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Vitamin D Recommendations for Children
In October of 2008, the American Academy of Pediatrics recommended increasing the amount of vitamin D for infants, children and teenagers to 400 international units (IU) per day to age 13. The previous RDA was 200 IU per day.

Why the increase? To learn that, we need to understand the ABCs of vitamin D.

Vitamin D is a fat-soluble vitamin that is difficult to get naturally from foods. We used to rely on the sun for it. But habitual sunscreen use—which is a good thing—along with smog and cloudy days has blocked or reduced our body's ability to produce this very important vitamin.

Most of us grew up knowing that our milk was fortified with vitamin D. In the 1930s, rickets, a softening of the bones caused by low vitamin D, was a major public health problem. The government began a massive, hugely successful milk fortification program.

Most U.S. fluid milk contains 100 IU vitamin D per cup, but drinking too much can also have negative health effects. Most other dairy products, like ice cream, cheese and yogurt are not fortified.

Vitamin D benefits our bodies in many ways. It promotes calcium absorption, which promotes strong bones and teeth. That calcium is also needed for your heart, and it keeps your muscles from developing painful cramps called tetany. Vitamin D is vital for a healthy immune system and is thought to be involved in preventing some cancers.

A few years back, the American Academy of Pediatrics started recommending vitamin D fortification for breastfed babies with darker skin pigmentation living in regions with reduced sun exposure. This was based on an alarming increase in cases of rickets. The recommendation was soon expanded to include all nursing infants. Now breastfed babies are routinely supplemented, including those who are only partially breastfeeding. If you are formula-feeding your child, ask your pediatrician whether you should supplement vitamin D to comply with the new guidelines.

The best food sources of vitamin D are fish—salmon, mackerel and tuna. Unfortunately, there are concerns about mercury content in mackerel and tuna, and it has been recommended that fish intake should be limited in children and pregnant women. Many foods, like cereals, are fortified but not in amounts sufficient to provide a full day's requirements. This leaves two options: sunshine or a vitamin supplement. While a supplement may be helpful for some, nothing can replace a healthy diet and outdoor exercise.

In addition to some breastfed infants, those at most risk for vitamin D deficiency are people who aren't exposed to the sun that often. That includes residents of northern states and individuals who wear robes and head covers for religious reasons. Similarly, adults with jobs that keep them indoors during the day may not get enough D.

People with dark skin are also at risk because their pigment reduces the skin's ability to produce vitamin D from sunlight. Obese people and those with fat malabsorption problems, including children, should be screened for low vitamin D stores.

Make it a point to discuss vitamin D with your child's pediatrician at the next visit. Screening requires a simple blood test. For a child at risk, treatment can be prescribed. Children with good levels of vitamin D have stronger bones and teeth, better immune systems and tend to be healthier overall.

Susan M. Leisner RD, IBCLC, RLC Nutritionist & Lactation Consultant