Years ago, when children drank lots of milk and spent much of their time
playing outside in the sunlight, parents and physicians didn’t worry if
kids were getting enough vitamin D. Today, with children often consuming
fewer dairy products and spending more time indoors playing video games,
pediatricians like me are seeing many more young patients who are deficient
in vitamin D, which is critical for healthy bone development.
I’m thrilled that so many parents these days are diligent in using
sunscreen to protect their children from skin cancer. But what many people
may not realize is that by blocking the sun’s rays, we make it more
difficult for the body to manufacture vitamin D on its own. In addition,
some children have limited intake of fortified dairy products and some
parents are embracing vegan lifestyles. These are just some of the factors
that may account for the significant rate of vitamin D deficiency we’re
increasingly seeing in otherwise healthy American children.
The human body needs vitamin D to absorb and retain calcium and phosphorus
that are essential for healthy bone formation. A deficiency in this key
nutrient can cause rickets, which can stunt a child’s growth and lead to
weakened bones that are more easily broken. It can also contribute to
osteoporosis, or low bone density, in later years.
In 2014, in response to this growing problem, the American Academy of
Pediatrics updated the amount of Vitamin D it recommends. Infants under 12
months of age, regardless of whether they are breast-fed or bottle-fed,
should be given daily supplement drops that provide 400 IU of the vitamin.
Older children and adolescents should receive a daily dose of 600 IU,
whether through diet, sun exposure or supplementation.
While medical opinions vary on what constitutes a healthy blood level of
vitamin D, doctors like me look for a minimum of 20 nanograms per
milliliter, determined through a simple blood test. Your pediatrician will
let you know if such a test is needed, based on your child’s dietary habits
and activity level, and on increased risk factors for deficiency. Kids
taking certain medications, and those with chronic diseases such as cystic
fibrosis, may need higher doses of Vitamin D.
If your child is found to be Vitamin D deficient, don’t panic. The good
news is that it’s very easy to boost Vitamin D intake – through sun
exposure, diet and supplementation. The best dietary sources of vitamin D
include fortified dairy products (such as milk); fortified orange juice;
fortified breakfast cereals; egg yolks; and fatty fish, such as salmon,
sardines and mackerel. If your pediatrician recommends a multivitamin for
your child, check to see that it contains the recommended 600 IU of vitamin
D per day. (It is possible to overdose on vitamin D, so be extremely
careful with supplement dosing.)
While we do want to limit our children’s exposure to harmful UV rays, 10 or
15 minutes of sun exposure at midday, without sunscreen, is an excellent
way to boost vitamin D levels for most children. Darker-skinned individuals
need more time in the sun to achieve this benefit, however, so
supplementation might be needed if adequate sun exposure is not possible.
It’s up to parents – in concert with their pediatrician – to balance the
risks and benefits for their children of a little play time outdoors
without sunscreen.
Also, keep in mind that in the winter months, the sun’s radiation effect is
not sufficient to maintain healthy levels of vitamin D, so supplementation
is often needed. Finally, healthy bones require both calcium and vitamin D.
So be sure to review your child’s calcium intake with your pediatrician or
a nutritionist. A minimum daily intake of 500 mg is recommended for all
children over the age of 12 months.
To learn more about the importance of vitamin D, visit:
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aap.org/en-us/about-the-aap/aap-press-room/pages/Kids-and-Vitamin-D-Deficiency.aspx
healthychildren.org/English/healthy-living/nutrition/Pages/Vitamin-D-On-the-Double.aspx
