Updated December 30, 2014.
Vitamin D is a very important vitamin that helps children develop strong bones and protects adults from developing osteoporosis (weak bones that break easily).
Unfortunately, vitamin D is naturally found in few foods, with the best sources being fish and cod liver oil. This is unlike most other vitamins and minerals that are much more abundant in the foods we eat.
So then how do we get vitamin D?
The primary source once was sunlight, as ultraviolet rays from the sun can actually help your body form vitamin D on its own.
Although a very efficient process, many experts are concerned that many kids aren't getting enough vitamin D sun exposure anymore, even though you only need about five to fifteen minutes of sunlight exposure two to three times a week.
The problem is that in addition to increased use of sunscreen, which block the UV rays that trigger the production of vitamin D, children with dark skin, who spend a lot of time inside, or who live in areas that don't get a lot of sun exposure, may not get enough vitamin D.
For these kids, food sources of vitamin D or vitamins are necessary to prevent a vitamin D deficiency.
Children need a minimum of 400 IU (International Units) of vitamin D each day. Unlike many other nutrients, there is no RDA or recommended dietary allowance for vitamin D, and instead experts talk about an adequate intake (AI) for vitamin D.
A lot of factors influence the AI for vitamin D, and the American Academy of Pediatrics even recommends that some kids may need up to 800 IU of vitamin D each day, including premature babies, infants and children with dark skin, and children who live in areas of the United States above a latitude of 40 degrees.
Surprisingly, that is basically anywhere north of Boulder, Colorado.
Although few foods naturally have high levels of vitamin D, that doesn't mean that there aren't plenty of foods that your kids can eat to get vitamin D. Many foods are now fortified with vitamin D.
Food sources of vitamin D include:
While baby formula is fortified with vitamin D, as long as the baby drinks at least 1 liter (about 33 ounces) a day, breast milk doesn't have enough vitamin D to prevent infants from developing a vitamin D deficiency. That is why experts now recommend that exclusively breastfed infants receive a vitamin D supplement of 400 IU each day (such as 1.0ml of Enfamil D-Vi-Sol). Babies drinking less than 1L of baby formula should also get a vitamin D supplement.
For older kids who aren't breastfeeding or drinking formula anymore, milk is usually the best source of vitamin D. That can be a problem for kids who don't drink milk though. Unfortunately, many foods that parents go to as alternatives to milk, because they are good sources of calcium, like orange juice, ice cream, and yogurt, are not always good sources of vitamin D.
If you check food labels and look for certain brands, you can find plenty of foods besides milk that have vitamin D though, such as:
*contain 10% or less of a child's daily requirement of vitamin D, whereas a glass of milk has about 25%.
There are vitamin D supplement for older kids who don't get enough vitamin D too.
Children who do not have enough vitamin D usually develop rickets, with bones that don't mineralize properly (they have weak bones). Although once thought to be rare in the United States, rickets is now thought to be a growing problem.
Children may be more at risk for rickets if they are exclusively breastfed, do not like to drink milk, have a milk allergy, have lactose intolerance, or follow a vegan diet (no meat, eggs, or dairy products). This is especially true if these children also have dark skin and/or limited exposure to sunlight, including the proper use of sunscreen. Children with certain chronic diseases, including cystic fibrosis, celiac disease, some liver problems, and kids taking anti-seizure medications may not be able to absorb vitamin D well and can also be at risk for rickets.
Symptoms of rickets can include:
Rickets can be diagnosed by doing blood tests (calcium, phosphorus, alkaline phosphatase, parathyroid hormone levels, and vitamin D levels), x-rays, and looking for a history of poor vitamin D intake and the typical symptoms of rickets.
Sources:
NIH. Office of Dietary Supplements. Dietary Supplement Fact Sheet: vitamin D. Updated 9/9/2008.
AAP Clinical Report. Prevention of Rickets and vitamin D Deficiency. PEDIATRICS Vol. 111 No. 4 April 2003, pp. 908-910.
Bowden, S. A. Prevalence of vitamin D Deficiency and Insufficiency in Children With Osteopenia or Osteoporosis Referred to a Pediatric Metabolic Bone Clinic. Pediatrics, Jun 2008; 121: e1585 - e1590.
Misra, M. Vitamin D Deficiency in Children and Its Management. Pediatrics, Aug 2008; 122: 398 - 417.
AAP Clinical Report. Prevention of Rickets and Vitamin D Deficiency in Infants, Children, and Adolescents. November 2008.
Vitamin D is a very important vitamin that helps children develop strong bones and protects adults from developing osteoporosis (weak bones that break easily).
Unfortunately, vitamin D is naturally found in few foods, with the best sources being fish and cod liver oil. This is unlike most other vitamins and minerals that are much more abundant in the foods we eat.
So then how do we get vitamin D?
The primary source once was sunlight, as ultraviolet rays from the sun can actually help your body form vitamin D on its own.
Although a very efficient process, many experts are concerned that many kids aren't getting enough vitamin D sun exposure anymore, even though you only need about five to fifteen minutes of sunlight exposure two to three times a week.
The problem is that in addition to increased use of sunscreen, which block the UV rays that trigger the production of vitamin D, children with dark skin, who spend a lot of time inside, or who live in areas that don't get a lot of sun exposure, may not get enough vitamin D.
