AAP Recommends Doubling Kids' Daily Vitamin D

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You hear a lot about why kids need nutrients like calcium and vitamin C. But vitamin D — not so much. The fact is, the often-forgotten vitamin D is essential for calcium absorption. Without enough vitamin D, the body can't take up and use calcium as it should to maintain strong, healthy bones and teeth.

Now, a new clinical report from the American Academy of Pediatrics (AAP) recommends that all children — from babies to teens — get 400 IU of vitamin D every day, starting as early as a few days old for some. Previous recommendations called for 200 IU, beginning by 2 months old for exclusively breastfed babies.

The new report suggests 400 IU of a daily vitamin D supplement for:

  • exclusively and partially breastfed babies beginning the first few days after birth
  • formula-fed infants and all older kids if they get less than one quart of vitamin D-fortified formula or milk daily (that's 32 ounces, or four 8-ounce bottles or cups)
  • teens who don't get 400 IU of vitamin D each day through foods

Why the change? Well, a lack of vitamin D or calcium in the diet can lead to rickets, a bone-softening disease that causes severe bowing of the legs, poor growth, and sometimes muscle pain and weakness. Upping kids' vitamin D according to the new recommendations not only can help prevent rickets, it can also help to treat it.

Although rickets is much less common today than in the past, doctors still see cases, particularly in infants. The condition and the resulting bowlegs can almost always be corrected, though, by adding vitamin D and calcium to the diet.

Exclusively breastfed babies are at the greatest risk of rickets because — although breastfeeding is considered the ideal form of nourishment for infants — breast milk doesn't have high enough concentrations of vitamin D, says the AAP.

But it's not just babies who need more vitamin D. When kids get plenty of the nutrient throughout their childhood, it can provide other benefits, including some that carry into adulthood, says the AAP. In fact, making sure kids get 400 IU of daily vitamin D can help curb infections and fend off health problems like:

  • osteoporosis
  • cancer
  • autoimmune diseases (like diabetes, thyroid disorders, celiac disease, etc.)

What This Means to You

Kids can get vitamin D from fortified foods, fish, and egg yolks. The thing is, most children don't get enough of it from food alone, says the AAP. And although the body also makes vitamin D when the skin is exposed to sunlight, it can be hard to gauge just how much sunshine is safe and effective for an individual child.

So, here are some ways to make sure everyone in your home gets enough vitamin D:

  • Incorporate vitamin-D-rich foods into your diet — eggs and fortified foods like dairy products, cow's milk, soy milk, rice milk, cereals, and bread. Look for the vitamin D content on the nutrition label.
  • Ask your doctor how much fish is OK if you're pregnant or have young kids. Although fish boasts vitamin D, some kinds may contain too much mercury — like shark, swordfish, king mackerel, tilefish, tuna steak, and canned albacore tuna. It's wise to eat no more than a serving or two a week of lower-mercury seafood options (like catfish, pollock, salmon, shrimp, clams, and tilapia).
  • Get the kids outside to help their bodies produce vitamin D from sun exposure. Just make sure to apply a broad-spectrum sunscreen (which protects against both UVA and UVB rays), even on cloudy days. But keep young babies out of the sun — direct sunlight is not safe or recommended for infants under 6 months.
  • Take your prenatal vitamins every day if you're pregnant. And talk to your doctor or midwife about whether you need an additional vitamin D supplement, too. A recent study showed that pregnant women require the nutrient to help their offspring avoid early childhood cavities.
  • Ask your doctor for a vitamin D drops prescription after the birth of your baby or at the first follow-up visit if you're breastfeeding. Of course, this new recommendation doesn't make nursing any less beneficial and does not mean that it's necessary to supplement with infant formula. Breastfeeding is still the best way to nourish newborns and babies throughout at least the first 6 months. This just means that a simple daily vitamin can keep your breastfed baby even healthier.

For formula-fed babies all the way up to the teens, talk to your doctor about your kids' daily intake of vitamin D and what kind of vitamin D supplement they might need as they grow. Also be sure to ask your doctor about whether your kids are at increased risk of having a vitamin D deficiency (maybe because they're taking certain medications) and may need even higher doses of the nutrient.

Reviewed by: Steven Dowshen, MD
Date reviewed: October 2008

Source: "Prevention of Rickets and Vitamin D Deficiency in Infants, Children, and Adolescents," AAP clinical report, Pediatrics, November 2008.

Related Resources

OrganizationNational Institutes of Health Office of Dietary Supplements (ODS) The ODS offers research information and news about dietary supplements.
Web SiteAmerican Dietetic Association The American Dietetic Association offers nutrition news, tips, resources for consumers and dietitians, and a find-a-nutritionist search tool.
OrganizationAmerican Academy of Pediatrics (AAP) The AAP is committed to the health and well-being of infants, adolescents, and young adults. The website offers news articles and tips on health for families.
Web SiteMilk Matters: Calcium Education from the National Institutes of Health Milk Matters is a public health education campaign launched by the National Institutes of Health to promote calcium consumption among tweens and teens, especially during the ages of 11 to 15, a time of critical bone growth.

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Note: All information is for educational purposes only. For specific medical advice, diagnoses, and treatment, consult your doctor.

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