Vitamin D Recommendations Doubled for Children

by Lindsay Hutton

The American Academy of Pediatrics (AAP) has doubled the amount of vitamin D it recommends for infants, children, and adolescents. As recently as 2003, the AAP recommended 200 international units (IU) a day starting within the first two months of life. A new clinical report now calls for 400 IU a day, beginning within the first few days after a child is born.

Vitamin D is a main component in helping to prevent rickets. Rickets is a bone-softening illness that interferes with normal ossification. A child with a vitamin D deficiency is much more susceptible to this disease, which can cause bowed legs and other bone deformities. The AAP has found that 400 IU a day can help to prevent and treat rickets. In addition, adequate vitamin D throughout childhood can help reduce the risk of osteoporosis. Evidence also shows vitamin D plays a role in the immune system, and may help prevent infections, cancer, and diabetes in adults.

Vitamin D can be found in some foods and is also synthesized by exposure to sunlight. Children can get an adequate amount of the nutrient by drinking six glasses of milk a day or eating fatty fish such as salmon or mackerel. (High mercury levels in certain kinds of fish, including mackerel, can be harmful to a child's health and should be limited. For a full list of fish and their mercury levels, print off our seafood safety guide.) However, because children's diets are unlikely to meet these standards, and prolonged exposure to sunlight is not recommended, a supplement may be needed. Although the prevalence of rickets has dropped off since it was first discovered in the 1800s, there have been increased reports of the disease in the U.S. in the past 5 to 10 years. However, recent concerns about the illness's return are hard to assess, since the Centers for Disease Control and Prevention does not have exact numbers on rickets cases. Children at the greatest risk for developing the disease are infants who are exclusively breastfed and are not supplemented with 400 IU a day. Although it is important to remember that breastfeeding is the best source of nutrition for infants, the AAP notes that many nursing mothers have a vitamin D deficiency, which can in turn affect the amount in their milk.

Updated Recommendations

The AAP's new vitamin D recommendations are listed below. Talk to your own pediatrician about what is right for your child.

Breastfed and partially breastfed infants should be supplemented with 400 IU of vitamin D beginning within the first few days of birth.

Non-breastfed infants, as well as older children, who do not consume at least one quart of vitamin-D fortified formula or milk a day should be supplemented with 400 IU a day.

Adolescents who do not get 400 IU a day of vitamin D through food should take a supplement that contains that amount.

Children who may be at a higher risk of a vitamin D deficiency due to certain medications may need a higher daily dose.

In addition to child supplementation, growing evidence shows adequate vitamin D is important for fetal development. Therefore, the AAP strongly recommends the testing of vitamin D levels in pregnant women, and supplementation when needed