For Professional Reference Only
Nutrition Guideline
Healthy Infants and Young Children
Vitamin D
Applicable to: Nurses, Physicians and Other Health Professionals
Recommendations
Healthy term infants (birth to 1 year):
In order to meet an infant’s vitamin D requirements:
a daily 400 International Unit (IU) vitamin D supplement is recommended for all healthy term infants.
This applies to exclusively breastfed, partially breastfed and formula fed infants.
Children (1 to 18 years):
To help meet a child’s vitamin D requirements:
a daily 400 IU vitamin D supplement is recommended for all children.
consumption of 200 IU of vitamin D from food sources is recommended for all children. Consumption
of 2 cups (500 mL) of fluid milk or fortified soy beverage* each day will provide around 200 IU of
vitamin D.
General:
Parents should be advised to look for the following when choosing a vitamin D supplement for their child:
a single vitamin D supplement;
an eight-digit Natural Product Number (NPN) on the label, indicating that it has been assessed by
Health Canada and has been found to be safe, effective and of high quality under its recommended
conditions for use;
dose of 400 IU of vitamin D;
a form suitable for the child’s stage of development; for example a liquid supplement is the most
appropriate choice for infants.
* Soy beverages are not recommended for children under two years of age.
Health Benefits:
Vitamin D (calciferol) is a very important vitamin for infants and children. The primary function of this fatsoluble vitamin is to aid in the absorption of calcium and phosphorus, thus helping to form and maintain strong
bones.1 Low vitamin D stores can lead to adverse effects such as rickets (softening of bones) in children 2 and
osteomalacia and osteoporosis in adults.3
Vitamin D’s other roles in human health include modulation of neuromuscular and immune function and
reduction of inflammation.3 Some research in the past decade has also linked vitamin D to positive health
outcomes in common diseases and conditions such as multiple sclerosis and other autoimmune disorders,
cancer, cardiovascular disease, diabetes, and metabolic syndrome.1,4,5 However, there is currently not enough
evidence to suggest causality.1
Vitamin D recommendations in this guideline are based on the Dietary Reference Intakes from the Institute of
Medicine.1 At this time, bone health is the only health indicator with evidence deemed strong enough to be
used for Dietary Reference Intake development for vitamin D.1
See ‘Appendix A’ for more information on the Dietary Reference Intakes (Recommended Dietary Allowance
[RDA], Adequate Intake [AI] and Tolerable Upper Intake Level [UL]).
May 2013
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Nutrition Guideline: Healthy Infants and Young Children
Vitamin D
Nutrition Guideline
Healthy Infants and Young Children
Vitamin D
For Professional Reference Only
Applicable to: Nurses, Physicians and Other Health Professionals
Key Questions
What are the risk factors for vitamin D deficiency?
There are many risk factors for vitamin D deficiency. Infants and children at risk of vitamin D deficiency are
those who are:6,7,8,9
born to vitamin D deficient mothers
exclusively breastfed
inadequate in their dietary intake
overweight or obese
living at latitudes north of 37 N during the winter months (October through March). Alberta’s latitude falls
north of 37 N.
not exposed to sunlight
dark skinned
Considering the above list, it can be assumed that all infants and children in Alberta would be considered at
risk of vitamin D deficiency. Therefore, the same recommendations for vitamin D in this guideline apply to all
healthy children and are independent of the risk factors listed.
What are the symptoms of vitamin D deficiency in infants and children?
Vitamin D deficiency can present with non-specific symptoms such as weakness, chronic musculoskeletal
pain, fatigue or easy tiring.10 However, there are often no obvious symptoms of vitamin D deficiency until it is
severe.11 The classic vitamin D deficiency disease in children is rickets, which is characterized by the
softening of bones (bowed legs) and skeletal deformities.3
Should a child’s vitamin D status (blood level) be routinely tested?
It is unnecessary to do routine screening of vitamin D status on those children who are otherwise
healthy.12,13,14 Parents who are concerned about their child’s vitamin D intake or status should discuss their
concerns with the child’s primary health care provider.
What are common sources of vitamin D?
