From the Hopkins Health Watch Q&A

VITAMIN D DEFICIENCY AND TESTING IN CHILDREN

Q: I got your vitamin D test and discovered that my vitamin D levels are low. I don’t really like swallowing pills so every sunny day for almost two months I spent 15 minutes to half an hour in the sun, without sunblock. I tested again and it worked! My levels are normal now. Thanks for making this test available. Now I have a question for my grandkids. I read an article saying that many children also have low vitamin D. This surprises me as most kids drink milk. Do you suggest any special foods for kids to help with vitamin D? Does your test also work for children?

A: Yes, the vitamin D test can be used for both children and adults.

The article you read was probably referring to a recent study done at Children’s Hospital in Boston with infants and toddlers, which found that 40 percent of the children tested were deficient in vitamin D and a third of those had lower-than-normal bone density. However, as with so many studies, the headlines are misleading. Most of the children tested were from poor black or Latino families living in the city. Being poor, having dark skin and living in an urban area are already well-known risk factors for vitamin D deficiency. Which is not to understate the problem of vitamin D deficiency in children, just to put it in perspective.

Breast feeding is a known risk factor for vitamin D deficiency in infants—not because Mother Nature made a mistake and forgot to provide vitamin D for infants—but because so many mothers are vitamin D deficient due to lack of sun exposure and using sunblock. The equation is simple: Vitamin D deficient mother = vitamin D deficient baby. Kids are somewhat less likely to be vitamin D deficient as they get older and start drinking milk.

The vitamin D provided in the womb and stored in a newborn’s body lasts about eight weeks, but at that point, even a small amount of sun exposure provides ample vitamin D to an infant. Getting vitamin D from food or supplements becomes a minor issue if there’s enough sun exposure.

Milk, which is fortified with vitamin D, can prevent vitamin D deficiency, but it’s highly debatable whether cow’s milk is good for human children. (Dr. John Lee thought not.) Fatty fish such as salmon contain vitamin D, but that would be a hard sell to a toddler. Vitamin D supplements of 200 to 400 IU daily are probably the best way, aside from sun exposure, to prevent deficiency in children.

Numerous studies of mothers, infants and vitamin D status have been done in countries where religious beliefs require women to be covered. Severe vitamin D deficiencies are rampant in these countries, and the single biggest risk factor is that the mother’s clothing covers her from head to toe so that she doesn’t get any sun exposure.

The conclusions of recent studies about children and vitamin D status is that they should receive supplements from infancy on. While vitamin D supplementation can be important when there’s little chance the mother will improve her own vitamin D status, the more important message, which applies to the majority of women and children, is to get outside and soak up the sun’s rays.

Vitamin D and Children References

Andiran N, Yordam N, Ozon A, “Risk factors for vitamin D deficiency in breast-fed newborns and their mothers, Nutrition 2002 Jan;18(1):47-50.

Atiq M, Suria A et al, “Vitamin D status of breastfed Pakistani infants,” Acta Paediatr 1998 Jul;87(7):737-40

Gordon CM, Feldman HA et al, “Prevalence of Vitamin D Deficiency Among Healthy Infants and Toddlers,” Arch Pediatr Adolesc Med. 2008;162(6):505-512.

Ziegler EE, Hollis BW et al, “Vitamin D Deficiency in Breastfed Infants in Iowa” Pediatrics Volume 118, Number 2, August 2006.

Salle BL, Delvin EE, “Perinatal metabolism of vitamin D1–3,” Am J Clin Nutr 2000;71(suppl):1317S–24S.