When Should Baby Switch From Vitamine D to Poly Vi Sol
Vitamin D Supplementation in Infants, Children, and Adolescents
Am Fam Physician. 2010 Mar fifteen;81(six):745-748.
Related Editorial
Patient information: See related handout on vitamin D in children, written by the authors of this article.
Article Sections
- Abstract
- Vitamin D in Health and Disease
- Guidelines for Vitamin D Intake
- Vitamin D and Sunlight
- Complications of Vitamin D Deficiency
- Supplementation Options
- References
Vitamin D deficiency in children tin can accept adverse health consequences, such every bit growth failure and rickets. In 2008, the American Academy of Pediatrics increased its recommended daily intake of vitamin D in infants, children, and adolescents to 400 IU. Infants who are breastfed and children and adolescents who swallow less than i L of vitamin D–fortified milk per day will likely need supplementation to reach 400 IU of vitamin D per twenty-four hour period. This recommendation is based on skillful opinion and recent clinical trials measuring biomarkers of vitamin D status. It is also based on the precedent of preventing and treating rickets with 400 IU of vitamin D. In addition to dietary sources, exposure to ultraviolet B sunlight provides children and adults with boosted vitamin D. Although the American Academy of Pediatrics recommends keeping infants out of directly sunlight, decreased sunlight exposure may increase children's risk of vitamin D deficiency. No randomized controlled trials assessing patient-oriented outcomes have been performed on universal vitamin D supplementation. However, vitamin D may reduce the risk of sure infections and chronic diseases. Physicians should assist parents choose the appropriate vitamin D supplement for their child.
Vitamin D deficiency in children has been linked to adverse effects, such as growth failure and rickets. Although vitamin D is available in several foods and drinks, contempo estimates suggest the prevalence of vitamin D deficiency among infants, children, and adolescents is between 12 and 24 percentage.1,2 Infants who are breastfed appear to be at higher risk of vitamin D deficiency. Family physicians should understand electric current recommendations for vitamin D supplementation, and be prepared to educate parents about breastfeeding, lord's day precautions, and nutrition throughout childhood and adolescence.
Vitamin D in Health and Affliction
- Abstract
- Vitamin D in Wellness and Disease
- Guidelines for Vitamin D Intake
- Vitamin D and Sunlight
- Complications of Vitamin D Deficiency
- Supplementation Options
- References
Vitamin D plays several important roles in the metabolism and absorption of other minerals in the torso. Vitamin D is essential for facilitating calcium metabolism and bone mineralization; is benign for phosphate and magnesium metabolism; and stimulates protein expression in the abdominal wall to promote calcium assimilation. Low levels of vitamin D lead to the release of parathyroid hormone, which causes calcium mobilization from the os. Over fourth dimension, excessive bone resorption tin can lead to rickets.
