Your child needs vitamin D

     Sometimes a trend in medicine will create a problem when combined with a second trend. For the last two decades, we have recommended breast-feeding for all infants. During that time we have also recommended minimal sun exposure for children. The combination of these recommendations can result in vitamin D deficiency.

     Vitamin D is necessary for the normal absorption and metabolism of calcium. It is necessary for good bone health. A severe deficiency in vitamin D results in a condition called rickets. Although this is rare, it is becoming more common and mild vitamin D deficiency is very common in both children and adults. It can cause bone pain, muscle pain, muscle weakness, poor growth and vomiting. Rickets can cause swollen joints, severe extremity pain, difficulty walking and even seizures.

     It is recommended that infants from birth to 1 year take in 400 IU (international units) of vitamin D daily and children from 1 year-olds to 18 year-olds 600 IU daily. Breast milk is usually low in vitamin D and an infant who drinks a normal daily amount of breast milk might only take in 10 – 40 IU of vitamin D in a day. It is estimated that to maintain an adequate level of Vitamin D, an infant would have to be exposed to midday sun for 30 minutes a week wearing only a diaper. This, of course, is against all sun-exposure recommendations. Using 30 SPF sunscreen decreases the body’s ability to synthesize vitamin D by 98%. So, doing what we are told to do – breast feeding, limiting sun exposure and using high SPF sunscreen – results in low vitamin D levels.

     Skin pigmentation serves as a natural sunscreen, so non-Caucasians have a greater risk of Vitamin D deficiency. It has been estimated that dark-skinned individuals need up to 3 times more sun exposure than Caucasians do. The only case of actual rickets I have diagnosed was in a 1 year-old African-American child whose mother still fed her breast milk all the time and also worked a late-night shift so neither of them was ever exposed to the sun.

     All formula, cow’s milk and soy milk are supplemented with Vitamin D. The risk of rickets is increased in children who are primarily breast-fed after 6 months of age, children allergic to cow’s milk or soy milk and in children on strict vegetarian diets. People living at higher latitudes or colder climates are also at greater risk for rickets. Some medications, especially anti-seizure medications, can decrease vitamin D levels.

     Dietary vitamin D is found in oily fish (salmon, sardines, mackerel, tuna), cod liver oil, egg yolk, and in foods and drinks fortified with vitamin D. For infants, it is recommended that they receive 400 IU of vitamin D supplementation daily which comes in a liquid you can purchase in a pharmacy without a prescription.