Vitamin D is a hormone vital to pediatric health and development. It is required for bone development, immune function, cellular health, mental health, and overall well-being.Β
In children, sufficient vitamin D levels are necessary for bone mineralization, skeletal strength, and immune health. It also protects against infections and supports metabolic and cellular function. However, at least 40% of children in the United States meet the criteria for vitamin D deficiency.Β
This guide provides integrative approaches to adequate vitamin D levels in children, including dietary sources of vitamin D, the role of sunlight exposure, and the potential use of supplementation.
Vitamin D2 is made by plants and fungi and obtained from plant foods.Β
Vitamin D3 is made by animals and obtained from animal products. Vitamin D3 has been found to be more bioavailable and better absorbed and used in the body than vitamin D2.Β
Vitamin D metabolites are obtained primarily from sunlight exposure, dietary intake, and supplements. All vitamin D forms, whether ingested or made in the skin from exposure to sunlight, are taken up into fatty molecules called chylomicrons, which transport vitamin D forms to the liver.Β
Within the liver, vitamin D undergoes hydroxylation by the cytochrome P450 pathway into 25-hydroxyvitamin D, called 25(OH)D, the most common circulating form of vitamin D in the blood. Vitamin D undergoes a second hydroxylation in the kidneys into 1,25(OH)2D (calcitriol), the biologically active form of vitamin D.
Limited sun exposure, potentially from indoor lifestyles or excessive sunscreen use
Geographic location, such as with less sunlight exposure in northern latitudes
Dietary restrictions, such as vegan diets or lactose intolerance
Darker skin pigmentation reduces the skin's ability to produce vitamin D
Certain medical conditions affecting fat absorption or kidney function, potentially impairing vitamin D metabolism
Signs and Symptoms of Vitamin D Deficiency in Children
Vitamin D deficiency in children can cause some signs and symptoms that are non-specific, but checking vitamin D levels is indicated if vitamin D deficiency is suspected. Certain symptoms of vitamin D deficiency should warrant assessment:
Skeletal deformities, like knocked knees or bowed legs
Muscle weakness, difficulty going from sitting to stand
Delayed motor development and milestone achievement
If any of these findings are present, especially if there are risk factors for vitamin D deficiency, it is necessary to seek medical attention and assess serum vitamin D status.
Integrative Approaches to Vitamin D Supplementation
Integrative strategies for vitamin D supplementation should include adequate dietary sources, supplementation, and safe sun exposure.Β
Dietary Sources of Vitamin D
Children should be encouraged to consume food sources high in vitamin D, especially if risk factors for deficiency are present:Β
Fatty fish (like salmon and tuna)
Egg yolks
Fortified products, including milk, yogurt, and cereals
Plant-based milk
Mushrooms
For patients who are vegan or lactose intolerant, getting adequate vitamin D from dietary sources can be challenging. Search for fortified foods with added vitamin D that fit within dietary restrictions.
Toddlers and children up to 12 years old: 600-1000 IU/day
Adolescents: 1000-2000 IU/day
When choosing a vitamin D supplement, opt for vitamin D3 (cholecalciferol) instead of vitamin D2 (ergocalciferol) because D3 has a greater bioavailability. Ensure the dose is appropriate for the patientβs age and health status.Β
It is important to remember that vitamin D is fat-soluble, meaning it can be stored in adipose tissue, potentially reaching toxic levels with excessive dosing. Discuss vitamin D supplementation with a healthcare professional, who will recommend an appropriate dose based on age, diet, lifestyle, and other medical conditions.Β
Safe Sun Exposure Guidelines
For most people, adequate sun exposure can be achieved by 10-15 minutes of sunlight exposure between 8 AM and 4 PM. This level of sun exposure has also been shown to improve mental health outcomes. Outside of this window, safe sun protection with protective clothing and sunscreen is important to protect skin health.Β
Additional factors like skin pigmentation, seasons, and geographic locations may change sun exposure requirements, given differences in sunlight angle, light penetration, and skin absorption.Β
Integrating Lifestyle Changes for Optimal Vitamin D Levels
Consider ways to improve vitamin D synthesis and absorption with lifestyle modifications.Β
Engaging in at least 10-15 minutes of outdoor activities in natural sunlight allows for vitamin D synthesis through the skin. This should be balanced with appropriate sun protection for children with prolonged exposure to bright sunlight.Β
Spending outdoor time exercising offers the added benefit of healthy weight maintenance. Obesity and increased fat mass increase the risk of vitamin D deficiency due to the sequestration of vitamin D in adipose tissue.Β
Eating a balanced, nutrient-dense diet rich in vitamin D nutrients that aid its absorption, such as calcium and magnesium, helps support adequate vitamin D levels.Β
Some medications or other medical conditions may impact vitamin D metabolism, so adopting a personalized, holistic care plan can help promote optimal vitamin D status.
