Is vitamin D supplementation beneficial for pediatric patients?

From the Guidelines

Vitamin D supplements are recommended for children at risk of deficiency, with a daily dose of 400-600 IU, as suggested by the ESPGHAN Committee on Nutrition 1. The decision to take supplements of vitamin D for children should be based on their individual risk factors and needs. Children who are at risk for vitamin D deficiency, such as those with limited sun exposure, darker skin tones, certain medical conditions, or restricted diets, may benefit from supplementation.

Key Considerations

• The ESPGHAN Committee on Nutrition recommends a total daily vitamin D intake of 400 IU/day for infants and 600 IU/day for children and adolescents 1.
• Preterm infants on parenteral nutrition (PN) should receive 200-1000 IU/day of vitamin D, while term infants up to 12 months of age should receive 400 IU/day, and older children should receive 400-600 IU/day 1.
• Paediatric patients receiving long-term PN should be monitored periodically for vitamin D deficiency, and additional supplementation should be provided if serum concentrations are < 50 nmol/L 1.
• Oral supplementation of vitamin D should be considered in patients on partial PN as well as during weaning from PN 1.

Important Notes

• Vitamin D is essential for calcium absorption and bone development, and deficiency can lead to rickets, a condition causing soft, weak bones.
• Over-supplementation can be harmful, as vitamin D is fat-soluble and can accumulate in the body.
• Before starting any supplement, it's best to consult with your child's healthcare provider, who can assess their specific needs and recommend appropriate dosing.

Recommendations

• Infants who are exclusively or partially breastfed should receive 400 IU of vitamin D daily starting in the first few days of life.
• Formula-fed infants who consume less than 32 ounces of formula per day should also receive 400 IU of vitamin D daily.
• For older children and adolescents, 600 IU of vitamin D daily is recommended.

From the Research

Vitamin D Supplementation for Children

• The American Academy of Pediatrics recommends that infants who are exclusively or partially breastfed require 400 international units of vitamin D daily from the first few days of life 2.
• Severe vitamin D deficiency may cause rickets in infants or children, and subclinical vitamin D deficiency is associated with osteoporosis and a higher incidence of falls or fractures 2.
• Vitamin D receptors are present all over the body, and insufficient vitamin D status may correlate with several extra-skeletal effects, such as pregnancy-related complications and immune dysfunction 2.
• The decision to take vitamin D supplements should be individualized, and medical advice should be sought to determine the appropriate dosage 2, 3.

Benefits and Risks of Vitamin D Supplementation

• Vitamin D supplementation can improve musculoskeletal health, reducing the rate of fractures and falls in older adults 3.
• However, the benefits of vitamin D supplementation for other health outcomes, such as autoimmune disease, cancer, and cardiovascular disease, are not well established 3, 4.
• The risks of vitamin D supplementation are generally considered to be low, but high doses can cause harm 3, 5.
• The optimal dosage and serum level of vitamin D are not well established, but a level of 30-80 ng/ml is generally considered to be optimal 3, 5.

Strategies for Addressing Vitamin D Deficiency

• Increasing dietary intake of vitamin D through food fortification or supplementation can help address vitamin D deficiency 6, 4.
• Sun exposure can also increase vitamin D levels, but it is not a reliable or safe method for maintaining adequate vitamin D status 2, 6.
• A worldwide public health intervention that includes vitamin D supplementation in certain risk groups and systematic vitamin D food fortification could help prevent severe vitamin D deficiency 4.