Adequate levels of vitamin D may also help reduce the risk of autoimmune conditions,3,iv infection,5 and type 2 diabetes.half dozen Evidence from observational studies supports the office of vitamin D supplementation in reducing the take chances of type i diabetes in infants and children.7 Although observational studies suggest that vitamin D may be protective against some cancers,eight a randomized controlled trial of calcium and vitamin D supplementation in 36,282 women did not notice a protective outcome confronting breast cancer.9
Guidelines for Vitamin D Intake
- Abstract
- Vitamin D in Wellness and Disease
- Guidelines for Vitamin D Intake
- Vitamin D and Sunlight
- Complications of Vitamin D Deficiency
- Supplementation Options
- References
In 2003, the American Academy of Pediatrics (AAP) published a guideline recommending that all children older than two months receive 200 IU of supplemental vitamin D daily.10 This practiced consensus argument was supported by studies of breastfed infants in the United States, Norway, and China and suggested that infants who ingest 100 or 200 IU of supplemental vitamin D daily were less likely to develop rickets.xi Since then, there have been concerns that these dosages may be bereft. These concerns are supported by studies showing that vitamin D deficiency tin occur early in life12; that serum 25-hydroxyvitamin D concentrations tend to be lower in breastfed infants13; and that 400 IU of vitamin D supplementation in these infants maintains higher concentrations of 25-hydroxyvitamin D.14 In improver, studies have shown that adolescents swallow bereft levels of dietary vitamin D 15,xvi and that supplementation increases 25-hydroxyvitamin D levels and bone mineral density.17
SORT: Key RECOMMENDATIONS FOR PRACTICE
| Clinical recommendation | Evidence rating | References | Comments |
|---|---|---|---|
| Infants ingesting less than i L (33.8 fl oz) of formula per day, too equally all breastfed or partially breastfed infants, should receive 400 IU of supplemental vitamin D daily. | C | 13, xix, 20 | Based on disease-oriented testify and expert stance |
| Children and adolescents consuming less than 1 L of vitamin D–fortified milk per day should receive 400 IU of supplemental vitamin D daily. | C | 21, 22 | Based on disease-oriented show and case series |
| Limiting sunlight exposure may predispose children to vitamin D deficiency. | C | 23, 25–27 | Based on disease-oriented evidence and expert opinion |
| The best available biomarker of vitamin D status is serum 25-hydroxyvitamin D levels. | C | 28, 29 | Based on consensus and disease-oriented prove |
| Children at increased risk of vitamin D deficiency may require higher dosages of supplemental vitamin D. | C | 32–34 | Based on disease-oriented testify and good opinion |
Consequently, the AAP issued an updated recommendation in 2008 that all infants, children, and adolescents receive a minimum of 400 IU of vitamin D daily through diet or supplements.18 Infants who are formula-fed exclusively will most likely have an adequate level of vitamin D. Infants who are breastfed or partially breastfed, too as children and adolescents who consume less than one L (33.viii fl oz) of vitamin D–fortified milk per day, should receive 400 IU of supplemental vitamin D daily.13,19–22
Despite these recommendations, there are no studies showing that universal supplementation improves patient-oriented outcomes, such every bit the reversal of lethargy, irritability, and growth failure, attributed to vitamin D deficiency. Only indirect bear witness supports the contention that 400 IU of supplemental vitamin D daily prevents and treats rickets.14 Prospective studies focusing on patient-oriented outcomes, rather than biomarkers, are needed before the actual clinical impact of supplemental vitamin D will be understood.
Vitamin D and Sunlight
- Abstract
- Vitamin D in Health and Illness
- Guidelines for Vitamin D Intake
- Vitamin D and Sunlight
- Complications of Vitamin D Deficiency
- Supplementation Options
- References
In addition to dietary sources, children and adults obtain vitamin D through exposure to ultraviolet B sunlight. Every bit little as 10 to 15 minutes of direct sunlight tin generate 10,000 to 20,000 IU of vitamin D. Many factors influence vitamin D synthesis, such equally skin pigmentation, breadth, and corporeality of skin exposed, making it difficult to appraise how much vitamin D volition be converted from sunlight exposure. Infants and children who have darker pigmentation require five to ten times the length of sunlight exposure to reach the aforementioned levels of 25-hydroxyvitamin D when compared with children who have lighter pigmentation.23 However, the AAP recommends that infants younger than 6 months be kept out of direct sunlight.24 Although the goal of limiting sunlight exposure is to minimize the take chances of skin cancer, it may likewise predispose children to vitamin D deficiency.25–27 Because the safe level of sunlight exposure needed for vitamin D conversion is unknown, increasing vitamin D supplementation is a reasonable culling.
