Mineral Supplements and Child Safety Beyond Iron: Zinc, Fluoride, Calcium and Gummies

If a child has swallowed supplements, act first

Call Poison Help at 1-800-222-1222 (US) or 911 in an emergency. MedlinePlus says to call even if you do not know the product, amount or time, and lists the useful details as the child's age and weight, the product name and strength, when it was swallowed and how much. [1] [2] Do not wait for those details: MedlinePlus says not to delay calling if they are not available. [2] The hotline gives further instructions. [3] Outside the US, see Poison Help by Country and Poisoning: What to Do First.

Iron is the mineral with the best-known danger for children and has its own page: Iron Overdose and Child Safety. MedlinePlus says iron overdose is particularly dangerous for children, and that a severe overdose can happen if a child eats adult multivitamins such as prenatal vitamins. [3] The NHS says very high iron doses can be fatal, particularly in children. [4] This page covers the other minerals.

Zinc

Zinc is in many multivitamin and mineral products. [2] MedlinePlus lists vitamin and mineral supplements among zinc sources and says to seek medical help right away after a poisoning. [2] Zinc supplements taken in large amounts may cause diarrhea, abdominal cramps and vomiting. [5] Health Canada's table lists a Tolerable Upper Intake Level (UL) of 7 mg a day of zinc for ages 1 to 3 and 12 mg for ages 4 to 8 (as extracted by a summarising tool; check the live table). [6] These are reference values for children's daily intake. We did not read a source that treats a UL as a poisoning threshold, so do not use it as one: a swallowed bottle is always a reason to call.

Fluoride

MedlinePlus says dangerous acute fluoride exposure is rare and usually occurs in small children. [1] Symptoms it lists include abdominal pain, vomiting, drooling and weakness, and fluoride is found in some mouthwashes, toothpastes and prescription vitamins with fluoride. [1] Swallowing a large amount of regular toothpaste may cause stomach pain and possible intestinal blockage. [7]

A separate issue is long-term fluoride supplements in young children. A 2008 systematic review found that fluoride supplements increased the risk of mild-to-moderate dental fluorosis, and called it a significant side effect. [8] A 2011 Cochrane review found limited information on adverse effects, and said the trials provide weak evidence about how well supplements work. [9] Health Canada's UL for fluoride is 1.3 mg a day for ages 1 to 3 and 2.2 mg for ages 4 to 8 (summarising-tool extract). [6] A dentist or pediatrician decides whether a child needs fluoride. See Fluoride: Dental Health, Sources and Excess.

Calcium

Calcium is the mineral children are most often given in larger amounts. MedlinePlus says up to 2,500 to 3,000 mg a day from food and supplements appears to be safe for children and adolescents, and that higher amounts over a long time raise kidney stone risk in some people. [10] Health Canada's UL is 2,500 mg a day for ages 1 to 8 (summarising-tool extract). [6] Contamination is a separate concern: see Heavy Metals and Contamination in Mineral Supplements.

Gummies and chewables

Gummy products look like candy. In one regional US poison center (2015 to 2017), 1,143 of 66,059 pediatric calls (1.7%) involved gummy medications, 74% of those involved vitamins and 24% melatonin. [11] The median age was 3 years and 7% were symptomatic. [11] The authors said these products should be stored safely. [11] That study did not separate minerals from vitamins, so it cannot show how often minerals caused harm. Proper evidence not found: US-wide figures for children swallowing mineral-only gummies. We searched PubMed for pediatric gummy and supplement ingestions.

MedlinePlus says that when a child eats too many pediatric multivitamins the effect is usually minor, while adult multivitamins, such as prenatal vitamins, are the greater concern. [3]

Talking with a clinician

Ask a pediatric clinician or pharmacist before giving any child a mineral product, particularly if the child takes medicines or has a kidney, liver or bowel condition. Keep adult supplements, prenatal vitamins and children's gummies out of reach in their original containers. See Children & Teens and Mineral Safety Quick Reference.