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MORE TENACIOUS ABOUT VITAMIN D
With the American Academy of Pediatrics now saying children of all ages don't get enough vitamin D, the Tribune spoke Monday with several experts about why the vitamin is so important for children, how to achieve the new recommended daily dose and what else parents should know about vitamins for their children.
Children are now recommended to get 400 international units of vitamin D daily, double the old level. For many children, that will mean taking a supplement.
Q Why are higher doses of vitamin D being recommended?
A Physicians are increasingly concerned about medical problems caused by vitamin D deficiency, including more children diagnosed with rickets. Caused by extreme or prolonged vitamin D deficiency, rickets results in a softening and weakening of children's bones and can bring about skeletal deformities such as bowlegs or a curved spine.
"The incidence of rickets has been increasing in the United States, from 65 reported cases between 1975 and 1985 to 166 reported cases between 1986 and 2003," said Dr. Jennifer Bryan of Glenbrook Pediatrics in Glenview. "The actual incidence is believed to be much higher. Rickets almost disappeared, and now it's increasing."
Our bodies produce vitamin D through exposure to sunlight, but many children are not outdoors long enough and don't get sufficient amounts of the vitamin in their diets to ensure good health, some experts say.
Dr. Joel Schwab, an associate professor of pediatrics at the University of Chicago Medical Center, said: "Kids need four glasses of milk to meet the recommendations. Most kids are not drinking that much. . . . I think supplementation is the only way to guarantee that kids are getting enough vitamin D."
Q Beside rickets, what other problems can vitamin D prevent?
A "It helps the immune system as well," Bryan said. "Infections, autoimmune disorders, cancer and diabetes are things that they think adequate vitamin D will prevent."
Q Which children should take a supplement?
A The academy is recommending vitamin D supplements for healthy children of all ages. Although vitamin D-only supplements are available, many doctors suggest a multivitamin that contains vitamins A, C and D. Supplements can be administered as drops to infants and in chewable form to older children.
"Infants just a few days old should start getting vitamin D supplementation," said Tara Gidus, a registered dietitian and spokeswoman for the American Dietetic Association. "If they are getting formula, they are already getting a fortified product so they are getting enough. But if they are breast-fed, they aren't. Those infants should get a liquid vitamin D supplement."
Q Why is it so hard to get enough vitamin D in food?
A Few foods contain vitamin D. Among the best sources is organ meat, such as kidney and liver—foods not commonly eaten by children.
"Vitamin D is present naturally in fatty fishes and fish oil—which are rare in our diet—and in milk and foods fortified with vitamin D such as soy milk, rice milk or orange juice," Bryan said. "Other vitamins are easier to get in a healthy diet because there are more food sources."
Q How do I know if my child is getting enough vitamin D?
A "The American Academy of Pediatrics says that after age 1, kids should be getting a liter of milk [about 4 cups] a day to get all of the vitamin D they need," Gidus said. "If they are getting less, you would want to supplement it. Other fortified foods include breakfast cereal and orange juice. You should read labels and see how much is in there. Teens should be drinking their fortified milk. If they are not getting a liter a day, they should be taking a multivitamin as well. Different brands have different levels in them."
Q Any chance of overdosing on vitamin D?
A Bryan: "Not if given correctly. The dose is safe. There was a time when cod liver oil was routinely recommended in the United States and children who were taking it probably were receiving 400 international units [of vitamin D]."
Q Are there any precautions people need to take?
A Vitamins are considered safe at recommended dosages. Some children might be tempted to eat too many of the flavored variety, which can be toxic when consumed in excess amounts. "It's important to make sure vitamins are kept out of the reach of kids," Schwab said.
October 14, 2008