How to Follow Vitamin D Recommendations for Kids (in 2022)

“Why the vitamin D recommendations for babies? I never gave you vitamin D. You didn’t get rickets.” My mom said this after she heard that newborns today are supposed to take vitamin D. A lot of grandmothers ask this. And, I have answers. Vitamin D is a nutrient found in some foods. It’s also something the human body makes after sun exposure to our skin. Today, we’ll discuss what vitamin D is and why it matters. We’ll review the American Academy of Pediatrics (AAP) recommendations for Vitamin D in kids and think about some ideas on how best to implement them. 

Why Do We Need Vitamin D?

First, what are we talking about? Vitamin D is a vitamin best known for being crucial to bone health. This is why my mom referred to rickets, a disease in children related to weak bones. Rickets can lead to weakness, fractures, and abnormal appearance of the bones. A classic image is an extreme bowing of the legs. It can also lead to scoliosis (curving of the spine). It’s related to calcium, and at more severe levels, a child could have seizures and heart rhythm problems. Not enough vitamin D, whether from diet or sunshine? This can lead to rickets. 

However, vitamin D is important in other parts of the body as well. It is related to the immune system. Sufficient amounts in the body may reduce the risk of some respiratory illnesses and auto-immune diseases like Type 1 Diabetes. We are learning more about how it may relate to risk reduction in COVID-19 patients. (That being said, most of the research I’ve seen is on adults). 

It may also reduce the risk of some types of cancer. 

Do you see all my hedging? It “may” reduce risk. It’s “related to” the immune system . . . etc? There is still a lot of research to be done. But, it’s generally trending towards this conclusion: Having enough vitamin D is important for our overall health. It goes beyond just strong bones–though that importance can’t be understated. 

Recommendations for Vitamin D Intake

The AAP recommends 400 IU (international units) of vitamin D daily for babies less than a year old. In 2003, the AAP recommended 200 IU daily for kids. In 2008, it was increased to 400 IU daily. The primary goal for the increase is to prevent rickets. They also acknowledged that there may be many other benefits as well. By 2008, a 400 IU daily dose was also well-established as safe in children. 

International Vitamin D Recommendations

While there’s a general consensus that vitamin D is important, the recommended doses of supplementation vary internationally.

In 2011, France recommended 1000 IU daily in breastfed infants. I mention this for two reasons. First, it’s evidence that larger doses may be reasonable. Second, it helps show that 400 IU daily plus whatever other incidental vitamin D (sun, diet etc) is likely perfectly fine. Of course, toxicity is possible. Someone could take too much vitamin D. It’s just not happening anywhere near the recommended levels. 

The United Kingdom recommends 400 IU for those over age 4 years.

Most Kids in the United States Do Not Get Enough Vitamin D

Today, in 2022, the recommendation is still at least 400 IU daily for infants under age one year. (600 IU daily over age 12 months, depending on the guidelines you choose to follow). And, according to a study published in June 2020, most babies and kids are not getting this amount. Yes, in 2020. After years of clear recommendations.

How To Make Sure Our Kids Get Enough Vitamin D 

To be fair, sun exposure is a hard-to-measure source. But. Sun exposure carries its own risks. The amount of vitamin D made from sun exposure also varies from one person to the next. As you can imagine, skin pigmentation, sunscreen, clothing, and where a person is on Earth (latitude!) are all variables. 

How do we make sure our kids are getting enough? Pediatricians do not recommend sunlight as the primary source, especially in babies with their more sensitive skin. Diet is one possibility. Most whole cow’s milk in the United States is fortified with vitamin D. Some fish, some mushrooms, and egg yolks are all sources as well. 

But. If we’re totally honest about what most kids eat most days? Many are not going to get enough solely from their diet either. 

For most families, a supplement is the best option. 

Vitamin D for Infants

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For infants under age 12 months, formula in the United States has the necessary vitamin D, provided a baby is drinking more than about 32 ounces a day. For exclusively breastfed babies, a supplement is essential. A baby can take the 400 IU daily by mouth. Many options are easily available. No prescription is needed. Most come in the form of a liquid supplement for babies, the dose being a few drops, depending on the concentration. (Many multivitamins for babies also include adequate vitamin D).  Personally, I use the Carlson’s brand (affiliate link) due to lack of additives and the fact the whole dose can be given in a single drop.