Vitamin D is photosynthesized in the skin by the sun when bare skin is exposed to ultraviolet B (UVB) radiation
and is found in a few foods such as fatty fish and egg yolk, as well as vitamin-D fortified foods including cow’s
milk and margarine.1 (See ‘What amounts of vitamin D can be found in food?’ section below.)
May 2013
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Nutrition Guideline: Healthy Infants and Young Children
Vitamin D
For Professional Reference Only
Nutrition Guideline
Healthy Infants and Young Children
Vitamin D
Applicable to: Nurses, Physicians and Other Health Professionals
Can the vitamin D needs of infants and children be met through sun exposure?
Even though sun exposure can contribute to one’s vitamin D status, sun exposure is an unreliable and
potentially unsafe way to meet a person’s vitamin D requirements. Latitude, season, time of day, skin
pigmentation, sunscreen use and clothing have a dramatic influence on the amount of vitamin D produced by
the skin.
Latitude and season:7,9 At latitudes north of 37 N and south of 37 S, sunlight is insufficient to synthesize
vitamin D in the skin in the winter months (October through March). Alberta’s latitude falls north of 37 N.
Time of day:15,16 In the spring, summer and fall, vitamin D is only produced in the skin between
approximately 10 a.m. and 3 p.m.
Skin pigmentation:11 People with darker skin pigmentation require longer exposures to sunlight to make
the same amount of vitamin D as people with lighter skin.
Sunscreen use:15 Sunscreens absorb UVB radiation, which reduces the capacity of the skin to produce
vitamin D. If sunscreen is used correctly, a sun protection factor (SPF) of 8 reduces vitamin D production
in the skin by more than 95%, and an SPF of 15 reduces it by more than 98%.
Clothing:16 Clothing absorbs most UVB radiation. Therefore, vitamin D is not made in skin covered by
clothing.
Windows:16 Vitamin D is produced in the skin only when it is directly exposed to UVB radiation. Glass and
plexiglass absorb UVB radiation; therefore, exposure of the skin to sunlight that has passed through a
window will not produce any vitamin D.
To reduce the health risks associated with sun exposure, such as the risk of skin cancer, parents should be
advised of recommendations for safe sun practices. Current recommendations are:17,18,19
Infants should be kept out of direct sunlight at all times of the day to reduce the risk of skin damage and
dehydration.
Children should stay out of the direct sun between 11 a.m. and 4 p.m., or any time of the day when the UV
index is three or higher.
After six months of age, sunscreen is recommended for areas of the skin not covered by clothing.
If these safe sun practices are followed, sun exposure cannot be relied upon for meeting an infant or child’s
vitamin D requirements. The RDA/AIs for vitamin D were developed assuming minimal sun exposure.1
(See ‘How much vitamin D do infants and children require?’ section below.)
How much vitamin D do infants and children require?
The daily Recommended Dietary Allowance (RDA) refers to the average daily nutrient intake level sufficient to
meet the needs of almost all healthy individuals in a particular life stage and gender group.20 Meeting the RDA
for vitamin D will support bone health.1 The RDA for vitamin D for infants and children is:1
Birth to one year: 400 IU (10 mcg)* [total from food and supplements]
1 to 18 years old: 600 IU (15 mcg) [total from food and supplements]
* AI rather than RDA (See ‘Appendix A’ for definitions)
IU = International Unit
mcg = microgram (sometimes presented as μg)
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Nutrition Guideline
Healthy Infants and Young Children
Vitamin D
For Professional Reference Only
Applicable to: Nurses, Physicians and Other Health Professionals
Can the vitamin D requirements of infants and children be met through food?
Breastmilk and infant formula:
An estimate of the typical amount of vitamin D in breastmilk is 10 IU of vitamin D per 1 cup (250 mL).21 Infant
formulas are fortified with vitamin D, with most standard cow’s milk infant formulas containing 85 - 103 IU of
vitamin D per 1 cup (250 mL).6,22,23
Considering the average amount of breastmilk an infant consumes, an infant cannot meet his or her vitamin D
requirements through breastmilk alone. Similarly, based on the average amount of formula a formula fed infant
consumes, formula fed infants may not meet their vitamin D requirements through infant formula alone.
Food:
Vitamin D is found in very few foods naturally.1 The best sources include fatty fish (e.g. salmon, trout, herring).
