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Vitamin D Guidelines For Infants And Children

On November 30, 2010, the U.S. and Canada released new guidelines for calcium and vitamin D intake. The vitamin D guidelines have long been awaited as there is tremendous interest in health effects of vitamin D. I have been privileged to participate in the development of these new as well as the previous guidelines. Here are some key points related to vitamin D and children:

First, and most importantly, breastfed infants should be given vitamin D drops. It is not safe to assume that they get enough vitamin D from the sun or from breast milk. These should generally be given from a dropper that provides 400 IU each day from a single dropper. Begin the drops in the first week or two of life. Then, at 4 months of age (sooner if a baby is born at less than about 5 1/2 pounds), make sure the drops have both vitamin D and iron.

Secondly, older children need their vitamin D, up to 600 IU daily. Milk is an important source of vitamin D (and calcium!) but isn't going to be the only source as each cup of milk has about 100 IU of vitamin D. Other vitamin D sources include some types of seafood (salmon, tuna, sardines) and fortified foods (juices, yogurts, breads, margarines, cereals, mushrooms). It is very important to look at the label and see how much vitamin D is in the food or beverage. The vitamin D intake will be listed as a percentage of the "Daily Value" of 400 IU. So, "10% Daily Value" means 40 IU/day, which is some, but not a lot, of the 600 IU needed each day. Much is being said about the possible benefits of very high doses of vitamin D, especially in adults. However, the evidence for benefits to high dose vitamin D supplementation in children is very limited.

There is a risk of children becoming toxic from too much vitamin D. The new guidelines say that the maximum safe amount of vitamin D intake for infants is 1,000 IU per day going up to 4,000 IU per day in children 9 years of age or more. Do not give higher doses of vitamin D to children without the advice of a physician who is monitoring the safety of these doses.