Supplementing the Diet

Many adopted children have nutrient needs that cannot initially be met by dietary intake alone. In general, supplementation is recommended during the initial period of catch-up growth post-adoption (often the first 12 months home, but can be longer).

The recommendations posted below are general recommendations for this group of children. Please share these with your health care provider to determine if they make sense for your child.

Recommendations for supplementation during the first six-to-twelve months post-adoption (these recommendations are not suitable for a breastfed infant):

  • Once on complementary foods, generally around 6 months of age, a multi-vitamin may be needed. At this stage, look for multi-vitamin drops not exceeding 100% of the Daily Value of an infant’s needs. Many infant supplements do not contain iron, which is the appropriate protocol for babies on an iron-fortified formula.

  • Do not give your infant an iron supplement if she is consuming iron-fortified formula unless your health care provider specifically recommends it. Many internationally adopted children may need supplemental iron, so check with your child’s pediatrician if this applies to her.

  • Consider an additional vitamin D supplement (also available as drops). Vitamin D is often lacking in many infants and children, especially those darker-skinned. Look into supplementing with 200 – 400 I.U. of Vitamin D daily.

  • If your infant is consuming non-fluoridated bottled water only, it’s worth checking with his pediatrician to see if he’s getting enough fluoride (a formula-fed infant may be just fine).

*Infants younger than 6 months should receive the majority, if not all, of their calories and other nutrients from iron-fortified infant formula (unless your child’s pediatrician has put her on a low-iron formula).

Once your child has been weaned from infant formula, you may want to consider a multi-vitamin for “added insurance” against nutrient deficiencies. The transition from an infant diet to a toddler diet is hard enough without the additional worries of malnutrition or under-nutrition. For many parents it makes sense to consider the following:

  • An iron supplement monitored by a pediatrician or registered dietitian.

  • A multi-vitamin (drops or chewables) that doesn’t exceed 100% Daily Value of the nutrients they deliver.

  • Vitamin D, which may also be present in some multi-vitamins. If you have dark-skinned children, an additional vitamin D supplement is recommended. Do not exceed 400 IU supplement/day, unless recommended by your child’s pediatrician for rickets or vitamin D deficiency.

  • If your child is consuming non-fluoridated bottled water only, you may need to discuss this with his pediatrician or dentist.

  • If your child is not consuming dairy milk, make sure his milk substitute contains at least 5-8 grams of protein per serving, at least 20-25% vitamins A and D, and contains B-vitamins. Soy milk is the preferred substitute for dairy milk as it is considered a “complete protein.” This is not the case with rice and almond milk. Many parents of non-dairy milk drinkers supplement their child’s diet with multi-vitamins.

Other Supplements Worth Considering

Essential Fatty Acids

Essential fatty acids (omega 3s) are being touted for enhanced immunity and brain development. Some health care practitioners feel they play a key role in facilitating growth and development, especially in children with a history of pre- or post-natal malnutrition, frequent infection, and/or ADHD and other learning disabilities. Other health care practitioners note that while the benefits of essential fatty acids have not yet been demonstrated scientifically, given in the correct doses they will do no harm. Still other health care practitioners may feel that essential fatty acids should not be given to children. Whether or not to add these supplements to your child’s diet is a decision that only you can make. It is certainly worth discussing with your child’s doctor or nutritionist.

Essential fatty acids are naturally occurring in cold-water fish like salmon, mackerel, sardines, and tuna. The NIH is actively investigating the potential positive effects of essential fatty acids versus the potential negative effects from the mercury found in fish. Handouts such as this one can help you make informed choices regarding the mercury content in fish: The iPhone even has an app that gives information about the mercury content of different fish and allows you to track your mercury intake:


Probiotics are another potentially beneficial supplement, especially to post-institutionalized children who may have less-healthy gut bacteria. Like essential fatty acids, probiotics are not universally recognized as scientifically proven, so parents will need to wade through the different points of view and make up their own minds. It may be worth considering, however, for adopted children with loose stools, those who are taking or have taken antiobiotics, or those prone to allergies. A recent study published in the European Journal of Clinical Nutrition by Dr. Merenstein and team of Georgetown University did show that probiotics helped prevent respiratory infections in children in the daycare setting, which may be applicable to adopted children coming out of institutional settings, especially those who will be going into daycare. ( See also the “Probiotics and Prebiotics” article from

Probiotics can be found in fermented foods like sauerkraut as well as some yogurts, cereal bars, and juices. Child-friendly probiotic supplements can also be purchased in powdered form as an “add-in” to juices or purees, or for older children in chewable form. They are often found in the refrigerated section of natural food stores.

Although research into essential fatty acids and probiotics is very active, their use has not yet been specifically studied in the adoptee population. Most importantly, talk to your doctor or registered dietitian about these supplements for your children.

Helping supplements work

Multi-vitamins and minerals should be taken with food for optimal results. Note that tea, common in international orphan diets, inhibits iron and other mineral absorption and should not be consumed within a few hours of a multi-vitamin.

Consuming vitamin C-rich foods like oranges and broccoli along with iron enhances absorption. Animal sources of iron, like liver and beef, tend to be better synthesized by the body than plant sources of this crucial mineral.

Supplement Safety

Some vitamins and minerals can be toxic when over-consumed. Make sure to talk to your health care practitioner about the dosage that is right for your child. Side effects for most supplements are minimal at most when taken in safe amounts. To reduce heartburn and constipation that may occur with iron supplementation, start with half a dose and gradually increase. Liquid iron can discolor teeth if taken straight from a dropper; mix with juice and use a straw, and brush teeth afterward to minimize staining. Any staining can be easily resolved with a routine dental cleaning.

Keep all supplements and medicines out of a child’s reach.

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