Some breastfeeding mothers choose to take 6400 IU daily themselves. We’re learning that if a mother takes that amount, enough vitamin D is passed through the breastmilk for her baby to get enough. 

Vitamin D for Children Over Age 12 Months

For children over age one year? Each family should choose what is right for them, based on their diet and their own habits.

The goal is 600 IU of vitamin D daily for children over age 12 months.

So, families can decide if their child gets enough from diet alone, or if a supplement is needed. Very generally, many kids can take a vitamin with 400 IU (a common dose) and get the remainder from what they eat. (I give my older child a supplement most days).

Finally, how do we know if our child’s levels are okay? If a child is otherwise healthy, we don’t typically measure vitamin D levels as a blood test. The results are too variable in children. (If a child has other health concerns, of course this may be a prudent test to check). Instead, we focus on adequate supplementation. If a child is taking at least 400 IU daily and has no other health issues? We probably don’t need a blood test, generally speaking. 

So, to answer my mom and others: our kids need more vitamin D today compared to a few generations ago because we know more now. Mainly, we know more about what is needed to prevent rickets and what is safe to take. We also know it may be very important in other parts of our body, particularly the immune system. 

What’s best for babies today? Whether it’s to prevent rickets or for the emerging importance in the immune system? The answer is straightforward. 400 IU daily. 

Maya M. Mahmood, D.O., F.A.A.P. is a board-certified pediatrician and mom. She is passionate about parents having evidence-based information to help their families be healthier. Subscribe to the newsletter or follow on social media @mayapeds.

References:

Carol, W. (2008). Prevention of Rickets and Vitamin D Deficiency in Infants, Children, and Adolescents. Pediatrics, 122(5). https://pediatrics.aappublications.org/content/122/5/1142?ijkey=b9d070859b6bb275364e6fa92d6a384b3e23e612&keytype2=tf_ipsecsha

Folsom, L. (2017, February 10). Recommendations released on prevention, management of rickets. AAP News. https://www.aappublications.org/news/2017/02/10/Rickets021017

Simon, A. (2020). Adherence to Vitamin D Intake Guidelines in the United State. Pediatrics, 145(6). https://pediatrics.aappublications.org/content/145/6/e20193574

Bouillon R. (2017). Comparative analysis of nutritional guidelines for vitamin D. Nature reviews. Endocrinology, 13(8), 466–479. https://doi.org/10.1038/nrendo.2017.31

Vidailhet, M., Mallet, E., Bocquet, A., Bresson, J. L., Briend, A., Chouraqui, J. P., Darmaun, D., Dupont, C., Frelut, M. L., Ghisolfi, J., Girardet, J. P., Goulet, O., Hankard, R., Rieu, D., Simeoni, U., Turck, D., & Comité de nutrition de la Société française de pédiatrie (2012). Vitamin D: still a topical matter in children and adolescents. A position paper by the Committee on Nutrition of the French Society of Paediatrics. Archives de pediatrie : organe officiel de la Societe francaise de pediatrie, 19(3), 316–328. https://doi.org/10.1016/j.arcped.2011.12.015

Pappa, H. M., & Gordon, C. M. (2010). Pediatrics: Supplements: when will vitamin D have its day in the sun?. Nature reviews. Endocrinology, 6(10), 539–540. https://doi.org/10.1038/nrendo.2010.127

Weir, E. K., Thenappan, T., Bhargava, M., & Chen, Y. (2020). Does vitamin D deficiency increase the severity of COVID-19?. Clinical medicine (London, England), 20(4), e107–e108. https://doi.org/10.7861/clinmed.2020-0301

Zipitis, C. S., & Akobeng, A. K. (2008). Vitamin D supplementation in early childhood and risk of type 1 diabetes: a systematic review and meta-analysis. Archives of disease in childhood, 93(6), 512–517. https://doi.org/10.1136/adc.2007.128579