AAP: Vitamin D recommendation doubled

October 14, 2008

A new American Academy of Pediatric (AAP) 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 within the first few days of life.

A new American Academy of Pediatrics (AAP) clinical report, “Prevention ofRickets and Vitamin D Deficiency in Infants, Children, and Adolescents,”recommends all children receive 400 IU a day of vitamin D, beginning within thefirst few days of life.

The previous 2003 recommendation called for 200 IU per day for infants, children,and adolescents. The change in recommendation comes after reviewing new clinicaltrials on vitamin D, and the historical precedence of safely giving 400 IU perday to the pediatric population.

Clinical data show that 400 IU of vitamin D a day will not only prevent rickets,but treat it. Rickets is preventable with adequate vitamin D, but dietary sourcesof vitamin D are limited. It is difficult to determine a safe amount of sunlightexposure to synthesize vitamin D in a given individual. Rickets continues to bereported in the United States in infants and adolescents. The greatest risk forrickets is in exclusively breastfed infants who are not supplemented with vitamin D.

“We are doubling the recommended amount of vitamin D children need eachday because evidence has shown this could have life-long health benefits,”said Frank Greer, MD, chair of the AAP Committee on Nutrition and co-author ofthe report. “Supplementation is important because most children will notget enough vitamin D through diet alone.”

“Breastfeeding is the best source of nutrition for infants. However, becauseof vitamin D deficiencies in the maternal diet, which affect the vitamin D inmother’s milk, it is important that breastfed infants receive supplementsof vitamin D,” said Carol Wagner, MD, member of the AAP section on BreastfeedingExecutive Committee and co-author of the report. “Until it is determinedwhat the vitamin D requirements of the lactating mother-infant dyad are, we mustensure that the breastfeeding infant receives an adequate supply of vitamin Dthrough a supplement of 400 IU per day.”

Adequate vitamin D throughout childhood may reduce the risk of osteoporosis. Inadults, new evidence suggests that vitamin D plays a role in the immune system,and may help prevent infections, autoimmune diseases, cancer, and diabetes. Greernotes that vitamin D is not just a vitamin, but a hormone as well.

The new 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 deficiencies, 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.