Thousands of children have been hospitalized after poisoning by vitamins and minerals in recent years, the majority ingested intentionally, a nationwide study showed.

Over just 3 years, the federal Healthcare Cost and Utilization Project Kids’ Inpatient Database recorded vitamin and mineral toxicity as a cause of hospitalization for 1961 children. That represented just the supplements for which there was a toxicity-related International Classification of Diseases-10 code, said Marina Masciale, MD, MPH, of Baylor College of Medicine in Houston, whose group reported the findings at the Pediatric Hospital Medicine (PHM) 2026 in Kansas City, Missouri. “Our study probably only scratched the surface,” she said.

A 2018 study of pediatric hospital visits due to poisonings that used the same inpatient database found only 14.5% of these resulted in inpatient admission. As for the bigger picture on toxicity, the most recent annual report from the databases of poison centers across the country noted dietary supplements, herbals, and homeopathic medicines together to be one of the fastest-growing types of exposures resulting in calls. Although accounting for only 0.11% of exposures overall, supplements represented the fifth most common exposure in children aged 5 years or younger resulting in poison control center calls (6.34%).

Even if zinc, vitamin A, gummy multivitamins, and the like fall far below the level of poisoning from non-opioid analgesics, they still cause significant illness in the US each year, Masciale said. “Some of these hospitalizations had extreme loss of function, severity of illness, and so it’s not insignificant.”

About one third of the hospitalizations involved extremely severe illness from toxicity. Median length of stay rose from 3 days in the first years analyzed, 2016 and 2019, to 4 days in the last year analyzed, 2022 (P < .01), but the worst cases were more likely to have stays exceeding 8 days.

Notably, 56% of the toxicities followed intentional ingestion. Teens aged 13-17 years accounted for 57% of the cases, and 73% were female.

Co-author Christina Abi Kheir, MD, second-year pediatric hospital medicine fellow at Baylor College of Medicine, cautioned that the observational study couldn’t determine what the intent of ingestion was or draw causal associations.

Some of the youth might have intentionally taken a bunch of pills in an attempt to get high or to get healthy, Masciale added. “But my guess is that the majority were intentional ingestions for self-harm,” she said. “It’s really heartbreaking.”

Another possibility is toxicity from unexpected ingredients or higher-than-expected dosages due to the minimal regulation of supplements, said Carl Baum, MD, pediatric emergency medicine and medical toxicology expert at Yale School of Medicine in New Haven, Connecticut.

When it comes to supplements, “We have no idea what’s in that bottle, even though it says X, Y, or Z is in the bottle,” he said. “It’s a real challenge because it’s the Wild West.”

While Masciale agreed that more regulation of the supplement industry is needed in general, “I don’t know if the answer is to make all this prescription-only because then people would lose access to vitamins and minerals that they need.”

Rather, her group advocated for greater awareness.

“A lot of families think that because vitamins and minerals are sold over the counter, they’re safe,” she said. For families, especially those with young children or children diagnosed with a mental health condition, a key takeaway message is to lock up supplements the same as they would pharmaceutical medications to reduce the risk for harmful ingestion, she said.

Physicians, too, need to start getting more comfortable talking about the risk from vitamin and mineral poisoning, Abi Kheir said.

The study was independently supported. Masciale, Abi Kheir, and Baum disclosed no relevant financial relationships. 

Crystal Phend is an award-winning medical journalist with decades of experience reporting on clinical research and healthcare developments across specialties. When not walking the halls at a medical conference, she can be found at a keyboard in upstate New York.