Monitoring and Adjusting Vitamin D Levels
Vitamin D levels are not routinely checked in pediatric patients for regular screening. However, if vitamin D deficiency is suspected, a serum 25(OH) vitamin D level should be assessed. For pediatric patients who are prescribed supplemental vitamin D, serum levels should be regularly assessed to ensure dose adequacy and safety. Ongoing monitoring of appropriate growth and development is vital to ensure the overall health of children at risk.
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Key Takeaways
Ensuring adequate vitamin D levels in children is necessary for many reasons:Β
Optimal bone health
Immune function
Metabolism
Lowered chronic disease risk
Improved mental and cognitive well-being
Integrative strategies, including enough dietary sources of vitamin D, healthy weight management, supplementation, and safe sun exposure, are all important in preventing and treating deficiency.Β
Regular monitoring of vitamin D levels ensures the adequacy of supplement dosage and the success of lifestyle modifications.Β
Using a personalized, holistic approach to vitamin D deficiency allows for prompt correction and optimal health outcomes.
Vitamin D is a hormone important for pediatric health and development. It plays a role in bone development, immune function, cellular health, mental health, and overall well-being.Β
In children, maintaining sufficient vitamin D levels is important for bone mineralization, skeletal strength, and immune health. It also supports the body's defense against infections and contributes to metabolic and cellular function. However, at least 40% of children in the United States may have low vitamin D levels.Β
This guide provides integrative approaches to supporting adequate vitamin D levels in children, including dietary sources of vitamin D, the role of sunlight exposure, and the potential use of supplementation.
Vitamin D2 is made by plants and fungi and obtained from plant foods.Β
Vitamin D3 is made by animals and obtained from animal products. Vitamin D3 has been found to be more bioavailable and better absorbed and used in the body than vitamin D2.Β
Vitamin D metabolites are obtained primarily from sunlight exposure, dietary intake, and supplements. All vitamin D forms, whether ingested or made in the skin from exposure to sunlight, are taken up into fatty molecules called chylomicrons, which transport vitamin D forms to the liver.Β
Within the liver, vitamin D undergoes hydroxylation by the cytochrome P450 pathway into 25-hydroxyvitamin D, called 25(OH)D, the most common circulating form of vitamin D in the blood. Vitamin D undergoes a second hydroxylation in the kidneys into 1,25(OH)2D (calcitriol), the biologically active form of vitamin D.
Limited sun exposure, potentially from indoor lifestyles or excessive sunscreen use
Geographic location, such as with less sunlight exposure in northern latitudes
Dietary restrictions, such as vegan diets or lactose intolerance
Darker skin pigmentation may reduce the skin's ability to produce vitamin D
Certain medical conditions affecting fat absorption or kidney function, potentially impacting vitamin D metabolism
Signs and Symptoms of Vitamin D Deficiency in Children
Vitamin D deficiency in children can cause some signs and symptoms that are non-specific, but checking vitamin D levels is indicated if vitamin D deficiency is suspected. Certain symptoms of vitamin D deficiency should warrant assessment:
Skeletal deformities, like knocked knees or bowed legs
Muscle weakness, difficulty going from sitting to stand
Delayed motor development and milestone achievement
If any of these findings are present, especially if there are risk factors for vitamin D deficiency, it is important to seek medical attention and assess serum vitamin D status.
Integrative Approaches to Vitamin D Supplementation
Integrative strategies for vitamin D supplementation should include adequate dietary sources, supplementation, and safe sun exposure.Β
Dietary Sources of Vitamin D
Children may benefit from consuming food sources high in vitamin D, especially if risk factors for deficiency are present:Β
Fatty fish (like salmon and tuna)
Egg yolks
Fortified products, including milk, yogurt, and cereals
Plant-based milk
Mushrooms
For those who are vegan or lactose intolerant, getting adequate vitamin D from dietary sources can be challenging. Look for fortified foods with added vitamin D that fit within dietary restrictions.
