What is the new policy on preventing Vitamin D Deficiency?

The American Academy of Pediatrics (AAP) is doubling the amount of Vitamin D it recommends for infants, children and adolescents.

All children should receive 400 IU/day of Vitamin D beginning in the first few days of life. This policy affects all infants, children, and adolescents. Infants that are strictly formula fed can receive this amount in their daily formula intake, however all other infants and children will need a supplement. This reflects an increase from 200 IU/day recommendation given in 2003.

This change is a result of new research on Vitamin D intake, sunlight exposure, and an increase in the diagnosis of a disease called rickets.

Your child may receive 400 IU of Vitamin D from TriViSol for infants, and most widely marketed children's chewable vitamins including Flintstones Complete Chewables© and Centrum Complete Kids©. One a Day Teen Advantage© also has 400 IU of Vitamin D.

What is Vitamin D? What does Vitamin D do for the body?

Vitamin D is a fat-soluble vitamin that is metabolized by the body by either sun (UV light) exposure or dietary intake. There are 2 molecules that make up Vitamin D: ergocalciferol (D2) and cholecalciferol (D3). Vitamin D3 is the main source for humans. The metabolism and physiology behind Vitamin D synthesis is complex, however, the absorption of UV-B rays from the sun play a large role. Synthesis of Vitamin D through the skin may be difficult through the common use of sunscreen and lack of sun exposure exercised by many individuals. The only other way to receive Vitamin D is food intake. Vitamin D is present in limited amounts in food. Fatty fish oils, egg yolks and fortified milk are some rich sources of Vitamin D in our diets.

Factoring in the current recommendations about decreasing sun exposure may mean that many individuals are Vitamin D deficient.

There is ongoing research about Vitamin D and its role in the body. There is a large body of research that indicates that infants may begin their lives Vitamin D deficient. There may be inadequate intake of Vitamin D and less sun exposure from the mother which may in turn decrease their unborn baby's Vitamin D stores.

We know that adequate Vitamin D throughout childhood may reduce the risk of osteoporosis. However, there is new research that vitamin D may also play a role in the immune system and may help prevent infections, autoimmune diseases, cancer (breast, ovarian, colon, and prostate) and Type I diabetes.

What is rickets?

Rickets is a disease that is an example of extreme Vitamin D deficiency. Rickets is a bone softening disease that may contribute to fractures and/or deformity in affected patients. This disease is entirely preventable with adequate Vitamin D, however dietary sources are limited. It is also difficult to quantify a safe amount of sunlight exposure for synthesis of Vitamin D.

Incidences of rickets continue to be reported in the United States. The greatest risk for rickets is in exclusively breastfed infants who are not supplemented with 400 IU of Vitamin D/day. The peak incidence is 3-18 months.

What role does the sun play in Vitamin D?

The amount of UV exposure available for the synthesis of Vitamin D depends on many factors other than just time spent outside. Other factors include: the amount of skin pigmentation, body mass, degree of latitude, season, the amount of cloud cover, air pollution, the amount of skin exposed, and the extent of UV protection, including clothing and sunscreens.

In addition, parents are instructed to limit exposure to UV light by the AAP, CDC, and the American Cancer Society. It is this advice that makes Vitamin D supplementation necessary.

What if I am pregnant? What about my newborn infant?

It is a fact that a mother's Vitamin D intake and concentration determine what her newborn infant's Vitamin D concentration will be. We are learning that with decreased Vitamin D intake, decreased absorption and limited sun exposure, a mother may unknowingly be placing her newborn at risk for Vitamin D deficiency at birth.

Adequate nutritional Vitamin D status for mother is important for fetal skeletal development, tooth enamel formation, and perhaps general fetal growth and development. These effects could be long term.

In light of this research, a new recommendation may follow for obstetricians to check the Vitamin D status of a pregnant patient to determine whether a Vitamin D supplement may be necessary, in addition to her regularly prescribed prenatal vitamin. The current level of Vitamin D supplementation (400 IU) may not be adequate for almost all pregnant women.

What are the recommendations on breastfeeding?

It is clear that human milk is the best nutrition for growing infants for the first year. There has been concern in recent years as to the amounts of Vitamin D present in breastmilk. The Vitamin D content of human milk is related to the mother's Vitamin D status. Infants who are exclusively breastfed but who do not receive supplemental Vitamin D or adequate sunlight exposure are at increased risk of developing Vitamin D deficiency or rickets. Infants with darker pigmentation are at greater risk of Vitamin D deficiency.

There is ongoing research at this time as to the safety of high dose Vitamin D for the pregnant and lactating mother to boost the level of Vitamin D to the necessary levels for their nursing infants. These studies are not completed, so the recommendation is to supplement your infant as well as taking prenatal vitamins. A supplement of 400 IU of Vitamin D is recommended for any breastfeeding infant regardless of whether or not he/she is supplemented with formula. In order to receive 400 IU of Vitamin D/day, a formula fed infant would need to consume 1 Liter of formula/day.

What about my strictly formula fed infant?

All infant formulas sold in the U.S. supply 400 IU/day of Vitamin D. A supplement is not necessary.

What about my older child/adolescent?

Vitamin D Deficiency is not limited to infancy and early childhood but covers the life span, with periods of vulnerability that coincide with periods of increased growth. Consuming 1 qt (32 oz) of Vitamin D Fortified milk is sufficient to supply 400 IU/day of Vitamin D, however this amount may be way too much to consume in one day. Children who do not consume milk in these quantities should receive a supplement of 400 IU/day. Usually a children's chewable vitamin will supply 400 IU of Vitamin D- check the label if you are unsure.

Sunlight exposure is difficult to quantify and may not be available in sufficient quantities in the Chicago area as well, so this Vitamin D source must be considered negligible.