About 2 weeks ago, the American Academy of Pediatrics announced a major change in the recommended daily intake of Vitamin D from 200 IU to 400 IU for children under 18. The reason for the change is especially interesting. Over the last couple of years, much research has shown that Vitamin D plays a big role not only in bone health (helping laying down strong, calcium rich bones) but its deficiency is associated with everything from some cancers to psoriasis to type 2 diabetes to auto immune disease. Sources of Vitamin D in our everyday diets are few…..milk (about a quart/day to meet the requirement), enriched breakfast cereals, and fatty fish. We also get Vitamin D from sun exposure but the number of minutes needed depends a lot on your skin tone (the darker the skin tone, the more time in the sun it takes to make Vitamin D) and the intensity of the sun. That makes it hard to estimate how much time is enough especially since sunscreen impairs the skin’s ability to synthesize it.
Given all of this new data, the AAP adjusted its recommendations dramatically. 400 IU is clearly safe in many studies and is probably the minimum amount needed to ensure bone health in children. Soooo if your child isn’t a milk lover or a huge cereal eater, you are left with the decision of which supplement to choose. The least expensive and most bioavailable form is cod liver oil. One teaspoon daily is all it takes to meet this requirement and has other benefits including omega 3 fatty acids. Cod liver oil also comes in capsule form for the kids who can swallow pills. The only kids who shouldn’t take it are infants with reflux since it could end up in their lungs when they reflux. Of course not all kids will take cod liver oil (although if you mix it with yogurt it isn’t that bad), so there are other ways to get Vitamin D. Most multivitamins have 400 IU in a single chewable and there are liquid versions like Poly vi sol and Tri vi sol and of course you can make milk a major part of life too, making sure that your child drinks 32 ounces a day to get the 400 IU.
I haven’t always been on the Vitamin D bandwagon, as many of you breast feeding moms know. The old data showed that although rickets was increasing in breast fed infants, especially African-American infants, most of the moms in my practice eat really healthy diets and since Vitamin D can be transferred in small amounts in breast milk, I didn’t see the urgent need for supplements. I am changing my recommendation now that we have this new data. I will now recommend all of my patients take Vitamin D supplements either in the form of a vitamin or cod liver oil.
Read the literature, be open minded and share what you learn and each day will be your best!
Molly O’Shea, MD Birmingham Pediatrics + Wellness Center