Smaller amounts are found in egg yolk.21
Some foods are, however, fortified with vitamin D. In Canada, vitamin D fortification of cow’s milk and
margarine is mandatory.24 Cow’s milk typically contains approximately 100 IU of vitamin D per 1 cup (250 mL)
and margarine contains approximately 25 IU of vitamin D per teaspoon (5 mL).21 Plant-based beverages and
goat’s milk may be fortified with vitamin D, but this is not mandatory.24 If they are fortified, the level of
fortification would be in the range outlined in Table 2.
Consumption of 200 IU of vitamin D from food sources is recommended for all children (1 to 18 years).
Canada’s Food Guide recommends consumption of 2 cups (500 mL) of fluid milk or fortified soy beverage*
daily.25 Two cups of cow’s milk, fortified goat’s milk or fortified soy beverage* would provide approximately 200
IU of vitamin D,21 contributing to a child’s vitamin D requirements. Children who are not drinking this amount
regularly will require vitamin D from other food sources. In this situation, health professionals should review
food sources of vitamin D with parents and facilitate a referral to a Registered Dietitian if required.
*Soy beverage is not recommended for children under two years of age.26
May 2013
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Nutrition Guideline: Healthy Infants and Young Children
Vitamin D
For Professional Reference Only
Nutrition Guideline
Healthy Infants and Young Children
Vitamin D
Applicable to: Nurses, Physicians and Other Health Professionals
What amounts of vitamin D can be found in food?
Table 1. Vitamin D content of selected foods21,22,23
Food (serving size)
Breastmilk
Best Sources
Good Sources
Sources
Breastmilk (1 cup, 250 mL)
Salmon, baked or broiled (2.5 ounces, 75 grams)
(Sockeye salmon has the highest levels of vitamin D)
Rainbow trout (2.5 ounces, 75 grams)
Approximate
vitamin D content
10 IU
200 - 700 IU
190 - 210 IU
Atlantic herring (2.5 ounces, 75 grams)
160 IU
Infant formula (1 cup, 250 mL)
Cow’s milk (1 cup, 250 mL)
Goat’s milk, fortified* with vitamin D (1 cup, 250 mL)
Fortified* soy beverage◊ (1 cup, 250 mL)
Atlantic mackerel (2.5 ounces, 75 grams)
Margarine (1 teaspoon, 5 mL)
Egg yolk (2 large)
Yogurt, made with vitamin D fortified milk (¾ cup, 175 grams)
85 - 103 IU
Orange juice, fortified with vitamin D (½ cup, 125 mL)
50 IU
100 - 105 IU
90 IU
78 IU
25 IU
50 - 90 IU
70 IU
* Goat’s milk, soy beverages and other plant-based beverages that are not fortified, will contain insignificant amounts of vitamin D.21
◊ Soy beverages are not recommended for children under 2 years of age.26 Fortified soy beverage can be used as an alternative to
milk for ages 2 and older.25 Plant-based beverages other than soy (e.g. rice, potato, almond etc.) are not considered replacements
for milk.27
What foods in Canada are fortified with vitamin D?
Table 2. Vitamin D fortification regulations24,28,29,30,31,32,33
Food
Mandatory/optional Fortification amount in regulations
All Cow’s Milk (fluid, evap, dried) Mandatory
300 - 400 IU/852 mL (88 - 117 IU/250 mL)
Margarine
Mandatory
530 IU/100 g (25 IU/5 mL)
Infant Formula
Mandatory
40 - 80 IU/100 kcal (67-134 IU/250 mL*)
Goat’s Milk
Optional
300 - 400 IU/852 mL (88 - 117 IU/250 mL)
Plant-based Beverages
Optional
300 - 400 IU/852 mL (88 - 117 IU/250 mL)
* Assuming
infant formulas contain 67 kcal per 100 mL
May 2013
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Vitamin D
Nutrition Guideline
Healthy Infants and Young Children
Vitamin D
For Professional Reference Only
Applicable to: Nurses, Physicians and Other Health Professionals
What is the recommended level of vitamin D supplementation for healthy term infants and children in
Alberta?
