Clinical Nutrition
www.connecticutchildrens.org 860.610.4286
WHAT SHOULD I TELL PEDIATRIC FAMILIES ABOUT VITAMIN D?
Current Recommendations
• T
he AAP recommends that all infants and children, including adolescents, have a minimum daily intake of 400 IU/day
beginning soon after birth.1
• A
ll breastfed infants and those who are consuming <1000 ml/day of commercial formula should receive Vitamin D
supplementation to achieve 400 IU/day.1
• T
o review the current IOM Vitamin D Dietary Reference Intakes for all ages visit: http://www.iom.edu/Reports/2010/
Dietary-Reference-Intakes-for-Calcium-and-Vitamin-D/DRI-Values.aspx
• M
ost experts agree that without adequate sun exposure, children and adults require approximately 800-1000 IU per day.2
Reasons for Deficiency
• V
ery few food sources contain Vitamin D unless fortified.
• V
itamin D can be synthesized by sunlight, though factors may limit one’s sun exposure (or reduce Vit D synthesis). These
factors include: living at high latitudes (winter months), air pollution, dense cloud coverings, clothing, sunscreen, homebound,
dark pigmented or aging skin.3
• Infants are particularly at risk for deficiency if there is a maternal deficiency (lack of prenatal vitamins), winter birth, dark skin,
maternal BMI >35.4 Also, if born prematurely and/or receiving long-term anticonvulsant or steroid therapy.
• A
lthough human milk is the ideal infant feeding, it may not have enough Vitamin D to prevent deficiency (typically contains
25 IU/liter or less).3 Formula fed infants need to consume >32 oz per day of a standard 20 cal/oz formula to achieve the
daily minimum recommended intake.
• V
itamin D supplementation is available as Cholecalciferol or Vitamin D3 (preferred mammal source) and Ergocalciferol or
Vitamin D2 (plant source). Infants can receive 400 IU of Vitamin D3 in 1 ml of D-Vi-Sol (Mead Johnson Nutrition).
Determining Deficiency
• M
easure 25-hydroxyvitamin D
• A
lthough there is no consensus on optimal levels of 25-hydroxyvitamin D as measured in serum, vitamin D deficiency is
defined by most experts as a 25-hydroxyvitamin D level of less than 20 ng per milliliter (50 nmol per liter).2
• 2
5-OH-D levels presently used at CT Children’s are (ng/mL): <10 deficient, 10-29 insufficient, 30-100 sufficient, and
>100 potential intoxication.
• V
itamin D supplements can be found in tablet, softgel, chewable/gummies and liquid form. Some easy to find brands are
NatureMade and Enfamil D-Vi-Sol drops.
References
1. Wagner CL, Greer FR; American Academy of Pediatrics Section on Breastfeeding; American Academy of Pediatrics Committee on Nutrition. Prevention of rickets and vitamin D deficiency in infants, children, and
adolescents. Pediatrics. 2008 Nov;122(5):1142-52. Erratum in: Pediatrics. 2009 Jan;123(1):197
2. Holick MF. Vitamin D Deficiency. N Engl J Med 2007;357:266-81
3. Centers for Disease Control and Prevention (2009, Oct 20). Vitamin D Supplementation. Retrieved July 18, 2011, from http://www.cdc.gov/breastfeeding/recommendations/vitamin_D.htm
4. Merewood A, Mehta SD, Grossman X, Chen TC, Mathieu JS, Holick MF, Bauchner H. Widespread vitamin D deficiency in urban Massachusetts newborns and their mothers. Pediatrics. 2010 Apr;125(4):640-7. Epub
2010 Mar 22.
282 Washington Street, Hartford, CT 06106 • © 2011 Connecticut Children’s Medical Center. All rights reserved. 11-298/23 New 12-11