New Vitamin D recommendations? Confused? Here's the 411.

Greetings from Boston! The weather is beautiful and the leaves are changing colors. It's also the site of the American Academy of Pediatrics annual convention this year. The AAP's major policy statement released at the convention is that all kids need more Vitamin D in their diets. The previous recommendation, which dates back to 2003, says that kids need 200 IU of Vitamin D. The updated statement doubles that daily requirement to 400 IU.

Why? Vitamin D is needed for bone strength. In young growing kids, vitamin D deficiency can lead to rickets (softening of the bones in children that leads to fractures and deformities). In adults, deficiency can lead to osteoporosis. There's also emerging data that shows Vitamin D can help prevent certain types of cancers, autoimmune disorders like Multiple Sclerosis, and diabetes.

In the good old days before sunscreen, UVB rays would help our bodies make Vitamin D naturally by setting off a chemical change through our skin. Now that we all (or most of us) wear sunblock, we need to get more Vitamin D from our diets. Unfortunately, that's not an easy task.

Vitamin D is found in large quantities in fatty fish (like cod liver oil) which most kids and adults don't probably eat that often. Milk is fortified with Vitamin D--about 100 IU per cup. Some yogurts also are fortified, but the amount of Vitamin D is significantly less--like 40 IU per serving.

So here is what the recommendations boil down to:

1. Newborns who are exclusively breastfed need a Vitamin D supplement, 400 IU per day. There are infant drops that are Vitamin D only, and others that contain Vitamins A, D, and C. Multivitamins or those with iron are not necessary unless directed by your doctor.

2. Newborns who are formula fed and eat at least 32 oz of formula per day do NOT need a Vitamin D supplement. However, babies aren't consuming that kind of volume until they are at least one month of age--sometimes up to four months of age. So, until that volume is reached, formula fed babies need a supplement too. And babies who get some breast milk and some formula need a vitamin D supplement until they are consuming at least 32 oz of formula per day.

3. All kids over age one need 400 IU of Vitamin D per day. If they get it in their diets, they do not need a supplement. This gets a little tricky, so follow along: The AAP  recommendation is for 1 to 2 year olds to drink 16 oz of whole milk a day (which also contains 200 IU of Vitamin D). To get the 400 IU Vitamin D requirement in, that would mean 32 oz of whole milk a day--NOT a good idea. So, if your child doesn't drink cod liver oil, he'll probably need to get the remaining 200 IU of Vitamin D from a vitamin supplement. 

4. For kids ages 2-3: The recommendation for milk changes to skim or 1% milk, but the volume remains 16 oz/day as the recommendation. Again, that only gives your child half of the daily Vitamin D he needs. But, if your child wants to drink more skim milk, that's fine.

5. For kids over age 3: Because this age group's daily calcium needs go up, we already recommend 3-4 servings of dairy a day. And yes, not every kid gets that. But, if he did, he would also fulfill his daily Vitamin D requirements. If that's not happening, yes, the recommendation would be to give a vitamin supplement.

Hopefully this helps clarify what you have been hearing on the news (I had to clarify it myself when I heard it!)

Comments

[Crystal]

Thanks.

I was really confused as to how my (hopefully) breastfed baby was supposed to get the Vitamin D (through me, via a supplement--how do you give a supplement to a baby anyways--classic first time parent head scratching, I suppose).

[Madeline]

Do I need to worry about the artifical color and flavor in the drops prescribed by my daughter's pediatrician? It's a multi-vitamin one by Enfamil.

[Colleen]

My 9-month old is exclusively breastfed and has received no Vitamin D supplements. Is he at higher risk for problems now or in the future because he's missed this vitamin? Is there any way for him to "catch up?"

[Ari Brown MD]

I personally am not too concerned about the Tr-Vi-Sol containing artificial color/flavor, and recommend them all the time. However, if you want to avoid these ingredients, you do have a few options. They just cost more, and you'll need to go to a natural foods store/pharmacy to find them.

[Ari Brown MD]

Colleen,
It's possible that your baby is getting enough Vitamin D through your breastmilk (if you drink large volumes of milk, eat a lot of fatty fish, or take a vitamin supplement)..especially if your baby is Caucasian, and lives in the south (those factors increase your baby's chance of making Vitamin D naturally from sun exposure). But, because we cannot test all women's breastmilk, and know exactly how much sun a baby is getting (lots of variables here), all babies who are exclusively breastfed should get a supplement.

Now that said, I wouldn't focus on the past and just look forward. I'd suggest starting a Vitamin D supplement now.

[Amanda]

Yes, I too used to take vitamin D for bones.

[Colleen]

Thanks for your response, Dr. Brown! I appreciate it.