For these kids, food sources of vitamin D or vitamins are necessary to prevent a vitamin D deficiency.
Vitamin D Requirements
Children need a minimum of 400 IU (International Units) of vitamin D each day. Unlike many other nutrients, there is no RDA or recommended dietary allowance for vitamin D, and instead experts talk about an adequate intake (AI) for vitamin D.
A lot of factors influence the AI for vitamin D, and the American Academy of Pediatrics even recommends that some kids may need up to 800 IU of vitamin D each day, including premature babies, infants and children with dark skin, and children who live in areas of the United States above a latitude of 40 degrees.
Surprisingly, that is basically anywhere north of Boulder, Colorado.
Food Sources of Vitamin D
Although few foods naturally have high levels of vitamin D, that doesn't mean that there aren't plenty of foods that your kids can eat to get vitamin D. Many foods are now fortified with vitamin D.
Food sources of vitamin D include:
- Fish, including salmon, mackerel, tuna fish, shrimp, cod, and sardines
- Vitamin D fortified Cow's Milk
- Vitamin D fortified (enriched) Soy Milk and Rice Drinks
- yoo-hoo chocolate drink (a good source of calcium, vitamin D, and sugar)
- Vitamin D fortified margarine
- Vitamin D fortified Tofu
- Breakfast cereals*
- Mushrooms*
- Egg yolks*
- Liver*
- Cheese*
While baby formula is fortified with vitamin D, as long as the baby drinks at least 1 liter (about 33 ounces) a day, breast milk doesn't have enough vitamin D to prevent infants from developing a vitamin D deficiency. That is why experts now recommend that exclusively breastfed infants receive a vitamin D supplement of 400 IU each day (such as 1.0ml of Enfamil D-Vi-Sol). Babies drinking less than 1L of baby formula should also get a vitamin D supplement.
For older kids who aren't breastfeeding or drinking formula anymore, milk is usually the best source of vitamin D. That can be a problem for kids who don't drink milk though. Unfortunately, many foods that parents go to as alternatives to milk, because they are good sources of calcium, like orange juice, ice cream, and yogurt, are not always good sources of vitamin D.
If you check food labels and look for certain brands, you can find plenty of foods besides milk that have vitamin D though, such as:
- Minute Maid Kids+ Orange Juice
- Tropicana Pure Premium Calcium + vitamin D
- Tropicana Pure Premium Healthy Kids
- YoKids Yogurt from Stonyfields Farms
- YoKids Squeezers from Stonyfields Farms*
- Yoplait and Yoplait Kids Yogurt
- Jell-O Cook & Serve Pudding & Pie Filling (made with vitamin D fortified Milk)
- Shedd's Spread Country Crock Plus Calcium & Vitamins
- Kraft Singles American 2% Milk Slices*
*contain 10% or less of a child's daily requirement of vitamin D, whereas a glass of milk has about 25%.
There are vitamin D supplement for older kids who don't get enough vitamin D too.
Vitamin D Deficiency
Children who do not have enough vitamin D usually develop rickets, with bones that don't mineralize properly (they have weak bones). Although once thought to be rare in the United States, rickets is now thought to be a growing problem.
Children may be more at risk for rickets if they are exclusively breastfed, do not like to drink milk, have a milk allergy, have lactose intolerance, or follow a vegan diet (no meat, eggs, or dairy products). This is especially true if these children also have dark skin and/or limited exposure to sunlight, including the proper use of sunscreen. Children with certain chronic diseases, including cystic fibrosis, celiac disease, some liver problems, and kids taking anti-seizure medications may not be able to absorb vitamin D well and can also be at risk for rickets.
Symptoms of rickets can include:
- bone pain
- bowlegs
- skeletal deformities
- increased risk of fractures
- tooth deformities
- short stature
- poor weight gain
- muscle weakness and poor muscle tone
Rickets can be diagnosed by doing blood tests (calcium, phosphorus, alkaline phosphatase, parathyroid hormone levels, and vitamin D levels), x-rays, and looking for a history of poor vitamin D intake and the typical symptoms of rickets.
What You Need To Know
- There have been at least 228 cases of rickets in the United States since 1986.
- Avoiding rickets and trying to boost your child's vitamin D levels is not a good reason to stop using sunscreen. The risks of unprotected sun exposure, including sun burns and sun cancer, are too great.
- A referral to a pediatric endocrinologist can be helpful if your child has rickets.
Sources:
NIH. Office of Dietary Supplements. Dietary Supplement Fact Sheet: vitamin D. Updated 9/9/2008.
AAP Clinical Report. Prevention of Rickets and vitamin D Deficiency. PEDIATRICS Vol. 111 No. 4 April 2003, pp. 908-910.
Bowden, S. A. Prevalence of vitamin D Deficiency and Insufficiency in Children With Osteopenia or Osteoporosis Referred to a Pediatric Metabolic Bone Clinic. Pediatrics, Jun 2008; 121: e1585 - e1590.
Misra, M. Vitamin D Deficiency in Children and Its Management. Pediatrics, Aug 2008; 122: 398 - 417.
AAP Clinical Report. Prevention of Rickets and Vitamin D Deficiency in Infants, Children, and Adolescents. November 2008.