Pediatric Views

June 2006

The scoop on vitamin D

Originally known as a vitamin that aids the body's absorption of calcium, vitamin D is gaining increasing attention for its role in maintaining good health and preventing disease. But despite its benefits, many children still do not receive adequate vitamin D.

Studies suggest that this deficiency may increase the risk for many chronic diseases, including common cancers, type 1 diabetes and multiple sclerosis. There's also been resurgence in the incidence of rickets, a childhood disease in which bones lack calcium and are deformed as a result of vitamin D deficiency.

Pediatric Views spoke with Children's Hospital Boston endocrinologist and researcher Catherine Gordon, MD, to find out what primary care clinicians need to know about vitamin D.

According to the Dietary Reference Intake (DRI) and the American Academy of Pediatrics, healthy children should get 200 international units (IUs) of vitamin D each day. But Dr. Gordon recommends at least 400 IUs. "With so many benefits, it might be that we should actually get 800 to 1,000 IUs a day," she says. "But 400 IUs is sufficient to prevent vitamin D deficiency."

There are several ways to make sure children get their daily dose of vitamin D. "Drinking four, 8-ounce glasses of milk will get you to 400 IUs," says Dr. Gordon. She cautions that while other dairy products like cheese, yogurt and ice cream provide calcium, most don't contain vitamin D.

"Drinking four, 8-ounce
glasses of milk
will get you to 400 IUs."

Research has consistently shown that many Americans do not spend enough time outside to get the UV exposure they need to produce enough vitamin D. The problem is especially acute during the winter months.

Kids can also get their vitamin D from the sun. "There's been some discussion that 10 to 15 minutes of unprotected sun exposure will provide the necessary vitamin D," says Dr. Gordon. But she cautions that unprotected sun exposure as a means to vitamin D still needs to be studied more carefully. "It's a continuous discussion with dermatologists," she says. "It's important to note that after that first 10 to 15 minutes, kids should then put on their sunscreen."

Taking a multivitamin, like Flintstones, also provides vitamin D. "A multivitamin can be especially important during the winter months, when kids aren't getting as much sun," says Dr. Gordon, "but milk may be a better source because it also provides protein and more calcium."

It seems easy enough: drink milk, take a multivitamin or get a daily does of sunshine. But despite this fact, many children are still vitamin D deficient, so it's important for primary care clinicians to recognize additional risk factors in their patients.

"Children are more prone to vitamin D deficiency if they have darker skin pigmentation, as can be found in Indian, African American or Hispanic ethnicities," says Dr. Gordon. "It's more difficult for them to absorb UV rays and this limits the skin's production of this vitamin."

Kids with chronic diseases, such as a seizure disorder for which a child takes an anti-convulsant that increases his or her ability to metabolize vitamin D, are also at risk. "It's very important that children with chronic conditions take supplemental vitamin D and be monitored closely for deficiency," say Dr. Gordon.

"From a public health standpoint, there is great excitement about vitamin D, as many common cancers and autoimmune diseases could be prevented by the provision of this one vitamin," she adds. "Further research is needed, but it would be remarkable and so easy to put into practice if these diseases could be prevented by a simple multivitamin or a few minutes of sunshine."

Children's Hospital Boston
300 Longwood Avenue | Boston, MA 02115 | 617-355-6000
www.childrenshospital.org