Public health guidance for vitamin D supplementation in Alberta is based on the premise of meeting the
RDA/AIs from the Institute of Medicine which were developed assuming minimal sun exposure and are
independent of skin pigmentation.1 (See ‘How much vitamin D do infants and children require?’ section.)
Vitamin D supplementation recommendations for children one year of age and older were made with the
assumption that children would obtain 200 IU vitamin D daily from food sources.
Table 3. Recommended daily vitamin D supplement amount
Recommended daily vitamin D supplement
Age group
amount
Birth to one year (healthy term infants)
Exclusively breastfed
400 IU
Partially breastfed
Formula/whole milk* fed
1 – 18 years old
*
400 IU
Whole milk should not be offered before 9 months of age26
Some infants and children may be advised higher levels of supplementation based on individual assessment by
their primary health care provider.
If a breastfeeding mother takes a vitamin D supplement, does her breastfed baby need to take a
vitamin D supplement as well?
Yes. Although mothers can satisfy their own requirements and increase the vitamin D content of their
breastmilk via diet, sun, and/or supplements, it is important that breastfed babies still be supplemented with
vitamin D.2 A breastfeeding mother would need to take a dose of 4000 - 6000 IU of vitamin D daily to satisfy
the vitamin D needs of her infant.12 This amount would exceed the Tolerable Upper Intake Level (UL) for
adults currently set at 4000 IU1 and would not be recommended unless specifically advised by the mother’s
primary health care provider.
Why do formula fed infants need a vitamin D supplement if formula has vitamin D in it?
Each 1 cup (250 mL) of infant formula contains approximately 100 IU of vitamin D.6,22,23 Therefore, a formula
fed infant drinking less than 4 cups (32 oz or 1000 mL) of formula each day would not receive 400 IU of
vitamin D.34 Infant formula intake usually ranges from 10 to 39 oz (300 to 1170 mL) each day for a formula fed
infant from birth through eleven months of age.35 This equates to an estimated vitamin D intake of 120 to 470
IU each day, indicating that formula fed infants may not meet the daily Adequate Intake (AI) of 400 IU vitamin
D. Since formula intake can be variable from day to day, supplementing all healthy term, formula fed infants
with 400 IU of vitamin D daily will ensure they will consistently meet the AI.
(See ‘If following the vitamin D supplementation recommendations outlined in this guideline, could an infant or
child exceed the Tolerable Upper Intake Level for vitamin D?’ section for more information on total intake for
formula fed infants.)
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Vitamin D
Nutrition Guideline
Healthy Infants and Young Children
Vitamin D
For Professional Reference Only
Applicable to: Nurses, Physicians and Other Health Professionals
If an infant receives both breastmilk and infant formula, does he/she require a vitamin D supplement?
Yes. If an infant is partially breastfed, it is unlikely that he or she would consume 4 cups (32 oz or 1000 mL) of
formula per day, the amount that would supply 400 IU of vitamin D;34 therefore, supplementation is
recommended.2
How long should a child continue to receive a 400 IU vitamin D supplement?
Given the eating patterns of many children,34,36 achieving a daily dietary intake of 600 IU of vitamin D (RDA for
over one year of age) is unlikely. The 2004 Canadian Community Health Survey reports a median range of
vitamin D intake for children and adolescents in Alberta from 220 IU to 316 IU daily.36 This indicates that
supplementation is required in order to meet the RDA. It is recommended that a 400 IU vitamin D supplement
be provided throughout childhood (birth to 18 years) to ensure that vitamin D requirements are met.
For vitamin D recommendations for adults, refer to the Nutrition Guidelines for Primary Care: Calcium and
Vitamin D.
What should parents look for when choosing a vitamin D supplement?
Vitamin D supplements for infants and children are available in many forms, including liquid/drops,
chewable tablets or “gummies”, tablets that can be swallowed, dissolvable tablets, lozenges, strips, and
sprays.37
Parents should be advised to look for the following when choosing a vitamin D supplement for their child:
a single vitamin D supplement;2
an eight-digit Natural Product Number (NPN) on the label, indicating that it has been assessed by Health
Canada and has been found to be safe, effective and of high quality under its recommended conditions for
use;37
dose of 400 IU of vitamin D;
a form that is suitable for the child’s stage of development; for example a liquid supplement is the most
appropriate choice for infants.2
A single vitamin D supplement should be chosen unless directed otherwise by the child’s primary health care
provider. Multivitamin supplements are not recommended for babies2 and not needed for most children.38
Parents who choose to provide a multivitamin supplement to their child should be advised to consult with a
pharmacist to choose an appropriate product. Multivitamin and natural health product supplements, including
cod liver oil, contain varying amounts and types of vitamins and minerals. These supplements may include
levels of vitamins (e.g. vitamin A) and minerals that could cause toxicity if incorrectly used.
