The American Academy of Pediatrics (AAP) is doubling the amount of vitamin D it recommends for infants, children and adolescents. The new clinical report, “Prevention of Rickets and Vitamin D Deficiency in Infants, Children, and Adolescents,” recommends all children receive 400 IU a day of vitamin D, beginning in the first few days of life. The previous recommendation, issued in 2003, called for 200 IU per day beginning in the first two months of life.
The change in recommendation comes after reviewing new clinical trials on vitamin D and the historical precedence of safely giving 400 IU per day to the pediatric population. Clinical data show that 400 units of vitamin D a day will not only prevent rickets, but treat it. This bone-softening disease is preventable with adequate vitamin D, but dietary sources of vitamin D are limited, and it is difficult to determine a safe amount of sunlight exposure to synthesize vitamin D in a given individual. Rickets continues to be reported in the United States in infants and adolescents. The greatest risk for rickets is in exclusively breastfed infants who are not supplemented with 400 IU of vitamin D a day.
“But parents need not panic,” said Cooper pediatrician April M. Douglas-Bright, M.D. “It is relatively easy for children to get the vitamin D supplementation they need through widely available over-the-counter multivitamin preparations. Parents should consult their pediatrician for examples of such vitamins, depending on the age of the child.”
Adequate vitamin D throughout childhood may reduce the risk of osteoporosis. In adults, new evidence suggests that vitamin D plays a role in the immune system and may help prevent infections, autoimmune diseases, cancer and diabetes.
“We are doubling the recommended amount of vitamin D children need each day because evidence has shown this could have life-long health benefits,” said Frank Greer, MD, FAAP, chair of the AAP Committee on Nutrition and co-author of the report. “Supplementation is important because most children will not get enough vitamin D through diet alone.”
“The new AAP guidelines are in response to recognition of widespread vitamin D deficiency throughout the lifespan leading to low levels of vitamin D right at birth. Increasing the dose of supplemental vitamin D will help offset not only rickets but also a number of other ailments linked to vitamin D deficiency states. While breastfeeding is the ideal source of nutrition, breastfeeding infants may not be getting enough vitamin D from their mother’s milk, and we can no longer recommend sunlight as a safe way to get vitamin D” said Lori Feldman-Winter, Cooper Adolescent Medicine specialist and member of the AAP Executive Committee on Breastfeeding, co-author of the report.
Recommendations include:
Breastfed and partially breastfed infants should be supplemented with 400 IU a day of vitamin D beginning in the first few days of life.
All non-breastfed infants, as well as older children, who are consuming less than one quart per day of vitamin D-fortified formula or milk, should receive a vitamin D supplement of 400 IU a day.
Adolescents who do not obtain 400 IU of vitamin D per day through foods should receive a supplement containing that amount.
Children with increased risk of vitamin D deficiency, such as those taking certain medications, may need higher doses of vitamin D. Given the growing evidence that adequate vitamin D status during pregnancy is important for fetal development, the AAP also recommends that providers who care for pregnant women consider measuring vitamin D levels in this population.