In Focus: Vitamin D
We recently started working with paediatric dietitian Bianca Parau: she offers expert advice and nutritional guidance to children and their families. She started her career in South-Africa, after graduating from the University of the Free State. Since relocating to the United Kingdom she's worked at various NHS hospitals and health centres across the country. In addition to private consultations, Bianca does consultancy work, she is a spokesperson for nutrition related topics and she writes peer reviews as well as articles for various publications. Her NHS clinical role at Chelsea & Westminster Hospital includes a specialist multidisciplinary Feeding Clinic, for children with eating problems often resulting from a history of gastrointestinal problems and food allergy.
I am so excited that Bianca will be contributing some brilliant content for the Mimi's bowl blog and feeds. This week we are talking Vitamin D and it's importance in young children:
Vitamin D plays an important role at every stage of life, but especially during periods of rapid growth seen in infants and teenagers as well as during pregnancy and breastfeeding.This fat soluble vitamin is actually a hormone that is essential for healthy bones, muscles and teeth as it regulates the amount of calcium in our blood. It also has a powerful effect on our immune systems.
Vitamin D deficiency is common in childhood, especially in infants that are exclusively breastfed beyond 6 months of age (particularly where the maternal vitamin D stores are insufficient) and where babies have not yet been established on a wide range of solid foods. Older children who have poor dietary intakes and / or limited exposure to sunlight are also at risk.
Vitamin D is available in small quantities of certain foods or from the sun. But, dietary sources of vitamin D are limited. Vitamin D is naturally found in oily fish and eggs, but the amounts are small. There are a couple of foods that are fortified with small amounts of vitamin D; e.g. some yoghurts and breakfast cereals and all infant formula milks, but it is worth mentioning that plain cow’s milk is not fortified with vitamin D in the UK and in general breast milk contains little Vitamin D (unless the maternal diet is supplemented).
Sunlight is the best natural source of vitamin D, especially as it is impractical to get sufficient amounts of vitamin D from the food we eat. Vitamin D is made in our skin when we are exposed to sunlight but only during periods and seasons where the sun is high in the sky. In the UK, it is not possible for everyone to get enough vitamin D through sunlight exposure alone, especially during the winter months (October and March).
Vitamin D also has a close relationship with calcium and although sunshine is the best source of Vitamin D, diet remains the best source of calcium. Extra care should be taken to prevent Vitamin D deficiency in children with limited dietary calcium intakes. Children with allergies or fussy diets, are often at an increased at risk of developing Rickets due to a calcium and or Vitamin D deficiency.
The risk factors for vitamin D deficiency in infants and children include:
- Infants who are exclusively breastfed for longer than 6 months and where weaning onto complimentary food is delayed (even more so in maternal vitamin D deficiency)
- Pigmented skin
- Poor dietary intakes with fussy eaters
- Limited sunlight exposure in older children and adolescents
- Children with disabilities (which limits their time spent outside)
- Children taking anticonvulsant treatment
- Seasonal changes in sunlight potency, latitude and pollution levels
- Clothing and the use of sunscreen
The Department of Health currently recommends vitamin supplementation (including vitamin D) in the following at-risk groups;
- All breastfed infants from 6 months of age
- Breastfed infants from 1 month of age if there is any doubt about the maternal vitamin D status during and after pregnancy
- Infants older than 6 months that is formula fed and taking less than 500ml of formula milk per day
- All children between 1 year ad 5 years old
- Infants or children previously treated for Ricketts or a vitamin D deficiency
- Fussy eaters or children on restricted diets
- Children of Asian, African, Afro-Caribbean and Middle Eastern origin
- Any child with limited exposure to sunlight i.e. covered skin due to cultural reasons or where they confined indoors for extended periods.
- As maternal vitamin D deficiency during pregnancy and breastfeeding is the leading cause of vitamin D deficiency in their infants, all mothers should take a vitamin D supplement throughout pregnancy and whilst breastfeeding.
There are two types of Vitamin D:
- Ergocalciferol (Vitamin D2) a plant product and
- Colecalciferol (Vitamin D3) obtained from fish or mammals.
Both Vitamin D2 and D3 are equally effective. Most vitamin D3 sources are acceptable to vegetarians and those adhering to a Halal or Kosher diets as the main commercial source is Lanolin.
Based on the current available evidence, the recommended dose for:
- Healthy term babies, children and teenagers is 400 units
- Pregnant and breastfeeding mothers should also take 400 units daily
- Breastfeeding mothers that are not taking any supplements (or is known to have a deficiency), should start their babies on Vitamin D supplements soon after birth
- Healthy term babies, born to a mother who is taking appropriate prenatal and or breastfeeding supplements can wait until one month of age before starting supplements. The recommended dose for babies is 300 – 400 units daily. For easy conversion; a dose of 10 micrograms of Vitamin D is equal to 400 units
When purchasing a vitamin and mineral supplement, always check the individual product label for suitability or ask your pharmacist. It is also advised to raise any allergy concerns when purchasing a vitamin and mineral supplement to avoid any adverse reactions.