Different brands of supplements have varying strengths of vitamin D (e.g. 400 IU versus 1000 IU). Product
labels may list vitamin D amounts in either International Units (IU) or micrograms (mcg or μg). Parents can be
informed that 1 mcg = 40 IU.39 Liquid vitamin D supplements have dosages indicated on the label in millilitres
(mL), in drops, or can be listed “per dropper” amount. The name of the supplement is not necessarily
descriptive of the dosing amount (e.g. a supplement may have “drop” in the name, but the dose is per
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Nutrition Guideline
Healthy Infants and Young Children
Vitamin D
For Professional Reference Only
Applicable to: Nurses, Physicians and Other Health Professionals
millilitre). Parents should be instructed to read product labels carefully and to consult with a pharmacist with
any questions, in order to ensure the correct dose is chosen and provided.
The most appropriate choice of vitamin D supplement for infants is a liquid supplement.2 Tablets and chewable
supplements can put infants who are still learning to chew and swallow at risk for choking. Once a child can
chew and swallow safely, they can take a chewable vitamin D supplement. It is important to review the
recommended ages and risk information on the label of any supplement and to consider the child’s stage of
development in order to ensure the vitamin D form is safe for the infant or child.
Chewable or gummy supplements appear and taste like candy, therefore as with all supplements, should be
kept out of reach of children to reduce the risk of toxicity or choking.
There are two forms of vitamin D available in vitamin D supplements. They are vitamin D3 and vitamin D2, and
are from animal and plant sources respectively. At this time, it would appear that at low doses vitamin D2 and
D3 are equally effective1,12 and thus vitamin D2 or vitamin D3 can be used as a vitamin D supplement for
children.
What recommendations can be provided to parents who feel that their child does not tolerate a
vitamin D supplement?
While there is little information available on this issue, some suggestions to ease the child’s sensitivity to
vitamin D include:
give the supplement around feeding time rather than on an empty stomach, or try mixing with food or
beverage;
try offering the supplement at different times of the day;
ask a pharmacist about using another vitamin D preparation.
If following the vitamin D supplementation recommendations outlined in this guideline, could an
infant or child exceed the Tolerable Upper Intake Level for vitamin D?
Table 4. Estimated total Vitamin D intake (food and supplements) and Tolerable Upper Intake Level
Estimated intake
Estimated daily
Recommended daily
Daily Tolerable
from food and
Age group
amount of vitamin
vitamin D
Upper Intake Level
supplements
D from food
supplement amount
(UL) for vitamin D1
combined
0 - 6 months
up to 470 IU*
400 IU
400 - 870 IU
1000 IU
7- 12 months
up to 470 IU*
400 IU
400 - 870 IU
1500 IU
◊
1 - 3 years
232 IU
400 IU
632 IU
2500 IU
4 - 8 years
220 IU◊
400 IU
620 IU
3000 IU
◊
9 - 18 years
168 - 316 IU
400 IU
568 - 716 IU
4000 IU
* Food intake value listed is an estimate based on the typical range of consumption of breastmilk, infant formula and/or whole milk.
Vitamin D intake from vitamin D containing solids was not included as no estimates of consumption are available. (See ‘Why do
formula fed infants need a vitamin D supplement if formula has vitamin D in it?’ section for estimates of formula intake.)
◊ Food intake value listed is based on the median vitamin D intake from the 2004 Canadian Community Health Survey report for
Alberta.36 (See ‘Can the vitamin D requirements of infants and children be met through food’? and ‘What amounts of vitamin D can
be found in food’ sections for more information on food sources of vitamin D.)
