How Much Vutamin D for Partially Breastfed Babies
Vitamin D Supplementation in Infants, Children, and Adolescents
Am Fam Physician. 2010 Mar 15;81(vi):745-748.
Related Editorial
Patient information: Meet related handout on vitamin D in children, written past the authors of this article.
Article Sections
- Abstract
- Vitamin D in Health and Disease
- Guidelines for Vitamin D Intake
- Vitamin D and Sunlight
- Complications of Vitamin D Deficiency
- Supplementation Options
- References
Vitamin D deficiency in children can have adverse health consequences, such as growth failure and rickets. In 2008, the American Academy of Pediatrics increased its recommended daily intake of vitamin D in infants, children, and adolescents to 400 IU. Infants who are breastfed and children and adolescents who eat less than 1 Fifty of vitamin D–fortified milk per day will likely demand supplementation to reach 400 IU of vitamin D per day. This recommendation is based on skilful opinion and recent clinical trials measuring biomarkers of vitamin D status. Information technology is as well based on the precedent of preventing and treating rickets with 400 IU of vitamin D. In addition to dietary sources, exposure to ultraviolet B sunlight provides children and adults with boosted vitamin D. Although the American Academy of Pediatrics recommends keeping infants out of directly sunlight, decreased sunlight exposure may increase children's hazard of vitamin D deficiency. No randomized controlled trials assessing patient-oriented outcomes have been performed on universal vitamin D supplementation. However, vitamin D may reduce the risk of sure infections and chronic diseases. Physicians should help parents choose the appropriate vitamin D supplement for their child.
Vitamin D deficiency in children has been linked to adverse effects, such as growth failure and rickets. Although vitamin D is available in several foods and drinks, contempo estimates propose the prevalence of vitamin D deficiency among infants, children, and adolescents is between 12 and 24 percent.ane,2 Infants who are breastfed appear to be at higher risk of vitamin D deficiency. Family unit physicians should empathize current recommendations for vitamin D supplementation, and be prepared to brainwash parents well-nigh breastfeeding, sun precautions, and nutrition throughout childhood and adolescence.
Vitamin D in Health and Illness
- Abstruse
- Vitamin D in Health and Illness
- Guidelines for Vitamin D Intake
- Vitamin D and Sunlight
- Complications of Vitamin D Deficiency
- Supplementation Options
- References
Vitamin D plays several important roles in the metabolism and assimilation of other minerals in the trunk. Vitamin D is essential for facilitating calcium metabolism and os mineralization; is benign for phosphate and magnesium metabolism; and stimulates protein expression in the intestinal wall to promote calcium absorption. Low levels of vitamin D pb to the release of parathyroid hormone, which causes calcium mobilization from the bone. Over fourth dimension, excessive bone resorption tin lead to rickets.
Adequate levels of vitamin D may also aid reduce the take a chance of autoimmune conditions,three,iv infection,5 and blazon two diabetes.6 Evidence from observational studies supports the role of vitamin D supplementation in reducing the risk of type one diabetes in infants and children.7 Although observational studies propose that vitamin D may be protective confronting some cancers,viii a randomized controlled trial of calcium and vitamin D supplementation in 36,282 women did not observe a protective effect against breast cancer.9
Guidelines for Vitamin D Intake
- Abstract
- Vitamin D in Health and Disease
- Guidelines for Vitamin D Intake
- Vitamin D and Sunlight
- Complications of Vitamin D Deficiency
- Supplementation Options
- References
In 2003, the American Academy of Pediatrics (AAP) published a guideline recommending that all children older than ii months receive 200 IU of supplemental vitamin D daily.x This adept consensus statement was supported by studies of breastfed infants in the U.s., Norway, and China and suggested that infants who ingest 100 or 200 IU of supplemental vitamin D daily were less probable to develop rickets.11 Since then, there accept been concerns that these dosages may be insufficient. These concerns are supported by studies showing that vitamin D deficiency tin can occur early in life12; that serum 25-hydroxyvitamin D concentrations tend to be lower in breastfed infants13; and that 400 IU of vitamin D supplementation in these infants maintains college concentrations of 25-hydroxyvitamin D.14 In add-on, studies take shown that adolescents consume bereft levels of dietary vitamin D 15,sixteen and that supplementation increases 25-hydroxyvitamin D levels and bone mineral density.17
