble like vitamin C and some fat soluble like that, say vitamin D,E,A,K. These vitamins are better absorbed from fatty foods. So we do need these healthy fats.

Host: Right. The healthy fats. Yeah. Yeah. It's a lot to think about as a parent, of course, as a, a chef in our home. So good that we have experts like yourself. And you mentioned picky eaters earlier, wondering when we think about the particular dietary patterns, if you will, vegetarian, vegan, picky eaters. , Like where or when might we consider supplements maybe a little more readily?

Mira Slizovsky, MD: The picky eater problem. Very frequently we have to discuss with the parents and to listen to the parents. What specifically do they call that picky eater. And usually the parents consider picky eater a child who doesn't eat what they think is a healthy diet, and, sometimes they don't account for their younger child ability to digest food for their, you know, ability to kind of accept food.

And, that part depends on the child's development, developmental stage and age. Very much. So, they're kind of a classic example is when parents come and say he does not eat anything, about toddler. What do you mean? He does not eat anything? He just gained proper quantity of weight since our last visit.

Host: Right. Must be eating something. Yeah.

Mira Slizovsky, MD: So, oh no, he's not eating, but he's drinking a lot of milk and he's snacking all day long. Okay. So, if you look at that diet, if he's drinking a lot of milk, we can of course correct that. But, picking all the time is a normal developmental and behavioral variation of toddler.

Toddlers are kind of thriving for independence, and yet they're very dependent on us. So what they do, they literally pick, they approach you, they want some food, you give them a little bit, they go because they're independent and they come back again. And so our job is to know about that and remember that no, he will not sit down and eat your balanced meal at the table, but he will pick.

So you have to be ready with the balanced assortment of the foods through the day for that picky eater. On the other hand, there's a lot of things that you can do to prevent really, really picky eater, in your family. And, usually it means that you accustom the child to the variety of foods, textures, taste since very early age.

So sometimes we advise the parents, even if it is not, you know, for food consumption, even not for calories or some nutrients in that food, but just for the variety of taste, give a child something that he's interested in, to lick on, to hold on to, to try to promote that adventurous behavior.

Host: Yeah.

Mira Slizovsky, MD: And if you don't do that, if you are concentrated on rigid diet that you consider to be proper in the future, you have a finicky eater. Nowadays, unfortunately, there are a lot of children that we see with autistic tendencies. And a lot of them have certain food preferences and certain sensory problems.

And autistic behavior sometimes manifest itself for the first time with this peaky eater behavior. So that should be assessed and diagnosed, and, addressed correctly with the therapy.

Host: Sure.

Mira Slizovsky, MD: On the other hand, when a child becomes an adolescent, here comes independence and struggle for freedom. So at that time, you really have to maybe like two adults sit down and discuss what are the nutrients that you need, what are you actually eating? Have a food diary and see what's going on and cooperate with your child rather than assert your authority.

Host: Yeah, cooperation is key, for sure.

Mira Slizovsky, MD: Yeah. With regards to vegan and vegetarian and other diets.Like right now is very popular, carnivore diet, paleo diet, and you name it. Different finicky diets like that. These usually are trends. Vegetarian diet, is very popular in many places in the world and if done properly, it definitely can bring benefits, certain benefits to health and can sustain normal development and growth of the child, with no problem.

But you have to understand what you're doing and, with this child, if the younger the child and the more restricted is the diet, the more I'm likely to actually do some labs to see if he's lacking certain vitamins and then supplement if needed, protein, you know, vitamins, fats, whatever seems to be lacking.

Host: Let's talk, like some specific things about supplements. Like kind of move into a new area here. When it comes to vitamins and minerals, which of the most common ones that you recommend for children and maybe under what circumstances?

Mira Slizovsky, MD: So a healthy child on regular diet really should not need any supplements. Even if the child is eating not perfect Western diet with a lot of processed foods and, fast food, still foods in our country are supplemented with a lot of vitamins and minerals. There are preparations of cereal, which is not particularly healthy, but it is actually supplemented with a whole group of vitamins, including B Group.

Group of B vitamins. There are preparations of milk, that are supplemented with additional, vitamin D, for example, orange juice could be supplemented with calcium. Many other preparations are supplemented. And this leads to the situation where the child eventually gets all his nutrients from the diet in our country, even if the diet is not perfect.