Complications of Vitamin D Deficiency
- Abstract
- Vitamin D in Health and Illness
- Guidelines for Vitamin D Intake
- Vitamin D and Sunlight
- Complications of Vitamin D Deficiency
- Supplementation Options
- References
Risk factors for vitamin D deficiency are summarized in Table 1. Physicians should confirm suspicion of vitamin D deficiency by measuring levels of 25-hydroxyvitamin D, which is the best available biomarker for checking vitamin D status.28,29 Vitamin D deficiency in adults is defined every bit 25-hydroxyvitamin D levels of less than twenty ng per mL (50 nmol per L), although this varies among studies.30 There is no gear up level of 25-hydroxyvitamin D to confirm vitamin D deficiency in infants, children, and adolescents. Although no set level has been established for children and adolescents, recent studies have used less than 15 to 20 ng per mL (37.44 to l nmol per L) as a cutoff for vitamin D deficiency in these historic period groups.
Table 1.
Take a chance Factors for Vitamin D Deficiency in Children
| Anticonvulsant medication therapy |
| Chronic diseases associated with fatty malabsorption |
| Darker skin pigmentation |
| Sectional breastfeeding without vitamin D supplementation |
| Bereft sunlight exposure |
| Depression maternal vitamin D levels (risk factor for infants) |
Patients with severe cases of rickets may present with growth failure, hypocalcemic seizures, decreased bone mass, and feature os changes or fractures (Figure ane). Nonspecific symptoms, such as irritability, languor, and developmental delay, may be less obvious. In a case-control written report of children hospitalized for acute illnesses, investigators found an increased rate of admissions for lower respiratory tract infections among those with rickets.31
Effigy one.
Ankle radiograph of a 17-month-old girl with healing rickets. Note the lateral bowing of the fibulas and the right tibia, as well as the bandlike lucency in the metaphysis.
Supplementation Options
- Abstract
- Vitamin D in Wellness and Illness
- Guidelines for Vitamin D Intake
- Vitamin D and Sunlight
- Complications of Vitamin D Deficiency
- Supplementation Options
- References
Vitamin D3, known as cholecalciferol, is the preferred course of vitamin D for supplementation. Children with certain atmospheric condition, such as fat malabsorption, and those who crave long-term use of seizure medications may need higher dosages of vitamin D because of increased risk of deficiency.32–34 Monitoring 25-hydroxyvitamin D levels every three months, and parathyroid hormone levels and bone-mineral status every six months, is recommended for these children.
Vitamin D deficiency during pregnancy may increment the risk of aberrant fetal growth and bone development, but further studies are needed before high-dose supplementation in pregnant women can be universally recommended.35
No testify suggests that daily supplementation of 400 IU of vitamin D is toxic. Physicians should provide patients with detailed administration instructions to avoid accidental overdose. Vitamin D3 drops, which are preferable for infants, are bachelor in formulations of 400, 1,000, and 2,000 IU per drop. Varying amounts of vitamin D3 are available inside formulations of the same make. Chewable and gummy vitamins for older children incorporate 200 or 400 IU of vitamin D, simply may vary by formulation from the aforementioned manufacturer. Physicians may prefer to recommend i brand and formulation for each historic period grouping to ensure that patients accomplish a daily dosage of 400 IU (Tables 2 and 3).
Table 2.
Vitamin D Liquid Supplements for Infants and Children Younger than 2 Years
| Brand | Vitamin D per serving (IU) | Serving size |
|---|---|---|
| Carlson Babe D Drops | 400 | one drop |
| Enfamil Poly-Vi-Sol Multivitamin Supplement Drops | 400 | i mL |
| Enfamil Tri-Half-dozen-Sol Vitamins A, C & D with Atomic number 26 | 400 | 1 mL |
| Sunlight Vitamins Just D infant vitamin drops | 400 | 1 mL |
| Twinlab Baby Care Multivitamin Drops with DHA | 400 | 1 mL |
Table 3.
