Rickets was a problem in the U.S. during the 18th century when factories shielded people from the sun’s rays – Today the American Academy of Pediatrics (AAP) is raising the guidelines on vitamin D for infants, children, and adolescents as rickets appears to be on the rise in the U.S. once again.
Vitamin D is important to build the body’s natural defenses against diseases such as cancer, heart disease, dementia, type 2 diabetes, as well as to strengthen bones.
The new guidelines for children’s daily levels of vitamin D is 400 international units (IU), double the previous recommendations. The new guidelines are to be published in the November issue of Pediatrics.
Sunlight exposure is generally sufficient to encourage the skin to manufacture vitamin D, but because of the potential for promoting skin cancers, supplements are recommended. Most supplements already carry the 400 IU level.
"Four hundred IU a day is the amount that is in a teaspoon of cod liver oil, which we have used for 75 years to prevent and treat rickets in children and, historically speaking, that is the amount that is in any chewable multivitamin tablet and in any liquid preparation for infants," said Dr. Frank Greer, a lead author on the report and chairman of the AAP National Committee on Nutrition.
And while vitamin D is not plentiful in food, with the exception of egg yolks from chickens fed vitamin D, and certain fatty fish such as salmon and mackerel and cod liver oil, it can be found in one quart of milk (400 IU) which is fortified. Infant formula is also fortified with vitamin d. Breast milk does not contain it.
Children can play in the sun without sunscreen for 5 or 10 minutes a few times weekly to receive adequate supplies. Children who sit indoors in front of television or computers are not being exposed to enough sunshine to encourage the production of vitamin D. Research shows that 800 IU would be more effective at fighting disease.
Rickets has been seen in primarily the minority populations who are part of the Women, Infants, Children program (WIC). It usually becomes apparent when the child begins to walk.
For adults the recommendation is at least 1,000 units a day, but those recommendations have not been updated. Double that dosage may be more realistic.
Vitamin D is essential for promoting calcium absorption in the gut and in maintaining blood calcium levels, therefore is essential to supplements for mature people to fight osteoporosis. Without adequate vitamin D, bones can become think, brittle or misshapen.
A study from the American Society of Clinical Oncology (ASCO) finds women with vitamin D deficiency are more likely to have a recurrence of breast cancer or to die from the disease. Only 24 percent of the patients in the study had adequate levels of vitamin D when they were diagnosed and these women were linked to poorer outcomes.
In June, Children’s Hospital in Boston reported that adolescents were largely deficient in the vitamin (42 percent) and that at least 40 percent of infants and toddlers are not getting enough of the “Sunshine vitamin” as it’s often called.
Vitamin D is actually a hormone, says Dr. Frank Greer, a lead author of the report. He tells U.S. News, "It acts directly on cells to promote gene transcription," he explained. "No other 'vitamin' does this, so it really is very, very powerful."
Here are the AAP's recommendations:
- Bottle fed infants and older children receive 400 International Units (IU) per day
- Breast-fed infants or partially breast-fed receive 400 IU beginning in the first few days of life
- Adolescents who do not obtain 400 IU of vitamin D per day through foods should receive a supplement
- Pregnant women supplement otherwise they may pass their deficiency onto their newborn
- Supplement until the child drinks a quart of milk a day or obtains enough vitamin D through food
- Infants should not be fed whole milk until the child has turned 1
- Children who are at risk of vitamin D deficiency, created by taking anti-seizure medications, may need a higher dose #