SORT: Cardinal RECOMMENDATIONS FOR PRACTICE
| Clinical recommendation | Prove rating | References | Comments |
|---|---|---|---|
| Infants ingesting less than 1 L (33.8 fl oz) of formula per day, too as all breastfed or partially breastfed infants, should receive 400 IU of supplemental vitamin D daily. | C | xiii, nineteen, 20 | Based on illness-oriented evidence and proficient stance |
| Children and adolescents consuming less than ane Fifty of vitamin D–fortified milk per day should receive 400 IU of supplemental vitamin D daily. | C | 21, 22 | Based on affliction-oriented evidence and case serial |
| Limiting sunlight exposure may predispose children to vitamin D deficiency. | C | 23, 25–27 | Based on disease-oriented prove and expert opinion |
| The best bachelor biomarker of vitamin D status is serum 25-hydroxyvitamin D levels. | C | 28, 29 | Based on consensus and disease-oriented evidence |
| Children at increased risk of vitamin D deficiency may require higher dosages of supplemental vitamin D. | C | 32–34 | Based on disease-oriented bear witness and expert stance |
Consequently, the AAP issued an updated recommendation in 2008 that all infants, children, and adolescents receive a minimum of 400 IU of vitamin D daily through diet or supplements.xviii Infants who are formula-fed exclusively will most likely accept an adequate level of vitamin D. Infants who are breastfed or partially breastfed, too equally children and adolescents who consume less than 1 L (33.8 fl oz) of vitamin D–fortified milk per day, should receive 400 IU of supplemental vitamin D daily.xiii,nineteen–22
Despite these recommendations, in that location are no studies showing that universal supplementation improves patient-oriented outcomes, such every bit the reversal of languor, irritability, and growth failure, attributed to vitamin D deficiency. But indirect prove supports the contention that 400 IU of supplemental vitamin D daily prevents and treats rickets.14 Prospective studies focusing on patient-oriented outcomes, rather than biomarkers, are needed before the actual clinical affect of supplemental vitamin D volition be understood.
Vitamin D and Sunlight
- Abstract
- Vitamin D in Health and Affliction
- Guidelines for Vitamin D Intake
- Vitamin D and Sunlight
- Complications of Vitamin D Deficiency
- Supplementation Options
- References
In addition to dietary sources, children and adults obtain vitamin D through exposure to ultraviolet B sunlight. As little every bit 10 to 15 minutes of direct sunlight can generate 10,000 to 20,000 IU of vitamin D. Many factors influence vitamin D synthesis, such every bit skin pigmentation, latitude, and corporeality of peel exposed, making it difficult to appraise how much vitamin D will be converted from sunlight exposure. Infants and children who take darker pigmentation crave five to ten times the length of sunlight exposure to attain the same levels of 25-hydroxyvitamin D when compared with children who have lighter pigmentation.23 However, the AAP recommends that infants younger than 6 months be kept out of direct sunlight.24 Although the goal of limiting sunlight exposure is to minimize the risk of peel cancer, it may also predispose children to vitamin D deficiency.25–27 Because the safe level of sunlight exposure needed for vitamin D conversion is unknown, increasing vitamin D supplementation is a reasonable alternative.
Complications of Vitamin D Deficiency
- Abstract
- Vitamin D in Health and Disease
- Guidelines for Vitamin D Intake
- Vitamin D and Sunlight
- Complications of Vitamin D Deficiency
- Supplementation Options
- References
Risk factors for vitamin D deficiency are summarized in Table one. Physicians should ostend suspicion of vitamin D deficiency by measuring levels of 25-hydroxyvitamin D, which is the best available biomarker for checking vitamin D status.28,29 Vitamin D deficiency in adults is defined every bit 25-hydroxyvitamin D levels of less than 20 ng per mL (50 nmol per 50), although this varies among studies.xxx In that location is no set level of 25-hydroxyvitamin D to confirm vitamin D deficiency in infants, children, and adolescents. Although no gear up level has been established for children and adolescents, recent studies accept used less than fifteen to twenty ng per mL (37.44 to l nmol per Fifty) as a cutoff for vitamin D deficiency in these age groups.
