Health Visitor Blog.
Vitamin D - Infants and children
Vitamin D deficiency is a major public health issue and health care professionals like myself are encouraged to identify children who may be at increased risk of deficiency as well as to raise awareness of the importance of getting enough vitamin D.
Why is Vitamin D important?
Vitamin D is actually a hormone and can be produced by the body. Vitamin D is essential for bone health and is required to absorb calcium and phosphorus into the body and regulate the movement of these minerals in and out of the skeleton, ensuring strong bones (Cowbrough 2015). Vitamin D is also important for immune function, muscle function and brain development. A lack of Vitamin D can lead to bone deformities such as rickets. Rickets was once described as a disease of the past however paediatricians are reporting an increasing number of children and infants diagnosed with it. Rickets occurs when children start to weight bear on soft bones and this causes the classic ‘bowed leg’ appearance. Usually children who are diagnosed with rickets will have had vitamin D deficiency for some time beforehand and therefore may have been complaining about pain for a while.
Vitamin D deficiency also can cause other problems such as hypercalcaemia which is basically low levels of serum calcium. This can lead to twitching, tingling, cramps and fits (NHS Choices 2013; Shaw and Mughal 2013 cited by Patience 2015)
Equally, optimum levels of Vitamin D can protect against many acute and chronic disorders.
How to ensure adequate Vitamin D intake
The main source of Vitamin D is the sun which actually provides 80-90% of the body’s requirement however it is also found in limited food such as oily fish, fortified cereals and margarines however the body’s vitamin D requirements can never be met through diet alone.
Some children are at higher risk of vitamin D deficiency than others (NICE 2014):
As mentioned before, the main source of Vitamin D is from exposure to the sun. This however creates a bit of a headache for parents as most parents are familiar with ‘Sun Safety’ and we all fear that our children will get burnt if they go out in the midday sun or if they go out without lots of sun protection cream, hats and glasses, leaving very little exposed skin for the sun to penetrate.
To add to this, in the UK, adequate vitamin D is available only from the sun in the summer months from April to September and during the day between 11am and 3pm. It has long been known that when babies and children’s skin is over exposed to UV radiation, especially during these times, there is an increased risk of skin cancer in adulthood (Balk 2011 cited by Geraghty et al 2015).
The good news is that we are all much more knowledgeable about the risks of sun exposure and therefore we are taking care to slather on the sun block but the downside is that it has reduced the body’s absorption of vitamin D.
Health professionals are advised to continue to encourage the practice of safe sun exposure with good protection but also the uptake of vitamin D through moderate sun exposure and combine this with dietary and supplementary uptake (Geraghty et al 2015). Currently the NHS advises that children under 6 months of age should not be placed in direct sunlight and that older children should play in the shade and wear sunscreen of at least SPF 15 and cover their skin with t-shirts and hats (NHS Choices 2014)
Supplementation of Vitamin D
It is recommended that all children aged 6 months to 5 years are given Vitamin D supplements (NHS Choices 2015)
If a mother has taken daily supplements of vitamin D(10ug) throughout pregnancy, the baby should not need a supplement until 6 months.
If a mother is at high risk of deficiency and did not take a vitamin D supplement throughout pregnancy then supplementation may be advised from one month old. If you feel that you could be at risk, talk to your Health visitor or GP about supplementation.
Formula Fed babies do not require additional vitamin D supplementation until they are having less than 500mls a day of formula (Patience 2015).
Vitamin supplementation is available on prescription. There are some available in supermarkets but these are considered to be dietary supplements rather than drugs so they are not subject to such stringent regulation (Patience 2015).