VITAMIN D DEFICIENCY IN KIDS AND TEENS

VITAMIN D DEFICIENCY IN KIDS AND TEENS

An estimated 1 billion people worldwide, across all ethnicities and age groups, have a vitamin D deficiency (VDD). This pandemic of hypovitaminosis D can be attributed to lifestyle (for example, reduced outdoor activities) and environmental (for example, air pollution) factors that reduce exposure to sunlight, which is required for ultraviolet-B (UVB)-induced vitamin D production in the skin. Because of the vitamin’s significant role in maintaining critical bodily processes, having low or deficient levels can greatly impact your health. High prevalence of vitamin D insufficiency is a particularly important public health issue because hypovitaminosis D is an independent risk factor for total mortality in the general population.

Vitamin D receptor (VDR) is present in most tissues and cells in the body. Vitamin D3 has a range of biological actions, such as inhibition of cellular proliferation, inducing terminal differentiation, inhibiting angiogenesis, stimulating insulin production, inhibiting renin production, and stimulating macrophage cathelicidin production. Vitamin D3 may be responsible for regulating up to 200 genes if not more that may facilitate many of the pleiotropic health benefits that have been reported for vitamin D3.

DETRIMENTAL EFFECTS OF VITAMIN D DEFICIENCY IN CHILDREN

Vitamin D deficiency can negatively affect a child’s growth, immune response, mental health, and more, which is why proper treatment is important.

In children, vitamin D deficiency is manifested as rickets, a disease characterized by a failure of bone tissue to become properly mineralized, resulting in soft bones and skeletal deformities 

The fortification of milk (a reliable source of calcium) and other staples, such as breakfast cereals and margarine, with vitamin D beginning in the 1930s along with the use of cod liver oil made rickets rare in the United States. However, the new studies are showing a growing trend of vitamin D deficiency among children and teens in the United States.

Best Sources of Vitamin D for Kids are as follows:

  • Salmon or light canned tuna
  • Herring
  • Sardines
  • Eggs
  • Vitamin D-fortified products like plain whole cow’s milk (for children 12 months and older), yogurt, cereals, and some juices fortified with vitamin D

Some ways to naturally fortify vitamin D in your child; sunlight may be the best source of vitamin D for kids, because the ultraviolet rays from sunlight can help the body to produce vitamin D naturally. Children typically need just less than an hour of direct sunlight each week to get a healthy dose of vitamin D.

However, certain children specially with darker skin or higher fat content appear to be at higher risk for vitamin D deficiency.

CHILDREN AT RISK OF LOW VITAMIN D

  • Children with very dark skin. The dark color of their skin (melanin) acts as a natural sunscreen and increases the time they need in the sun to make vitamin D naturally.
  • Children whose skin is rarely exposed to the sun e.g., those who stay inside or who wear covering clothing.
  • Babies born prematurely.
  • Breastfed babies who have one or more of the above risk factors. Breast milk is the best type of food for babies, but it does not contain much vitamin D. A baby will get their initial store of vitamin D from their mother; so, they are at risk of low vitamin D if their mother has low vitamin D and/or if they have dark skin.
  • Children with conditions affecting how the body absorbs and controls vitamin D, such as liver disease, kidney disease, problems absorbing food (e.g., cystic fibrosis, celiac disease, inflammatory bowel disease) and some medicines (such as some epilepsy medicines).

HOW IS VITAMIN D DEFICIENCY TREATED IN CHILDREN?

After vitamin D levels have normalized, it’s recommended that babies under 12 months old receive a daily maintenance dose of 400 IU (10 mcg), while children 1 year or older receive a daily dose of 600 IU (15 mcg). However, these recommendations are for children with adequate and normal levels of vitamin D in their body and in need of maintenance dosing. For children with severe vitamin D deficiency or onset of rickets doctors and centers recommendations can be as varying as 5000iu to 300,000iu daily in children and teens under direct medical supervision.*

The Reference Daily Intakes (RDIs), recommended by FDA for Infants through 12 months is 10 mcg (400 IU), for Children 1 through 3 years is 15 mcg (600 IU), and for children four and above is 20 mcg (800IU).

Again, this dosage may be inadequate on children and teens who are already low on their levels and need to play catch up to obtain a healthy level of vitamin D. Your child’s pediatrician is the best person to supervise their nutritional needs.

WHAT IS AN ACCEPTABLE BLOOD LEVEL OF VITAMIN D?

The range of vitamin D level seen on a blood test is usually indicated from 30 to 100nmol/L. The range considered adequate for bone and overall health children and teens is anything between 50 to 100nmol/L. Anything over 100nmol/L and specially reaching 125nmol/L is considered toxic.

SUMMARY

Vitamin D deficiency is common in all age groups, including children. Treatment for vitamin D deficiency differs by age. For example, infants require lower doses of the vitamin compared with older children and teens.

Because vitamin D deficiency is common — especially in kids who have more body fat, certain medical conditions, and darker skin tones — it is important to have your child’s vitamin D levels tested regularly.

Vitamin D appears to be involved in a multitude of functions in our children’s body and it is imperative that it is included in a healthy diet as a supplement. Treatment for vitamin D deficiency depends on factors like age, the severity of the deficiency, underlying medical conditions, and more. Your child’s doctor will determine the best treatment protocol based on your child’s specific needs.

This information is only for educational purposes and is not medical advice or intended as a recommendation of any specific products. Consult your health care provider for more information. These statements have not been evaluated by the Food and Drug Administration. These products are not intended to diagnose, treat, cure, or prevent any disease.

References:

  • Elder CJ, Bishop NJ. Rickets. Lancet. 2014 May 10;383(9929):1665-1676. doi: 10.1016/S0140-6736(13)61650-5. Epub 2014 Jan 10. PMID: 24412049.
  • Wang, Thomas J et al. “Vitamin D deficiency and risk of cardiovascular disease.” Circulation vol. 117,4 (2008): 503-11. doi:10.1161/CIRCULATIONAHA.107.706127
  • Stolzenberg-Solomon, Rachael Z et al. “Serum vitamin D and risk of pancreatic cancer in the prostate, lung, colorectal, and ovarian screening trial.” Cancer research vol. 69,4 (2009): 1439-47. doi:10.1158/0008-5472.CAN-08-2694
  • Chlebowski, Rowan T et al. “Calcium plus vitamin D supplementation and the risk of breast cancer.” Journal of the National Cancer Institute vol. 100,22 (2008): 1581-91. doi:10.1093/jnci/djn360
  • Nair, Rathish, and Arun Maseeh. “Vitamin D: The "sunshine" vitamin.” Journal of pharmacology & pharmacotherapeutics vol. 3,2 (2012): 118-26. doi:10.4103/0976-500X.95506
  • Frunutta Neonutta Vitamin D3 For Kids (600 IU).  [Accessed 24 March 2022].
  • Office of Dietary Supplements - Vitamin D. Accessed 24 March 2022.
  • Vitamin D Deficiency in Kids: Signs, Symptoms and More. [Accessed 24 March 2022].
  • What Are Ultraviolet Rays? (with pictures). [Accessed 24 March 2022].
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