Toddlers and children up to 12 years old: 600-1000 IU/day
Adolescents: 1000-2000 IU/day
When choosing a vitamin D supplement, vitamin D3 (cholecalciferol) is often preferred over vitamin D2 (ergocalciferol) due to its greater bioavailability. Ensure the dose is appropriate for the patientβs age and health status.Β
It is important to remember that vitamin D is fat-soluble, meaning it can be stored in adipose tissue, potentially reaching high levels with excessive dosing. Discuss vitamin D supplementation with a healthcare professional, who can recommend an appropriate dose based on age, diet, lifestyle, and other medical conditions.Β
Safe Sun Exposure Guidelines
For most people, adequate sun exposure can be achieved by 10-15 minutes of sunlight exposure between 8 AM and 4 PM. This level of sun exposure has also been shown to support mental health outcomes. Outside of this window, safe sun protection with protective clothing and sunscreen is important to protect skin health.Β
Additional factors like skin pigmentation, seasons, and geographic locations may change sun exposure requirements, given differences in sunlight angle, light penetration, and skin absorption.Β
Integrating Lifestyle Changes for Optimal Vitamin D Levels
Consider ways to support vitamin D synthesis and absorption with lifestyle modifications.Β
Engaging in at least 10-15 minutes of outdoor activities in natural sunlight allows for vitamin D synthesis through the skin. This should be balanced with appropriate sun protection for children with prolonged exposure to bright sunlight.Β
Spending outdoor time exercising offers the added benefit of healthy weight maintenance. Obesity and increased fat mass may increase the risk of vitamin D deficiency due to the sequestration of vitamin D in adipose tissue.Β
Eating a balanced, nutrient-dense diet rich in vitamin D nutrients that aid its absorption, such as calcium and magnesium, helps support adequate vitamin D levels.Β
Some medications or other medical conditions may impact vitamin D metabolism, so adopting a personalized, holistic care plan can help promote optimal vitamin D status.
Monitoring and Adjusting Vitamin D Levels
Vitamin D levels are not routinely checked in pediatric patients for regular screening. However, if vitamin D deficiency is suspected, a serum 25(OH) vitamin D level should be assessed. For pediatric patients who are prescribed supplemental vitamin D, serum levels should be regularly assessed to ensure dose adequacy and safety. Ongoing monitoring of appropriate growth and development is vital to ensure the overall health of children at risk.
[signup]
Key Takeaways
Ensuring adequate vitamin D levels in children is important for many reasons:Β
Optimal bone health
Immune function
Metabolism
Supporting overall health
Improved mental and cognitive well-being
Integrative strategies, including enough dietary sources of vitamin D, healthy weight management, supplementation, and safe sun exposure, are all important in supporting adequate vitamin D levels.Β
Regular monitoring of vitamin D levels ensures the adequacy of supplement dosage and the success of lifestyle modifications.Β
Using a personalized, holistic approach to vitamin D levels allows for prompt support and optimal health outcomes.
The information in this article is designed for educational purposes only and is not intended to be a substitute for informed medical advice or care. This information should not be used to diagnose or treat any health problems or illnesses without consulting a doctor. Consult with a health care practitioner before relying on any information in this article or on this website.
Alonso MA, MantecΓ³n L, Santos F. Vitamin D deficiency in children: a challenging diagnosis!. Pediatr Res. 2019;85(5):596-601. https://pubmed.ncbi.nlm.nih.gov/30653195/
Brustad N, Yousef S, Stokholm J, BΓΈnnelykke K, Bisgaard H, Chawes BL. Safety of High-Dose Vitamin D Supplementation Among Children Aged 0 to 6 Years: A Systematic Review and Meta-analysis. JAMA Netw Open. 2022;5(4):e227410.Β https://pubmed.ncbi.nlm.nih.gov/35420658/
Corsello A, Spolidoro GCI, Milani GP, Agostoni C. Vitamin D in pediatric age: Current evidence, recommendations, and misunderstandings. Front Med (Lausanne). 2023;10:1107855.Β https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10060648/
Elliott TM, Gordon LG, Webb A, Kift R, Foeglein A, Neale RE. Making the sunshine vitamin - How much sun exposure is needed to maintain 25-hydroxy vitamin D concentration?. Photochem Photobiol. Published online September 10, 2023. https://onlinelibrary.wiley.com/doi/10.1111/php.13854
Fischer PR, Johnson CR, Leopold KN, Thacher TD. Treatment of vitamin D deficiency in children. Expert Rev Endocrinol Metab. 2023;18(6):489-502. https://pubmed.ncbi.nlm.nih.gov/37861060/
Palermo NE, Holick MF. Vitamin D, bone health, and other health benefits in pediatric patients. J Pediatr Rehabil Med. 2014;7(2):179-192. https://pubmed.ncbi.nlm.nih.gov/25096870/
Peroni DG, Trambusti I, Di Cicco ME, Nuzzi G. Vitamin D in pediatric health and disease. Pediatr Allergy Immunol. 2020;31 Suppl 24:54-57. https://pubmed.ncbi.nlm.nih.gov/32017212/
Tripkovic L, Lambert H, Hart K, et al. Comparison of vitamin D2 and vitamin D3 supplementation in raising serum 25-hydroxyvitamin D status: a systematic review and meta-analysis. Am J Clin Nutr. 2012;95(6):1357-1364. https://pubmed.ncbi.nlm.nih.gov/22552031/
ββZhang X, Liu Z, Xia L, et al. Clinical features of vitamin D deficiency in children: A retrospective analysis. J Steroid Biochem Mol Biol. 2020;196:105491. https://pubmed.ncbi.nlm.nih.gov/31586638/
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