The American Academy of Pediatrics (AAP) announced recently it is doubling the amount of vitamin D it recommends for infants, children, and adolescents. Anita Moonjely, MD, pediatrician at University of Iowa Children's Hospital, talks about this recommended change:
What caused the AAP to reconsider the amount of vitamin D recommended for children?
In 1997 when the initial recommendations came into play, they recommended at least 200 international units (IUs) per day of vitamin D to prevent physical signs of vitamin D deficiency. The recommendation was made even though years of clinical experience showed that 400 IUs would not only prevent rickets, but treat it as well. With that in mind, and new information coming out about adults linking other biomarkers like bone mineralization and insulin resistence to vitamin D deficiency, there was a growing concern that 200 IUs was not enough for infants and children.
What is rickets?
It's an example of extreme vitamin D deficiency. This typically occurs between three and 18 months of age, but there have been cases in adolescents reported, as well. Basically, it is a defect in the mineralization of the bone.
Will an increase in vitamin D prevent or cure rickets in children?
It will definitely prevent and it will help cure rickets in children. If there is a case of rickets, vitamin D levels would be checked and the actual dosage would be decided on a case by case basis.
Where do most children and adults get their vitamin D?
Historically, the main source of vitamin D was via sunlight. The skin makes vitamin D from cholesterol after exposure to UVB light. But with growing public awareness about the adverse affects of prolonged sunlight exposure with the risk of various skin cancers, we are not recommending that method as the preferred way to attain adequate vitamin D levels. And, often in our climate, it is not possible. Most of our kids these days get vitamin D from vitamin D-fortified milk, or other vitamin D-fortified foods like eggs and fortified cereals.
What is included in the new recommendations for vitamin D?
Some of the recommendations are:
- Breastfed and partially breastfed infants be supplemented with 400 IUs of vitamin D beginning in the first few days of life. This supplementation should be continued in breastfed babies until their transition to whole milk at 1 year of age. Partially breastfed babies, also should be supplemented unless they are consuming at least one quart—that is 32 ounces of vitamin D-fortified formula.
- Older children and adolescents, should have at least 400 IUs of vitamin D through their diet.
It's sometimes hard to consume that much in a normal diet. In eight ounces of vitamin D-fortified milk, there's 100 IUs, so you'd have to consume 32 ounces to get the requirement. Other sources of vitamin D would be 40 IUs in egg yolk. One half cup of dried, fortified cereals contain about 40 IUs as well.
Children with increased risk of vitamin D deficiency may need more than the 400 IUs. Those are kids that have chronic fat malabsorption or if they're on chronic anti-seizure meds. The needs of those children need to be determined on a case by case basis.
How does the AAP suggest children get the increased daily dose of vitamin D?
Luckily, for infants, those breastfed infants or the partially breastfed infants, there are already several over-the-counter liquid formulations that contain the right dosage. In older children and adolescents, if they can't get their requirement through their diet, they are recommending over the counter supplements, as well.
If parent have questions concerning their child's intake of vitamin D, what steps should they take?
The easiest thing would be to talk to their local pediatrician. |
