Prevention of Rickets and Vitamin D Deficiency in Infants, Children, and Adolescents

TLDR

Rickets remains common in U.S. infants due to insufficient vitamin D intake and limited sun exposure, and vitamin D deficiency is also a concern for older children and adolescents, prompting revised guidelines that now recommend 400 IU daily for all pediatric ages while emerging evidence links vitamin D to immunity and disease prevention. The updated 400 IU daily recommendation is grounded in new clinical trials and the established safety of this dose in children and adolescents.

Abstract

Rickets in infants attributable to inadequate vitamin D intake and decreased exposure to sunlight continues to be reported in the United States. There are also concerns for vitamin D deficiency in older children and adolescents. Because there are limited natural dietary sources of vitamin D and adequate sunshine exposure for the cutaneous synthesis of vitamin D is not easily determined for a given individual and may increase the risk of skin cancer, the recommendations to ensure adequate vitamin D status have been revised to include all infants, including those who are exclusively breastfed and older children and adolescents. It is now recommended that all infants and children, including adolescents, have a minimum daily intake of 400 IU of vitamin D beginning soon after birth. The current recommendation replaces the previous recommendation of a minimum daily intake of 200 IU/day of vitamin D supplementation beginning in the first 2 months after birth and continuing through adolescence. These revised guidelines for vitamin D intake for healthy infants, children, and adolescents are based on evidence from new clinical trials and the historical precedence of safely giving 400 IU of vitamin D per day in the pediatric and adolescent population. New evidence supports a potential role for vitamin D in maintaining innate immunity and preventing diseases such as diabetes and cancer. The new data may eventually refine what constitutes vitamin D sufficiency or deficiency.