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Vitamin D
Nutrition Guideline
Healthy Infants and Young Children
Vitamin D
For Professional Reference Only
Applicable to: Nurses, Physicians and Other Health Professionals
As shown in Table 4, the combination of estimated amounts of vitamin D obtained from food and
recommended supplemental amounts do not exceed the UL for any of the age groups listed.
It is unlikely that excessive amounts of vitamin D would be obtained through food. Data on usual intakes from
food gathered in Alberta in 2004 indicates that less than 3% of children age 1-18 years (for the majority of age
categories, closer to 0%) exceeded the UL for vitamin D.36 In 2004, the UL was even more conservative than it
is now (2000 IU versus 2500 - 4000 IU),1,40 and therefore it is likely that even less children would exceed the
UL with the new recommendations.
Prolonged sun exposure does not result in the production of excess quantities of vitamin D that would cause
intoxication.15 Once maximum cutaneous production occurs, additional sun exposure will not result in
additional net input to the system.10 The same UVB that produces vitamin D in the skin also degrades it,
causing a steady-state that generally limits cutaneous production.10
Incorrect supplement use would be the most likely cause of exceeding the UL, specifically the consumption of
multiple supplements and/or the accidental consumption of incorrect dosages of vitamin D. (See ‘What should
parents look for when choosing a vitamin D supplement?’ section for more information on how to choose an
appropriate supplement and dose.)
What are the symptoms of vitamin D toxicity in infants and children?
Vitamin D toxicity is a rare event11 but can cause symptoms such as feeding difficulties, irritability, diarrhea,
and poor weight gain.41 Vitamin D toxicity can also raise blood calcium levels, causing heart rhythm
abnormalities and mental changes such as confusion.3
Are there any handouts on Vitamin D for healthy infants and children that I can use with my clients?
For infant nutrition resources visit Nutrition Education Materials at
http://www.albertahealthservices.ca/nutrition/Page11115.aspx and click on Infants.
For more information related to healthy infants and children see Healthy Parents Healthy Children.
May 2013
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Nutrition Guideline
Healthy Infants and Young Children
Vitamin D
For Professional Reference Only
Applicable to: Nurses, Physicians and Other Health Professionals
Appendices
Appendix A – Dietary Reference Intakes from the Institute of Medicine
The Institute of Medicine is an independent, non-profit organization that works outside of government to
provide unbiased and authoritative advice to Canadian and American health professionals and the public.42
The Dietary Reference Intakes (DRI) are “a common set of reference values [on macro and micro nutrients]
based on scientifically grounded relationships between nutrient intakes and indicators of adequacy, as well as
the prevention of chronic diseases, in apparently healthy populations.”20
The Institute of Medicine uses the following terms within their DRI recommendations:
Recommended Dietary Allowance (RDA):
“The average daily dietary nutrient intake level that is sufficient to meet the nutrient requirements of nearly all
(97-98%) healthy individuals in a particular life stage and gender group.”20
Adequate Intake (AI):
“The recommended average daily intake level based on observed or experimentally determined
approximations of estimates of nutrient intake by a group (or groups) of apparently healthy people that are
assumed to be adequate; used when an RDA cannot be determined.”20
Tolerable Upper Intake Level (UL):
“The highest average daily nutrient intake level that is likely to pose no risk of adverse health effects to almost
all individuals in the general population. As intake increases above the UL, the potential risk of adverse effects
may increase.”20
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References:
1.
Institute of Medicine (IOM). Dietary reference intakes for calcium and vitamin D [report on the Internet]. Washington,
DC: The National Academies Press; 2011 [cited 2013 Feb 27]. Available from:
http://www.iom.edu/Reports/2010/Dietary-Reference-Intakes-for-Calcium-and-Vitamin-D.aspx.
2.
Health Canada, Canadian Paediatric Society, Dietitians of Canada, Breastfeeding Committee for Canada. Nutrition
for healthy term infants: recommendations from birth to six months [document on the Internet]. 2012 [updated 2012
Oct 31; cited 2013 Feb 14]. Available from: http://www.hc-sc.gc.ca/fn-an/nutrition/infant-nourisson/recom/indexeng.php.
3.
National Institutes of Health: Office of Dietary Supplements. Dietary supplement fact sheet: vitamin D [document on
the Internet]. [reviewed 2011 Jun 24; cited 2013 Feb 14]. Available from:
http://ods.od.nih.gov/factsheets/vitamind.asp.