Table 1.
Hazard Factors for Vitamin D Deficiency in Children
| Anticonvulsant medication therapy |
| Chronic diseases associated with fatty malabsorption |
| Darker skin pigmentation |
| Exclusive breastfeeding without vitamin D supplementation |
| Insufficient sunlight exposure |
| Low maternal vitamin D levels (hazard factor for infants) |
Patients with severe cases of rickets may present with growth failure, hypocalcemic seizures, decreased bone mass, and feature bone changes or fractures (Effigy 1). Nonspecific symptoms, such as irritability, lethargy, and developmental delay, may be less obvious. In a case-control study of children hospitalized for astute illnesses, investigators establish an increased rate of admissions for lower respiratory tract infections amid those with rickets.31
Figure 1.
Ankle radiograph of a 17-calendar month-sometime girl with healing rickets. Note the lateral bowing of the fibulas and the right tibia, every bit well equally the bandlike lucency in the metaphysis.
Supplementation Options
- Abstract
- Vitamin D in Health and Disease
- Guidelines for Vitamin D Intake
- Vitamin D and Sunlight
- Complications of Vitamin D Deficiency
- Supplementation Options
- References
Vitamin Dthree, known as cholecalciferol, is the preferred class of vitamin D for supplementation. Children with sure conditions, such as fat malabsorption, and those who require long-term employ of seizure medications may need higher dosages of vitamin D because of increased risk of deficiency.32–34 Monitoring 25-hydroxyvitamin D levels every three months, and parathyroid hormone levels and bone-mineral status every vi months, is recommended for these children.
Vitamin D deficiency during pregnancy may increase the risk of abnormal fetal growth and os evolution, but farther studies are needed before high-dose supplementation in pregnant women can be universally recommended.35
No evidence suggests that daily supplementation of 400 IU of vitamin D is toxic. Physicians should provide patients with detailed administration instructions to avoid accidental overdose. Vitamin Dthree drops, which are preferable for infants, are available in formulations of 400, ane,000, and 2,000 IU per driblet. Varying amounts of vitamin Dthree are available within formulations of the same brand. Chewable and gluey vitamins for older children contain 200 or 400 IU of vitamin D, but may vary past formulation from the same manufacturer. Physicians may prefer to recommend ane brand and conception for each age group to ensure that patients reach a daily dosage of 400 IU (Tables 2 and 3).
Table 2.
Vitamin D Liquid Supplements for Infants and Children Younger than Two Years
| Make | Vitamin D per serving (IU) | Serving size |
|---|---|---|
| Carlson Babe D Drops | 400 | 1 driblet |
| Enfamil Poly-Vi-Sol Multivitamin Supplement Drops | 400 | 1 mL |
| Enfamil Tri-Half-dozen-Sol Vitamins A, C & D with Fe | 400 | 1 mL |
| Sunlight Vitamins Only D babe vitamin drops | 400 | 1 mL |
| Twinlab Infant Care Multivitamin Drops with DHA | 400 | ane mL |
Table 3.
Multivitamins Containing Vitamin D for Children and Adolescents
| Brand | Vitamin D per serving (IU) | Serving size | |
|---|---|---|---|
| Centrum Kids Consummate Multivitamins, chewable tablets | 400 | 1 tablet for children four years and older (1/2 tablet for children ii and three years of age) | |
| Disney Gummies Children's Multivitamin | 200 | Two gummies for children two years and older | |
| Flintstones Children's Complete Multivitamin, chewable tablets | 400 | One tablet for children four years and older (1/ii tablet for children two and three years of age) | |
| Flintstones Gummies with Calcium & Vitamin D, multivitamin | 400 | 2 gummies for children four years and older (1 pasty for children ii and three years of age) | |
| Li'l Critters Gummy Vites Kids Multivitamin | 240 | 2 gummies for children two years and older | |
| Sundown Spider-man Consummate Children's Gummies | 200 | 2 gummies for children two years and older | |
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REFERENCES
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