Current strategies in Pediatric supplementation: from correction of deficiencies to functional bioactives

Abstract

Objective: To synthesize recent evidence on pediatric supplementation, highlighting the evolution from traditional deficiency-correction approaches to strategies aimed at optimizing body composition, linear growth, and immunological modulation. Methods: A narrative review was conducted based on publications from 2020 to 2025, including randomized clinical trials, systematic reviews, and relevant clinical guidelines. The analysis focused on micronutrient interventions, the efficacy of oral nutritional supplements (ONS) on growth and body composition, and the emerging role of bioactive compounds. Results: High rates of iron, vitamin D, zinc, and iodine deficiency persist globally, with consequences for neurocognitive and physical development. Recent trials demonstrate that complete ONS, when combined with dietary counseling, promote greater linear catch-up growth and lean mass accretion compared with counseling alone, without disproportionate fat gain. Functional ingredients such as lactoferrin, TGF-β, nucleotides, and prebiotics show potential immunomodulatory and gastrointestinal benefits, although the evidence remains heterogeneous. An increasing and largely unsupervised use of supplements is noted among children and adolescents, often driven by aesthetic goals or perceived immune benefits. Conclusion: Contemporary pediatric supplementation should prioritize evidence-based, individualized interventions focused on the quality of growth, while addressing the rising misuse of supplements in otherwise healthy populations. ONS and functional bioactives appear promising for at-risk groups but require careful prescription and clinical oversight.