How Much Poly Vi Sol to Give My 19 Month Old Baby
Vitamin D Supplementation in Infants, Children, and Adolescents
Am Fam Physician. 2010 Mar 15;81(6):745-748.
Related Editorial
Patient data: Run into 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 have adverse wellness consequences, such as 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 1 L of vitamin D–fortified milk per twenty-four hour period volition likely demand supplementation to reach 400 IU of vitamin D per twenty-four hour period. This recommendation is based on expert opinion and recent clinical trials measuring biomarkers of vitamin D condition. 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 additional vitamin D. Although the American University of Pediatrics recommends keeping infants out of direct 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 adventure of certain infections and chronic diseases. Physicians should help parents choose the appropriate vitamin D supplement for their child.
Vitamin D deficiency in children has been linked to adverse furnishings, such as growth failure and rickets. Although vitamin D is available in several foods and drinks, recent estimates suggest the prevalence of vitamin D deficiency among infants, children, and adolescents is between 12 and 24 percent.ane,ii Infants who are breastfed appear to be at higher risk of vitamin D deficiency. Family unit physicians should understand current recommendations for vitamin D supplementation, and be prepared to brainwash parents about breastfeeding, sun precautions, and nutrition throughout childhood and boyhood.
Vitamin D in Health and Disease
- Abstruse
- Vitamin D in Wellness and Illness
- 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 body. Vitamin D is essential for facilitating calcium metabolism and bone mineralization; is beneficial for phosphate and magnesium metabolism; and stimulates protein expression in the abdominal wall to promote calcium absorption. Low levels of vitamin D lead to the release of parathyroid hormone, which causes calcium mobilization from the bone. Over time, excessive os resorption can lead to rickets.
Adequate levels of vitamin D may likewise help reduce the risk of autoimmune atmospheric condition,3,4 infection,5 and blazon ii diabetes.6 Evidence from observational studies supports the part of vitamin D supplementation in reducing the risk of type one diabetes in infants and children.7 Although observational studies propose that vitamin D may be protective against some cancers,viii a randomized controlled trial of calcium and vitamin D supplementation in 36,282 women did not notice a protective effect against breast cancer.nine
Guidelines for Vitamin D Intake
- Abstract
- Vitamin D in Wellness and Illness
- 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 expert consensus statement was supported by studies of breastfed infants in the United States, Norway, and Red china and suggested that infants who ingest 100 or 200 IU of supplemental vitamin D daily were less likely to develop rickets.11 Since so, in that location have been concerns that these dosages may be insufficient. These concerns are supported by studies showing that vitamin D deficiency tin can 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.xiv In addition, studies have shown that adolescents consume insufficient 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 | Bear witness rating | References | Comments |
|---|---|---|---|
| Infants ingesting less than 1 Fifty (33.8 fl oz) of formula per day, besides as all breastfed or partially breastfed infants, should receive 400 IU of supplemental vitamin D daily. | C | 13, 19, 20 | Based on illness-oriented evidence and adept opinion |
| Children and adolescents consuming less than one L of vitamin D–fortified milk per day should receive 400 IU of supplemental vitamin D daily. | C | 21, 22 | Based on disease-oriented evidence and case series |
| Limiting sunlight exposure may predispose children to vitamin D deficiency. | C | 23, 25–27 | Based on disease-oriented evidence and skilful opinion |
| The best available biomarker of vitamin D condition is serum 25-hydroxyvitamin D levels. | C | 28, 29 | Based on consensus and disease-oriented evidence |
| Children at increased chance of vitamin D deficiency may require higher dosages of supplemental vitamin D. | C | 32–34 | Based on illness-oriented evidence and practiced 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, likewise equally children and adolescents who swallow less than 1 Fifty (33.8 fl oz) of vitamin D–fortified milk per day, should receive 400 IU of supplemental vitamin D daily.13,19–22
Despite these recommendations, in that location 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 evidence 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 earlier the actual clinical impact of supplemental vitamin D will be understood.
Vitamin D and Sunlight
- Abstruse
- Vitamin D in Health and Disease
- 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. As footling equally ten to fifteen minutes of straight sunlight can generate 10,000 to 20,000 IU of vitamin D. Many factors influence vitamin D synthesis, such as skin pigmentation, latitude, and amount of pare exposed, making it hard to assess how much vitamin D will exist converted from sunlight exposure. Infants and children who accept darker pigmentation require v to 10 times the length of sunlight exposure to reach the same levels of 25-hydroxyvitamin D when compared with children who have lighter pigmentation.23 Notwithstanding, the AAP recommends that infants younger than six months be kept out of direct sunlight.24 Although the goal of limiting sunlight exposure is to minimize the take a chance of skin cancer, it may likewise predispose children to vitamin D deficiency.25–27 Considering the safe level of sunlight exposure needed for vitamin D conversion is unknown, increasing vitamin D supplementation is a reasonable alternative.