4.
Munger KL, Zhang SM, O-Reilly E, Hernan MA, Olek MJ, Willett WC, et al. Vitamin D intake and incidence of
multiple sclerosis. Neurology. 2004;62:60-5.
5.
Munger KL, Levin LI, Hollis BW, Howard NS, Ascherio A. Serum 25-hydroxyvitamin D levels and risk of multiple
sclerosis. JAMA. 2006 Dec 20;296(23):2832-8.
6.
Godel JC, Canadian Paediatric Society, First Nations, Inuit, and Métis Health Committee. Vitamin D
supplementation: recommendations for Canadian mothers and infants. Paediatr Child Health [serial on the
Internet]. 2007 (reaffirmed 2012 Mar) [cited 2013 Feb 14];12(7):583-9. Available from:
http://www.cps.ca/english/statements/ii/fnim07-01.htm.
7.
Dietitians of Canada. How much sunlight exposure, at what times of the year and at what latitude, is adequate in
Canada for adequate skin vitamin D synthesis? In: Practice-based evidence in nutrition [knowledge pathway online].
2008 Nov 10 [cited 2013 Feb 14]. Available from: http://www.pennutrition.com. Restricted access to members only.
8.
Holick MF. High prevalence of vitamin D inadequacy and implications for health. Mayo Clin Proc. 2006;81(3):35373.
9.
Webb AR, Kline L, Holick MF. Influence of season and latitude on the cutaneous synthesis of vitamin D3: exposure
to winter sunlight in Boston and Edmonton will not promote vitamin D3 synthesis in human skin. J Clin Endocrinol
Metab. 1988 Aug;67(2):373-8.
10.
Cannell JJ, Hollis BW, Zasloff M, Heaney RP. Diagnosis and treatment of vitamin D deficiency. Expert Opin
Pharmacother. 2008 Jan;9(1):107-18.
11.
Holick MF. Deficiency of sunlight and vitamin D. BMJ. 2008;336:1318-9.
12.
Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, et al. Evaluation, treatment, and
prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. [serial
on the Internet]. 2011 Jul [cited 2013 Feb 15];96(7):1911-30. Available from:
http://www.ncbi.nlm.nih.gov/pubmed/21646368\.
13.
Hanley DA, Cranney A, Jones G, Whiting SJ, Leslie WD, Cole DEC, et al. Vitamin D in adult health and disease: a
review and guideline statement from Osteoporosis Canada. CMAJ. 2010;182(12):610-8.
14.
Papiaoannau A, Morn S, Cheung AM, Atkinson S, Brown JP, Feldman S, et al. Clinical practice guidelines for the
diagnosis and management of osteoporosis in Canada: summary. CMAJ. 2010;(17):1864-73.
May 2013
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Healthy Infants and Young Children
Vitamin D
For Professional Reference Only
Applicable to: Nurses, Physicians and Other Health Professionals
15.
Holick MF. Sunlight and vitamin D for bone health and prevention of autoimmune diseases, cancers, and
cardiovascular disease. Am J Clin Nutr 2004;80(suppl):1678S-88S.
16.
Holick MF. McCollum aware lecture, 1994: Vitamin D – new horizons for the 21st century. Am J Clin Nutr.
1994;60:619-30.
17.
Health Canada. Tips for parents [page on the Internet]. 2008 Dec 15 [cited 2013 Feb 15]. Available from:
http://www.hc-sc.gc.ca/hl-vs/sun-sol/protect-protegez/tips-trucs-eng.php.
18.
Canadian Dermatology Association. Sun safety – protecting your family [page on the Internet]. 2013 [cited 2013 Feb
3]. Available from: http://www.dermatology.ca/skin-hair-nails/skin/sun-safety/#!/skin-hair-nails/skin/sunsafety/protecting-your-family/.
19.
Canadian Cancer Society. Sun safety and children [page on the Internet]. 2011 Jul 14 [cited 2013 Feb 3]. Available
from: http://www.cancer.ca/Canadawide/Prevention/Sun%20and%20UV/Being%20safe%20in%20the%20sun/Sun%20safety%20and%20children.aspx
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