With the introduction of vitamin D supplementation of infant formula and milk, rickets was soon considered a rare disease. However, cases of rickets continue to be reported in the United States as some kids don't get enough vitamin D.
In addition to supplements, children can receive vitamin D from exposure to sunlight, which stimulates vitamin D production in the skin. Because dark skinned children and those that aren't exposed to enough sunlight have always been thought to be at risk of rickets, it has long been recommended that they receive vitamin D supplements if they weren't drinking baby formula (infants) or vitamin D fortified milk (older children), but it wasn't thought that most other kids needed extra vitamin D.
The American Academy of Pediatrics, in its clinical report, 'Prevention of Rickets and Vitamin D Deficiency in Infants, Children, and Adolescents,' now recommends that all children, beginning in the first two months of life, receive at least 400 IU of vitamin D each day.
Sunlight and Vitamin DIf children can make vitamin D when being exposed to the sun, what is wrong with just letting him play outside each day?
Direct exposure to sunlight without sun protection is known to increase a child's risk of getting skin cancer, so sun exposure without sunscreen is being discouraged more and more. The AAP goes so far as to say that infants under 6 months of age should have no direct sun exposure. Everyone else should apply a generous amount of a broad spectrum sunscreen with at least SPF 15 to 30 before going outside, even though that decreases the body's ability to make vitamin D.
Who needs Vitamin D?Everyone does, but most infants and children will get enough vitamin D from drinking infant formula or milk fortified with vitamin D as long as they are drinking at least 1000ml (about 32 ounces) each day or other foods fortified with vitamin D.
Children who are exclusively breastfeeding or toddlers who aren't drinking much milk will also need vitamin D supplements. Just because children don't get enough vitamin D from breastfeeding is not a reason to supplement with formula or to not breastfeed, it just means that you should give your child a vitamin with vitamin D.
Older children and teens who don't drink at least 32 ounces of milk will also need extra vitamin D.
How to get Vitamin D supplements?Most children can get vitamin D from drinking a vitamin D fortified infant formula or milk. Both cow's milk and many brands of soy milk are fortified with vitamin D and are good choices for older children. Breastfeeding infants and older children not drinking milk can get their extra vitamin D from a daily vitamin.
Keep in mind that some brands of yogurt and orange juice are now fortified with vitamin D. Check food labels and look for brands fortified with vitamin D, especially if your kids don't drink much milk.
Good choices of vitamin D supplements for infants and toddlers include:
- Enfamil D-Vi-Sol Drops (vitamin D only)
- Enfamil Poly-Vi-Sol Drops with iron (a multivitamin plus iron)
- Enfamil Poly-Vi-Sol Drops (a multivitamin)
- Enfamil Tri-Vi-Sol Drops with iron (vitamins A, D, and C plus iron)
- Enfamil Tri-Vi-Sol Drops (vitamins A, D, and C)
- Flintstones Children's Multivitamin plus Calcium (a multivitamin with vitamin D)
- Flintstones Gummies plus Bone Building Support (has Calcium and vitamin D)
- GNC Kids Vitamoo Soft Chews (Calcium and Vitamin D)
- L'il Critters Calcium Gummy Bears with vitamin D
- L'il Critters Vitamin D Gummy Bears
- NBA All-Star Vitamin D Gummies
- Rhino Gummy Calci-Bears with vitamin D
American Academy of Pediatrics. Clinical Report. Prevention of Rickets and Vitamin D Deficiency in Infants, Children, and Adolescents. Pediatrics 2008 122: 1142-1152.
Sethuraman, Usha MD. Vitamins. Pediatrics in Review. 2006;27:44-55.