Article written by Dr. Marie Carrier Kinsley
Importance of Vitamin-D
Vitamin-D deficiency and insufficiency is a common problem in children. Low levels of vitamin-D is a problem that more and more patients and providers are checking for.
Vitamin-D is an essential vitamin that plays a large role in calcium regulation and bone health. At the turn of the century, Ricketts, a childhood bone disorder that can cause weak bones and stunted growth, was rampant. Fortunately, nowadays Ricketts is not common, but low vitamin-D levels continue to be a problem. Low levels of vitamin-D can lead to osteoporosis or osteomalacia or weak bones.
In addition, low vitamin-D levels have been associated with muscle weakness and effects on the immune system although much is not known regarding the effects of vitamin-D deficiency. It is possible but as yet unclear whether low levels of vitamin-D plays a part in fatigue and mood regulation for some people. More research is needed in these areas. The test to check for vitamin-D levels is a blood test.
Vitamin-D is only naturally found in a few food sources. Examples of these are fatty fish such as salmon (especially the wild type), herring, mackerel, sardines, and canned tuna. It is in egg yolks and some mushrooms. It is fortified in many foods in particular in milk and milk products, soy milk, orange juice, and some bread and cereals.
Risk Factors for Low Vitamin-D
Humans make vitamin-D upon sunlight exposure but this process is blocked by sunscreen. Because of the risk of sun damage and skin cancer from sun exposure, it is not recommended to rely on sun exposure as a primary source for vitamin D. In addition, darker skin individuals require longer lengths of time to make vitamin-D in the sun than lighter-skinned individuals. It is for this reason that darker-skinned children are at the highest risk for vitamin-D deficiency. Vitamin-D deficiency is more prevalent in the winter months and at more Northern latitudes.
Other risk factors for vitamin-D deficiency include prematurity, being on some medications such as some epilepsy medications, or having a disease that impairs nutrient absorption such as celiac disease or cystic fibrosis. Babies who breastfeed without vitamin D supplementation are also at a higher risk of deficiency since the vitamin-D content in breast milk is low. Children and adolescents with obesity require higher amounts of vitamin-D and so are also at risk for low levels.
– All exclusively breastfed infants should take 400 IU (international units) of vitamin-D daily
– Children and adolescents age 1-18 years should take either 600 IU daily through high vitamin-D foods/beverages or through a supplement. High-risk groups may need more.
– Adults age 18- 70 years require 600 IU daily and adults >70 require 800 IU daily
– Vitamin-D fortified milk intake (or equivalent dietary sources) of 2 cups per day in 1-2-year-olds, 2-3 cups fortified milk in 2-8-year-olds and 3 cups in 9—18-year-olds is recommended in order to ingest adequate vitamin-D and calcium in children
– Other food sources of calcium and vitamin-D should be encouraged as well, with a supplement for those children who are not able to eat/drink enough high vitamin-D containing foods and beverages