Multivitamins Containing Vitamin D for Children and Adolescents
| Brand | Vitamin D per serving (IU) | Serving size | |
|---|---|---|---|
| Centrum Kids Consummate Multivitamins, chewable tablets | 400 | Ane tablet for children four years and older (1/2 tablet for children two and 3 years of age) | |
| Disney Gummies Children's Multivitamin | 200 | 2 gummies for children 2 years and older | |
| Flintstones Children's Complete Multivitamin, chewable tablets | 400 | One tablet for children four years and older (1/2 tablet for children ii and 3 years of age) | |
| Flintstones Gummies with Calcium & Vitamin D, multivitamin | 400 | Two gummies for children four years and older (1 viscous for children two and 3 years of historic period) | |
| Li'l Critters Gummy Vites Kids Multivitamin | 240 | Two gummies for children two years and older | |
| Sundown Spider-man Consummate Children's Gummies | 200 | Two gummies for children two years and older | |
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REFERENCES
testify all references
1. Gordon CM, Feldman HA, Sinclair Fifty, et al. Prevalence of vitamin D deficiency among healthy infants and toddlers. Arch Pediatr Adolesc Med. 2008;162(vi):505–512. ...
two. Gordon CM, DePeter KC, Feldman HA, Grace E, Emans SJ. Prevalence of vitamin D deficiency among salubrious adolescents. Arch Pediatr Adolesc Med. 2004;158(6):531–537.
iii. Munger KL, Zhang SM, O'Reilly Eastward, et al. Vitamin D intake and incidence of multiple sclerosis. Neurology. 2004;62(1):60–65.
iv. Merlino LA, Curtis J, Mikuls TR, Cerhan JR, Criswell LA, Saag KG, for the Iowa Women'southward Health Report. Vitamin D intake is inversely associated with rheumatoid arthritis: results from the Iowa Women's Health Written report. Arthritis Rheum. 2004;fifty(1):72–77.
5. Liu PT, Stenger Southward, Li H, et al. Toll-like receptor triggering of a vitamin D-mediated human antimicrobial response. Science. 2006;311(5768):1770–1773.
six. Chiu KC, Chu A, Go VL, Saad MF. Hypovitaminosis D is associated with insulin resistance and beta cell dysfunction. Am J Clin Nutr. 2004;79(five):820–825.
7. Hyppönen E, Läärä E, Reunanen A, Järvelin MR, Virtanen SM. Intake of vitamin D and risk of type one diabetes: a birth-accomplice study. Lancet. 2001;358(9292):1500–1503.
8. Tuohimaa P, Tenkanen Fifty, Ahonen M, et al. Both high and low levels of blood vitamin D are associated with a higher prostate cancer risk: a longitudinal, nested case-control study in the Nordic countries. Int J Cancer. 2004;108(1):104–108.
9. Chlebowski RT, Johnson KC, Kooperberg C, et al., for the Women's Health Initiative Investigators. Calcium plus vitamin D supplementation and the adventure of breast cancer. J Natl Cancer Inst. 2008;100(22):1581–1591.
ten. Gartner LM, Greer FR, for the Department on Breastfeeding and Commission on Diet. American Academy of Pediatrics. Prevention of rickets and vitamin D deficiency: new guidelines for vitamin D intake. Pediatrics. 2003;111(4 pt 1):908–910.
11. Standing Committee on the Scientific Evaluation of Dietary Reference Intakes Food and Diet Board, Institute of Medicine Dietary Reference Intakes: Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride. Washington, DC: National Academies Press; 1997:250–287.
12. Hollis BW, Wagner CL. Cess of dietary vitamin D requirements during pregnancy and lactation. Am J Clin Nutr. 2004;79(5):717–726.
13. Greer FR, Marshall S. Bone mineral content, serum vitamin D metabolite concentrations, and ultraviolet B light exposure in infants fed man milk with and without vitamin Dtwo supplements. J Pediatr. 1989;114(two):204–212.
14. Rajakumar Yard, Thomas SB. Reemerging nutritional rickets: a historical perspective. Arch Pediatr Adolesc Med. 2005;159(iv):335–341.
15. Greer FR, Krebs NF, for the American Academy of Pediatrics Commission on Nutrition. Optimizing bone health and calcium intakes of infants, children, and adolescents. Pediatrics. 2006;117(2):578–585.
16. Bowman SA. Potable choices of young females: changes and impact on food intakes. J Am Nutrition Assoc. 2002;102(ix):1234–1239.
