Recently while basking in the warm sun of San Diego (thanks to my husband’s business trip) and faced with the reality of returning home to a much cooler, cloudy climate in Virginia (sigh), I was reminded of the importance of Vitamin D. Vitamin D is sometimes called the sunshine vitamin because our bodies will make a certain amount of Vitamin D when the skin is exposed to sunlight. We also need to obtain Vitamin D through foods and even supplements. Vitamin D is added to milk (Vitamin D fortified milk). It is also available as a dietary supplement, although it may not be present in all multi-vitamins.
Vitamin D is a fat-soluble vitamin which is needed for bone growth. It also promotes calcium absorption in the gut, plays a role in immune function (keeping your child healthy), and reduces inflammation. It works with the muscles, heart, lungs, and brain for healthy functioning. It may play a role in cancer protection. There is debate that Vitamin D may help decrease hypertension (high blood pressure), diabetes, and multiple sclerosis. One thing is true: Vitamin D is vital for bone health.
Vitamin D deficiency is on the rise. Vitamin D deficiency can cause rickets (softened bones, bowing legs, and skeletal deformity) in children. With the increase in breast feeding (without Vitamin D supplementation), an increase in rickets has taken place. Rickets can cause permanent skeletal deformities, including the classic bowing of the legs.
Our bodies can make a certain amount of Vitamin D from sun exposure. Sun exposure is determined by the time of day, cloudiness, smog, and the use of sunscreen. Generally, 5-30 minutes between the hours of 10 a.m. and 3 p.m. twice a week to face, arms, legs, or back (without sunscreen) is sufficient. Of course, there is a risk in not using sunscreen (skin cancer) so weigh the risks and benefits. Be prudent, and apply the sunscreen. We likely miss enough places on our body that our skin can still make some Vitamin D.
In the late 19th century, children were given daily doses of cod liver oil (yuck!) to prevent rickets. Since 1930, America has fortified the pasteurized milk supply with Vitamin D to prevent rickets and osteoporosis. Vitamin D is also present in some foods, such as egg yolks (20 IU) and salmon (100-250 IU/serving for farmed salmon).
The best way for kids over a year of age to get Vitamin D is through fortified milk. Two cups of fortified milk will fulfill the daily requirement of Vitamin D in children. Although milk is fortified, cheese and yogurt are NOT generally fortified with Vitamin D. Raw milk (unpasteurized) is not fortified and is not safe for human consumption. Drinking raw milk has a risk of bacterial infections.
Infants from birth to one year need 400 IU/day of Vitamin D, and children over the age of 1 year need 600 IU/day of Vitamin D. Infant formula is fortified with Vitamin D. Any infant that is exclusively formula fed does not need additional supplementation. Breast-fed infants should get a supplement of 400 IU/day of Vitamin D each day. Poly-Vi-Sol with Iron is the preferred daily supplement for breast-fed infants.
Older children who are not getting at least 600 IU of Vitamin D through their diets should receive a dietary supplement of Vitamin D. These are available as chewable vitamins and often contain calcium as well (Calcium + D). Vitamin D can interact with certain medications (such as steroids), so be sure to speak to your healthcare provider about any other medications which your child is taking.
If a little is good, then more must be better, right? Wrong. Excessive Vitamin D can be toxic. It can cause kidney stones, weight loss, and heart arrhythmias. Vitamin D toxicity does not come from excessive sun exposure. This comes from an excessive amount of supplemental or dietary Vitamin D. Vitamin D toxicity is rare. It is far more common to see Vitamin D deficiency. Your child can be tested for Vitamin D deficiency with a simple blood test.
The easiest way to ensure that your child has the Vitamin D that they need is to give children over 1 year of age two cups of Vitamin D-fortified milk each day. Infants under a year of age should get fortified infant formula, and breast-fed infants need Vitamin D supplementation daily (Poly-Vi-Sol with iron). If your child won’t drink milk, then give them a daily Vitamin D supplement. Let’s keep those bones strong and healthy. See milk and cookies are good for us. I knew it!
Dr. Melanie J. Wilhelm, DNP, CPNP, is a Doctor of Nursing Practice and a Certified Pediatric Nurse Practitioner at Pediatric Specialists in Norfolk, as well as a lecturer at Old Dominion University. Her first book, Raising Today’s Baby, is available on Amazon.com or at RaisingTodaysChild.com. You may email her at firstname.lastname@example.org. Follow her on Facebook at www.facebook.com/RaisingTodaysChild and twitter at www.twitter.com/Rzn2dayschild.