So there is no recommendation. Parents frequently come in and say, must they give him vitamins? And what kind of vitamins? No, you don't have to give vitamins to a healthy child on regular diet. Unless you want to. Some vitamins could be stored in the body.

Some could not be stored, and they will be just eliminated if you give access. The ones that are stored, if you give them in excess, they can cause side effects. They are very biologically active substances. This is why we need them. And so you gotta be careful with supplementing with vitamins if they're not really needed.

Host: Right.

Mira Slizovsky, MD: Some other substances like iron, for example. Some people are convinced that they must supplement with iron. Not really. And, this supplementation, sometimes leads to uncontrolled ingestion of huge quantities and, problems with it. Complications and, overdoses and toxic effect.

So, people should understand that before they decide to give vitamins or any kind of specific preparation over the counter from their pharmacy, they really should consult their physician.

Host: That's the best advice, right? When in doubt, speak with your doctors, speak with your providers. I, I know, doctor, that probiotics are very popular. I wonder what your take is on them, and maybe are there some specific situations where you find them to be really beneficial?

Mira Slizovsky, MD: Probiotics could be beneficial for our health and there is a lot of evidence but there is no convincing evidence, a hundred percent evidence yet, and there is no recommendation how much exactly of what probiotic to buy and to give to the child. And the problem is that probiotics are supposed to be live organisms.

And they work only in your body if they are alive and function. And, what people are getting from the pharmacy is usually sitting on the shelf for a long time. They alive? What is going on with them? We simply do not know. So probiotics, we recommend them, but then I give people a lecture of what is a good probiotic, you know, how exactly to store them and how to give them.

Host: Sure.

Mira Slizovsky, MD: So, they come in different forms nowadays, in very convenient forms like gummies and, drive in straws that you can put in your juice and suck from it, and you will get a dose of probiotic, supposedly. They're very safe, with rare exceptions of immunocompromised people, very young infants and people with specific allergies. The preparations are safe, so you can try them, but you should understand that it's not anything that will give you spectacular, fast effect.

Host: Right. not a magic. They're not, they're not magic pills, right?

Mira Slizovsky, MD: Yes, exactly. It's not a pill that you take and you get them. So you gotta, take them for quite some time. They are expensive. When they are added to food, then there is always a question again, did they survive in that food? How was it stored? And, stuff like I frequently hear from the parents, can I give him yogurt? Yogurt you have to really give the right, type of yogurt and the right quantity of yogurt, and not the yogurt with what is called fruit at the bottom means a lot of sugar and, some live cultures which are not alive anymore.

So this is the problem with probiotics.

Host: For sure. How about Omega-3 fatty acids? I hear a lot about those, but I don't really know much about them. Are there any clear benefits for kids? And, if there are, then how do we ensure that our, our kiddos get enough?

Mira Slizovsky, MD: Omega -3 fatty acids are very beneficial for our body. We must have them. Now, the supplement is another story again. Most of the children, again, do not need supplements outside of infancy. In the infancy, a lot of formulas have nowadays, special fatty acids, which are added to promote brain development and eyesight development.

The company specifically add them because the formula is a very complex preparation and they have to be added specifically.

Host: Okay.

Mira Slizovsky, MD: Outside of that time, yeah, there is an evidence that they might improve mood, behavior of the child. Again, this is not something that clearly benefits any child right away.

It takes a long time, for this to work and on its own, it's not going to treat your ADHD or depression, but it might help.

Host: Might help. Sure. yeah. If we, uh, think about the some of the risks and safety concerns, which I know a lot of parents have wondering, uh, you know, about unregulated supplements. I feel like you just stay away from those entirely. But from your perspective, what do we look out for or try to avoid when we're buying supplements for our kids?

Mira Slizovsky, MD: So to buy a good supplement is very tricky. And, parents are always are asking for advice, where to buy the good ones. And there are several rules. There is really no tight regulation in our country. As opposed to other countries. And so, when we buy supplements, we should understand they regulated as food, which means that nobody specifically tested this bottle that you are getting from the pharmacy and what is inside that bottle or inside that pill, not always, and not necessarily is what the company claims it to be.

