Pediatricians Double Vitamin D Recommendation

by | Oct 16, 2008 | 2008, Infant and Children's Health, Vitamin D - Recommended Levels

Written by Greg Arnold, DC, CSCS. There is evidence to support the need for increasing our recommended daily allowance for Vitamin D from 200 IU to 400 IU per day.

Defined as “a condition associated with bone defor­mity due to inadequate mineralization in growing bones” (1), rickets was first reported in Europe in the 1600s (2). It wasn’t until the 1800s when sunlight (ultraviolet radia­tion) and cod-liver oil were found to be effective in treating rickets. And it was not until the early 1900s that vitamin D was isolated and found to be the essential ingredi­ent in helping prevent rickets (3). Unfortunately, economic costs of rickets and childhood bone disorders are not readily available (4) but cod liver oil has also been found to help increase bone mineral density in females (5), decrease blood pressure (6), improve wound healing (7), decrease intestinal inflammation (8) and may decrease type 1 diabetes in infants (9).

Fifty years of clinical research shows that 400 IU of vitamin D, found in a teaspoon of cod liver oil, is effective in both preventing and treating rickets (10). Despite this evidence, the current recommendations by the National Academy of Sciences (11) and the National Institutes of health (12) has remained at 200 IU of vitamin D.

Vitamin D’s role in maintaining health in children also extends to helping increase birth weight in newborns (13). Its positive health benefits have led to more and more support for recommendations that vitamin D intake in kids needs to be increased (14) and supplementation should be available to children, especially those at risk (15). Now a new study by the American Academy of Pediatrics (16) has again recommended increasing the current vitamin D recommendation for infants from 200 IU to 400 IU per day.

In their report, the researchers make six recommendations:

  • Breastfed and partially breastfed infants should be supplemented with 400 IU per day of vitamin D, beginning in the first few days of life and continued for the first year until they are put on one liter per day of vitamin D–fortified formula or whole milk.
  • All non-breastfed infants, as well as older children who are ingesting 1 liter per day of vitamin D–fortified formula or milk should receive 400 IU per day of vitamin D.
  • Adolescents who do not obtain 400 IU of vitamin D per day through vitamin D–fortified milk or vitamin D–fortified foods should receive a vitamin D supplement of 400 IU per day.
  • Vitamin D blood levels in infants and children should be at least 50 nanomoles per liter.
  • Children with digestion problems or who are on seizure medications may require more than 400 IU per day to avoid being vitamin D deficient.  Blood tests should be performed every 3 months, until blood levels reach 50 nanmoles per Liter.
  • Pediatricians and other health care professionals should strive to make vitamin D supplements readily available to all children within their community, especially for those children most at risk.

For the researchers, “These revised guidelines for vitamin D intake for healthy infants, children, and adolescents are based on evidence from new clinical trials and the historical precedence of safely giving 400 IU of vitamin D per day in the pediatric and adolescent population.”

Source: Wagner, Carol L., and Frank R. Greer. “Prevention of rickets and vitamin D deficiency in infants, children, and adolescents.” Pediatrics 122, no. 5 (2008): 1142-1152.

© 2008 by the American Academy of Pediatrics

 Posted October 16, 2008.

Greg Arnold is a Chiropractic Physician practicing in Danville, CA.  You can contact Dr. Arnold directly by emailing him at mailto:PitchingDoc@msn.com or visiting his web site at
www.CompleteChiropracticHealthcare.com

References:

  1. Pettifor JM. Nutritional and drug-induced rickets and osteomalacia. In: Favus MJ, editors. Primer on the metabolic bone diseases and disorders of mineral me­tabolism. 6th ed. Washington, DC: American Society for Bone and Mineral Research, 2006:399-407.
  2. Rajakumar K. Vitamin D, cod-liver oil, sunlight, and rickets: a historical perspective. Pediatrics 2003;112:e132-5.
  3. Combs GF, Jr. The vitamins: fundamental aspects in nutrition and health. 2d ed. New York, NY: Academic Press, 1998. 618 p.
  4. “Bone Health and Osteoporosis: A Report of the Surgeon General” posted on the Surgeon General website.
  5. Sigurdsson G, Franzson L, Steingrimsdottir L, Sigvaldason H. The association between parathyroid hormone, vitamin D and bone mineral density in 70-year-old Icelandic women. Osteoporos.Int. 2000;11:1031-5.
  6. Moritz V, Singer P, Forster D, Berger I, Massow S. Changes of blood pressure in spontaneously hypertensive rats dependent on the quantity and quality of fat intake. Biomed.Biochim.Acta 1985;44:1491-505.
  7. Terkelsen LH, Eskild-Jensen A, Kjeldsen H, Barker JH, Hjortdal VE. Topical application of cod liver oil ointment accelerates wound healing: an experimental study in wounds in the ears of hairless mice. Scand.J Plast.Reconstr.Surg.Hand Surg. 2000;34:15-20.
  8. Guarner F, Vilaseca J, Malagelada JR. Dietary manipulation in experimental inflammatory bowel disease. Agents Actions 1992;Spec No:C10-C14.
  9. Stene LC, Ulriksen J, Magnus P, Joner G. Use of cod liver oil during pregnancy associated with lower risk of Type I diabetes in the offspring. Diabetologia 2000;43:1093-8.
  10. Marriott W, Jeans P. Infant Nutrition: A Textbook of Infant Feeding for Students and Practitioners of Medicine. 3rd ed. St Louis, MO: Mosby; 1941.
  11. Standing Committee on the Scientific Evaluation of Dietary Reference Intakes Food and Nutrition Board, Institute of Medicine. Calcium, phosphorus, magnesium, vitamin D and fluoride. In: Dietary Reference Intakes. Washington, DC: National Academy Press; 1997:250–287.
  12. “Vitamin D” posted on the Office of Dietary Supplements Website.
  13. Olafsdottir AS. Relationship between dietary intake of cod liver oil in early pregnancy and birth weight.  BJOG. 2005 Apr;112(4):424-9.
  14. Short term and long term safety of weekly high dose vitamin D supplementation in school children.  J Clin Endocrinol Metab 2008 Apr 29. [Epub ahead of print].
  15. Zipits CS.  Vitamin D deficiency: primary or tertiary prevention?  Arch Dis Child 2006;000:1–5.
  16. Wanger CL.  Prevention of Rickets and Vitamin D Deficiency in Infants, Children, and Adolescents.  Pediatrics 2008;122:1142–1152.