Complications of Vitamin D Deficiency
- Abstract
- Vitamin D in Health and Disease
- Guidelines for Vitamin D Intake
- Vitamin D and Sunlight
- Complications of Vitamin D Deficiency
- Supplementation Options
- References
Take a chance factors for vitamin D deficiency are summarized in Table ane. 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 divers as 25-hydroxyvitamin D levels of less than xx ng per mL (50 nmol per L), although this varies among studies.xxx In that location is no gear up level of 25-hydroxyvitamin D to ostend vitamin D deficiency in infants, children, and adolescents. Although no set level has been established for children and adolescents, recent studies accept used less than 15 to 20 ng per mL (37.44 to fifty nmol per Fifty) as a cutoff for vitamin D deficiency in these age groups.
Table 1.
Risk Factors for Vitamin D Deficiency in Children
| Anticonvulsant medication therapy |
| Chronic diseases associated with fat malabsorption |
| Darker skin pigmentation |
| Sectional breastfeeding without vitamin D supplementation |
| Bereft sunlight exposure |
| Depression maternal vitamin D levels (risk gene 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 one). Nonspecific symptoms, such every bit irritability, sluggishness, and developmental delay, may exist less obvious. In a case-control study of children hospitalized for acute illnesses, investigators constitute an increased charge per unit of admissions for lower respiratory tract infections among those with rickets.31
Effigy 1.
Talocrural joint radiograph of a 17-month-one-time girl with healing rickets. Note the lateral bowing of the fibulas and the correct tibia, as well as the bandlike lucency in the metaphysis.
Supplementation Options
- Abstract
- Vitamin D in Health 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 form of vitamin D for supplementation. Children with certain atmospheric condition, such as fat malabsorption, and those who require long-term employ of seizure medications may need higher dosages of vitamin D considering of increased risk of deficiency.32–34 Monitoring 25-hydroxyvitamin D levels every iii months, and parathyroid hormone levels and os-mineral status every half dozen months, is recommended for these children.
Vitamin D deficiency during pregnancy may increment the risk of abnormal fetal growth and bone development, merely 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 available in formulations of 400, 1,000, and 2,000 IU per driblet. Varying amounts of vitamin Diii are bachelor inside formulations of the same make. Chewable and gummy vitamins for older children contain 200 or 400 IU of vitamin D, but may vary by formulation from the same manufacturer. Physicians may adopt to recommend one brand and formulation for each age group to ensure that patients reach a daily dosage of 400 IU (Tables 2 and three).
Tabular array 2.
Vitamin D Liquid Supplements for Infants and Children Younger than Two Years
| Brand | Vitamin D per serving (IU) | Serving size |
|---|---|---|
| Carlson Baby D Drops | 400 | i drib |
| Enfamil Poly-6-Sol Multivitamin Supplement Drops | 400 | i mL |
| Enfamil Tri-Half dozen-Sol Vitamins A, C & D with Iron | 400 | 1 mL |
| Sunlight Vitamins Just D infant vitamin drops | 400 | one mL |
| Twinlab Infant Care Multivitamin Drops with DHA | 400 | i mL |
Table 3.
Multivitamins Containing Vitamin D for Children and Adolescents
| Make | Vitamin D per serving (IU) | Serving size | |
|---|---|---|---|
| Centrum Kids Complete Multivitamins, chewable tablets | 400 | I tablet for children iv years and older (1/ii tablet for children two and three years of historic period) | |
| Disney Gummies Children'due south Multivitamin | 200 | Two gummies for children two years and older | |
| Flintstones Children'south Complete Multivitamin, chewable tablets | 400 | One tablet for children four years and older (1/2 tablet for children two and three years of age) | |
| Flintstones Gummies with Calcium & Vitamin D, multivitamin | 400 | Two gummies for children iv years and older (i gummy for children 2 and three years of historic period) | |
| Li'l Critters Viscid Vites Kids Multivitamin | 240 | Two gummies for children two years and older | |
| Sundown Spider-homo Complete Children'due south Gummies | 200 | Ii gummies for children two years and older | |
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REFERENCES
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