Vitamin D is an important nutrient that helps the body build strong bones and teeth. Maintaining an adequate level of Vitamin D is important for all stages of life. It is especially important for children while their bones and teeth are developing. ⁽¹⁾ Vitamin D is sometimes called the “sunshine vitamin.” That’s because the body creates its own Vitamin D when exposed to sunlight ⁽¹⁾. Children and adults obtain Vitamin D through exposure to ultraviolet B sunlight. As little as 10 to 15 minutes of direct sunlight can generate 10,000 to 20,000 IU of Vitamin D. Many factors influence Vitamin D synthesis, such as skin pigmentation, latitude, and amount of skin exposed, making it difficult to assess how much Vitamin D will be converted from sunlight exposure. Infants and children who have darker pigmentation require five to ten times the length of sunlight exposure to reach the same levels of Vitamin D when compared with children who have lighter pigmentation. ⁽²⁾ Less than 10% of Vitamin D is acquired from a diet. Most people get very little Vitamin D from the food they consume. That’s because there are very few foods that contain Vitamin D. Food that naturally contains Vitamin D includes fatty fish, fish oil, eggs, cheese, and butter. There are also foods and drinks that have been fortified with Vitamin D, such as toddler adapted milk, milk alternatives, some brands of orange juice, and some vitamin-fortified breakfast cereals. ⁽¹⁾ In October 2014, the American Academy of Pediatrics (AAP) responded by increasing the amount of Vitamin D it recommends for children and adolescents. According the AAP clinical report, Optimizing Bone Health in Children and Adolescents, children and adolescents require 600 IU per day. ⁽³⁾ A low level of Vitamin D in the body is referred to as a “Vitamin D Deficiency.” The reference range for Vitamin D has changed recently to be in line with international guidelines. The local recommendation is for children to have a serum Vitamin D of more than 50nmoll-1. • Normal: >50nmoll-1 • Insufficiency: 30-50 nmoll-1 • Deficiency: <30nmoll-1 ⁽⁴⁾ Children might be at risk of Vitamin D Deficiency if they: ⁽³⁾• Keep their skin covered • Spend most of their time indoors and don’t get exposed to sunshine • Have a condition affecting how the body controls Vitamin D levels – for example, liver disease, kidney disease, conditions that cause problems with absorbing food (like coeliac disease or cystic fibrosis), and some medicines can affect vitamin D levels • Have darker skin • Have been breastfed for a long time and have a mother whose Vitamin D is low Many people with low levels of Vitamin D do not have symptoms, but some children with low Vitamin D get bone and muscle pain. Very low Vitamin D can lead to soft bones, causing rickets in children and a condition called osteomalacia in adolescents and adults. Rickets* only occurs when children are growing – if a child has softer bones from low Vitamin D, the bones can bend and cause 'bow legs' or 'knock knees', as well as other changes. ⁽⁴⁾ Low Vitamin D can cause low calcium, which can lead to muscle cramps in children. Low calcium can also cause seizures (convulsions or fits), particularly in young babies. ⁽¹⁾ So Vitamin D deficiency can delay a child’s growth and it can lead to cavities and problems with teeth structure. Children who don’t get enough vitamin D are at a high risk for rickets. ⁽¹⁾ (Rickets is a disorder that affects the bones. It is a condition of softening of the bones that occurs in growing children. It happens when the bones cannot take up enough calcium and phosphorus to make hard, healthy bone. Although there are genetic and metabolic causes of rickets, the most common cause is a lack of Vitamin D. This is also called Nutritional Rickets.) Dr. Mohamad ZBIB Pediatric Allergist 1. https://familydoctor.org/vitamin-d/Copyright © American Academy of Family Physicians Last Updated: July 31, 2020 2. https://www.aafp.org/afp/2010/0315/p745.htmlCATHERINE F. CASEY, MD; DAVID C. SLAWSON, MD; and LINDSEY R. NEAL, MD, University of Virginia Medical Center, Charlottesville, Virginia Am Fam Physician. 2010 Mar 15;81(6):745-748. 3. https://www.healthychildren.org/English/healthy-living/nutrition/Pages/Vitamin-D-On-the-Double 4. National institute of health (USA) Vitamin D for professionals fact sheet 5. http://pediatrics.aappublications.org/cgi/reprint/122/5/1142 Pediatrics, November 2008 (correction published in January 2009 issue) 6. J Pediatr Pharmacol Ther. 2013 Oct-Dec; 18(4): 277–291.doi: 10.5863/1551-6776-18.4.277 Bledina is not the author of this article, as it has been written by Dr Mohammad ZBIB who is the owner of the content.

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