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Vitamin D: On the Double

If you think your child is getting enough vitamin D by just drinking milk, you’re probably wrong. Recent studies show that most children aren’t getting enough of this essential vitamin. In October 2008, the American Academy of Pediatrics (AAP) responded by doubling the amount of vitamin D it recommends for babies and children to 400 International Units (IU) per day.

Why Vitamin D?

Most often associated with milk and sunlight, vitamin D hasn’t been top-of-mind for parents in recent years. Common wisdom says that if you’re child drinks milk and plays outside, he’s getting what he needs, right? Surprisingly, not necessarily. “We’re seeing evidence of vitamin D deficiency in infants and children of all ages as well as adolescents and adults,” says Carol Wagner, M.D., FAAP, professor of pediatrics at the Medical University of South Carolina. “We know more about vitamin D than we did even five years ago. Because of lifestyle changes and sunscreen usage, the majority of the population shows signs of deficiency as determined by measured vitamin D levels in blood.”

Vitamin D helps ensure the body absorbs and retains calcium and phosphorus, both critical for building bone. A vitamin D deficiency can lead to rickets, a bone-softening disease that continues to be reported in the United States mostly in children in the first two years of life. At greatest risk for rickets are infants exclusively breastfed who do not receive a daily vitamin D supplement.

"There is epidemiologic evidence that vitamin D not only makes for strong bones, but may play a role in preventing some chronic diseases later in life, including those involving the immune and cardiovascular systems,” explains Frank R. Greer, M.D., FAAP, professor of pediatrics at University of Wisconsin School of Medicine and Public Health.

Based on these findings the AAP has changed its previous recommendation of 200 IU per day to 400 IU a day beginning in the first days of life. “We are doubling the recommended amount of vitamin D children need each day because evidence has shown this could have life-long health benefits,” says Dr. Greer, chair of the AAP Committee on Nutrition and co-author of the AAP’s clinical report on vitamin D. “Supplementation is important because most children will not get enough vitamin D through diet alone.”

Supplements for All

The AAP recommends vitamin D supplements for infants, children, and adolescents, including those who are breastfed. "Breastfeeding is the best source of nutrition for infants,” explains Dr. Wagner, a member of the AAP Section on Breastfeeding Executive Committee and co-author of the AAP’s clinical report on vitamin D. “However, it is important that breast-fed infants receive supplements of vitamin D. Until it is determined how much vitamin D a nursing mother should take, we must ensure that the breastfeeding infant receives an adequate supply of vitamin D through a supplement of 400 IU per day.” Once the child is weaned, a vitamin D supplement is needed throughout childhood and adolescence as well, she adds.

For formula-fed babies, the requirements are the same. Unless the child is drinking 32 ounces of infant formula per day, a vitamin D supplement is required.

Giving Supplements

When it comes to giving your child a vitamin D supplement, there’s nothing new about the process. “Any chewable multivitamin supplement for kids that contains 400 IU of Vitamin D is acceptable,” says Dr. Greer. “There are several liquid vitamin preparations for infants that contain 400 IU vitamin D per dose as well. Chewable vitamins are generally regarded as safe for  children over the age of three who are able to chew hard foods and candy.”

For breast- or bottle-fed babies, liquid supplements are the best option. “There are liquid preparations that give the recommended intake of 400 IU in 1/2 or 1 mL, which are considered to be safer by some,” says Dr. Wagner. “There are also liquid drop solutions available that provide one drop that equals 400 IU per day. The care provider can put the vitamin D drop on an index finger and then place the finger in the baby’s mouth,” she suggests. “Alternatively, the drop can be put on a pacifier or breast and then when the infant sucks the pacifier or breast, the infant receives the vitamin.”

As with all medications and supplements, vitamin D supplements should be kept out of a child’s reach. “The risk with drop solutions is that an infant or other children in the house could receive too much vitamin D,” Dr. Wagner says.

Finding D Naturally

In addition to vitamin supplements, enriched foods are another way to increase the vitamin D in your child’s diet. Look for foods fortified with vitamin D such as milk, cereal, orange juice, yogurt, and margarine.

Vitamin D is found naturally in only a few foods — they include oily fish, beef liver, cheese, egg yolks, and some mushrooms. Oily (or fatty) fish are one of the best sources of the vitamin. For example, 3.5 ounces of cooked salmon offers approximately 360 IU (about 90 percent of your child’s daily recommended value) of vitamin D per serving. Other examples of oily fish include tuna, mackerel, trout, herring, sardines, kipper, anchovies, carp, and orange roughy.

Quick Tips: The ABCs of Vitamin D

How to make sure your child is getting enough vitamin D:

  • Breastfed and partially breastfed infants should be supplemented with 400 IU a day of vitamin D beginning in the first few days of life.
  • All non-breastfed infants, as well as older children, who are consuming less than 32 ounces per day of vitamin D-fortified formula or milk, should receive a vitamin D supplement of 400 IU a day. 
  • Adolescents who do not get 400 IU of vitamin D per day through foods should receive a supplement containing that amount.
  • Children with increased risk of vitamin D deficiency, such as those taking certain medications and with chronic diseases such as cystic fibrosis, may need higher doses of vitamin D. Consult your pediatrician.

Quick Tips: Adding it Up

Here’s a look at some food sources of Vitamin D:



IU per serving*

Percent DV**

Cod liver oil, 1 tablespoon 



Salmon, cooked, 3.5 ounces 



Mackerel, cooked, 3.5 ounces 



Tuna fish, canned in oil, drained, 1.75 ounces



Sardines, canned in oil, drained, 1.75 ounces 



Milk (nonfat, reduced fat, and whole), Vitamin D-fortified, 1 cup 



Margarine, fortified, 1 tablespoon



Ready-to-eat cereal, fortified with 10% of the Daily value for vitamin D, 0.75-1 cup 



Egg, 1 whole (vitamin D is found in yolk) 


Liver, beef, cooked, 3.5 ounces 



Cheese, Swiss, 1 ounce 


*International Units
**Daily Value based on recommended 400 IU for children.

Source: National Institutes for Health, Office of Dietary Supplements


This article was featured in Healthy Children Magazine. To view the full issue, click here.

Last Updated
Healthy Children Magazine, Summer/Back to School 2009
The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.
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