Host: Okay.

Mira Slizovsky, MD: So, when you are trying to buy supplement, first of all, go to a reputable retailer. Start with that, of course, after you consulted your provider.

Host: Right.

Mira Slizovsky, MD: When you go to CVS and you are buying some supplement there, it is probably much safer than you buy it on TikTok.

Host: Uh, you know that yeah, that's, that's going to be a key takeaway today. Don't buy your supplements on TikTok.

Mira Slizovsky, MD: Yeah, so you know, once you decide on some supplement, you take a look at, was it tested by some entities. And there are a lot of different entities that actually test natural supplements. There is a US Pharmacopeia, there is a Consumer Lab, different companies that provide third party testing.

 The more certifications you see on that bottle, probably the better. Then read the label yourself and avoid vague statements like proprietary blend, or mixture of this and that and no specific ingredients. Don't buy something that has many ingredients. Read the warnings.

Very important. Okay. And, eventually, send a picture of that active and especially inactive ingredients to your physician. Okay. For example, in that gripe water that, parents very much like, there is something which is baking soda. Would you just take a little bit of baking soda and give it to your neoate? Probably not. Right.

Host: Right.

Mira Slizovsky, MD: But it is in that gripe water.

Host: Okay.

Mira Slizovsky, MD: Okay.

Host: Yeah. When you think about it like that, you're like, no, I would never just give a spoonful baking soda to my child.

Mira Slizovsky, MD: But it's an antiacid of sorts.

Host: Of course. Right, right. Maybe back in the fifties they used to do that. But yeah, I, yeah, I, I totally hear you and I, I want to talk about potential interactions between supplements and prescription meds that parents really need to be aware of.

Mira Slizovsky, MD: Yeah, this is a very important topic and, not even every time, every provider knows right away how this, that supplement, works with your medications. Many supplements are very complex s ubstances. There are herbs, there are preparations from the plants and animals. There's a stuff like, for example, extract from bovine thyroid gland or extract from bovine pituitary gland.

And how does that work with your medications? Really needs to be thought of, and, all you have to do, you have to tell your physician, Hey, I'm going to try this or that, what do you think, and it might take your provider some time. Don't be surprised, to research, to look at it and give you the report.

Host: Another key takeaway today is really when in doubt or in all cases, you know, consult with your provider, send pictures of bottles, whatever you need to do. It's all great advice from an expert today. I wish we could stay on longer, but, you know, just try to put as much as we can out in the form of this podcast.

As we wrap up here, Doctor, final thoughts, takeaways, but your biggest you know key points that you want folks to remember, parents to remember when it comes to supplements, you know, where to buy them, when to buy them, when to use them, all that good stuff from you.

Mira Slizovsky, MD: So the key point should be never do supplements in the privacy of your home, secretly. Always tell your provider what you're doing. We are not judgmental. We understand that you want the best for your child, and we always will research it for you. Use our professional sources that you might not have access to, and, give you, you know, the complete picture, whether the expectations and is it worth it.

Host: Yeah.

Mira Slizovsky, MD: And be very careful with it, especially with children, with medical conditions and, young children.

Host: Right. Yeah. And as you said, you know, healthy children really shouldn't need supplements. Right.

Mira Slizovsky, MD: Yes. This is probably key takeaway.

Host: Yeah. Like if, if we're feeding them well and, you know, divvying up the plate, right? Some protein, some carbs, and we're doing all that, right? Three meals a day, two snacks. If we're doing our part and the kids are meeting us, maybe halfway, let's say, some of the time, most of the time, right? They really shouldn't need them.

But if they do, if you want to follow the, just in case you know, sort of plan, speak with your provider, speak with the pediatricians. Consult them, rely on their expertise. Don't buy supplements on TikTok, all that good stuff. Thank you so much though. I really appreciate your time today.

Mira Slizovsky, MD: You are welcome. Pleasure. Bye-bye.

Host: And to learn more, visit franciscanhealth.org and search Children's Health.

 And if you found this podcast helpful, please share it on your social channels, and be sure to check out the full podcast library for additional topics of interest. This is the Franciscan Health Doc Pod. I'm Scott Webb. Stay well, and we'll talk again next time.