Friday, July 12, 2013

Vitamin D/ Is your child getting enough?


 Please see the updated version of this post September 2015



The American Academy of Pediatrics recommends that all breast fed babies start getting 400 iu of a Vitamin D supplement within the first few weeks of life. They should continue to get supplemented until they are assured of getting adequate amounts from other dietary sources.
Children over the age of one and all adults, should make sure they are getting at least 600 iu daily.  
( iu stands for international units, which is a common way that Vitamin D is measured)

Occasionally, some of our families find out about this and are surprised that it wasn't brought up at one of their well child exams. Frankly, in our office we sometimes simply forget to discuss it.

Here's the scoop about Vitamin D.

Years ago, Vitamin D deficiency was most associated with Ricketts (a disease that causes very soft bones) More and more recent studies are finding that Vitamin D levels are also very important well beyond good bone health . Deficiencies are linked to multiple illnesses including diabetes, cancer prevention, heart disease and even mood disorders. There are also current studies going on to see if there is a link between low Vitamin D levels and increased allergies. 

At the same time that scientists were stressing the importance of this vitamin, they were also discovering that many folks are surprisingly quite Vitamin D deficient without being aware of it. The segment of the population who test the lowest for Vitamin D are the pregnant and  breast feeding women.  

Supplements added to milk and orange juice, some fatty fish and cod liver oil  are the main dietary sources of Vitamin D but the fact is that historically much of our vitamin D is/ was from sun exposure.
Folks with paler skin or those who live in sunny climates generally have higher levels.
Being out in the sun, unprotected for 30 minutes 2 or 3 times a week will give most people the amount they need.
But wait!! Do we really want to expose ourselves and our children to the risks associated with sunburn?
It is hard to find the right balance here.

In fact, our recent healthier sun screen practices are quite likely the cause of our lower Vitamin D levels.


Quality infant formulas do have vitamin D in them.
Babies who get 1000 ml of formula per day have their needs covered. ( there are 30 ml in an ounce, so this is about 32 ounces)

But what about the majority of our babies who are partially or completely breast fed? Instinctively it is hard for me to wrap my brain around the concept that breast milk is not a "complete source" for all of your baby's needs.
It comes down to the mom.
If a mom doesn't have adequate Vitamin D herself, her breast milk will be deficient in this one regard.
On the other hand, if mom is taking her prenatal vitamins and is quite certain that her vitamin D level is fine ( The only real way to tell is with a blood test) then I think the baby's level is most likely fine without a supplement. 

If you do end up giving your baby Vitamin D supplements, one of the most common brands is the 
Enfamil D-Vi-SOL that gives the daily dose 400iu/ dropperful.

Babies seem to tolerate this well.
There are some other forms out there that give 400iu/ in each drop. That is quite a difference.
It is very important that you pay attention to the form that you are giving.

If you are giving your baby a multi vitamin supplement like Poly-Vi-Sol, that already has the D in it. Be a label reader!
 Vitamin D is one of the fat soluble vitamins. You cannot get "too much" from sun or diet. But, as with any supplement, too much can cause some toxicity. 
Most studies suggest that the upper limit for safe supplementation  is 1000 iu/ day for babies or 2,000 iu for adults. ( I know that there are some folks advocating taking much higher doses, but I am not familiar with any real science to back of those claims) 

I do believe that the sweeping suggestion that all babies get vitamin D is meant to protect the smaller percentage that actually needs it.
If you are one of the many folks out there who has a low level, it is very important that your baby get the Vitamin D that they need. ( and yourself as well!!!!) 
Even if your level is fine, giving your baby a daily vitamin D supplement is certainly harmless if giving the proper dose.
If you choose to skip the Vitamin D recommendation, consider getting a blood test to see what your level is. It is worth knowing for your health as well.




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