17. Viljakainen HT, Natri AM, Kärkkäinen MM, et al. A positive dose-response event of vitamin D supplementation on site-specific bone mineral augmentation in adolescent girls: a double-blinded randomized placebo-controlled one-year intervention. J Os Miner Res. 2006;21(half-dozen):836–844.
eighteen. Wagner CL, Greer FR, for the 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 [published correction appears in Pediatrics. 2009;123(1):197]. Pediatrics. 2008;122(v):1142–1152.
nineteen. American University of Pediatrics Committee on Nutrition. The prophylactic requirement and the toxicity of vitamin D. Pediatrics. 1963;31(three):512–525.
20. Greer FR. Issues in establishing vitamin D recommendations for infants and children. Am J Clin Nutr. 2004;80(6 suppl):1759S–1762S.
21. Schnadower D, Agarwal C, Oberfield SE, Fennoy I, Pusic Thousand. Hypocalcemic seizures and secondary bilateral femoral fractures in an adolescent with primary vitamin D deficiency. Pediatrics. 2006;118(5):2226–2230.
22. Bouillon R, Norman AW, Lips P. Vitamin D deficiency [letter]. North Engl J Med. 2007;357(19):1980–1981.
23. Clemens TL, Adams JS, Henderson SL, Holick MF. Increased skin paint reduces the chapters of peel to synthesise vitamin Diii. Lancet. 1982;1(8263):74–76.
24. Ultraviolet light: a hazard to children. American University of Pediatrics Committee on Environmental Health. Pediatrics. 1999;104(two pt one):328–333.
25. Reichrath J. The challenge resulting from positive and negative furnishings of sunlight: how much solar UV exposure is appropriate to balance between risks of vitamin D deficiency and peel cancer? Prog Biophys Mol Biol. 2006;92(one):ix–16.
26. Lucas RM, Ponsonby AL. Considering the potential benefits besides as adverse effects of sun exposure: can all the potential benefits exist provided past oral vitamin D supplementation? Prog Biophys Mol Biol. 2006;92(i):140–149.
27. Matsuoka LY, Wortsman J, Hanifan Due north, Holick MF. Chronic sunscreen use decreases circulating concentrations of 25-hydroxyvitamin D. A preliminary report. Arch Dermatol. 1988;124(12):1802–1804.
28. Hollis BW, Wagner CL, Drezner MK, Binkley NC. Circulating vitamin D3 and 25-hydroxyvitamin D in humans: an important tool to ascertain acceptable nutritional vitamin D status. J Steroid Biochem Mol Biol. 2007;103(3–5):631–634.
29. Wolpowitz D, Gilchrest BA. The vitamin D questions: how much practice you need and how should you get it? J Am Acad Dermatol. 2006;54(ii):301–317.
30. Hollis BW, Wagner CL. Normal serum vitamin D levels [letter]. North Engl J Med. 2005;352(v):515–516.
31. Najada As, Habashneh MS, Khader Thou. The frequency of nutritional rickets among hospitalized infants and its relation to respiratory diseases. J Trop Pediatr. 2004;50(half-dozen):364–368.
32. Aris RM, Merkel PA, Bachrach LK, et al. Guide to bone health and illness in cystic fibrosis. J Clin Endocrinol Metab. 2005;90(three):1888–1896.
33. Mikati MA, Dib 50, Yamout B, Sawaya R, Rahi Ac, Fuleihan Gel-H. Ii randomized vitamin D trials in convalescent patients on anticonvulsants: affect on bone. Neurology. 2006;67(eleven):2005–2014.
34. Valsamis HA, Arora SK, Labban B, McFarlane SI. Antiepileptic drugs and bone metabolism Nutr Metab (Lond). 2006;iii:36.
35. Mahomed Thousand, Gulmezoglu AM. Vitamin D supplementation in pregnancy. Cochrane Database Syst Rev. 2000;(2):CD000228.
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