Vitamin D and children

"Vitamin D? It is undoubtedly one of the fundamental pillars for the solid development of the child, from birth to adolescence "

. Word of Giuseppe DiMauro, family pediatrician and president of the Del Paesena Society of Preventive and Social Pediatrics (Sipps). So fundamental that in many situations it is recommended to supplement it with supplements specific. Also because obtaining it at adequate levels with power alone or with exposure to sunlight (the main source) is not always taken for granted.

What is vitamin D used for?

It is called vitamin D and one immediately thinks of it bone health. In fact, it is a fundamental vitamin for the growth and development of bone mass, from fetal life onwards: an effect that vitamin D exerts in particular through its action on metabolism of calcium and phosphorus, but also, more indirectly, by stimulating it muscle development.

It is no coincidence that it is an alteration in bone growth - the rickets - the main manifestation of significant deficiencies of this vitamin, characterized by mineralization problems and consequent deformities. Even if it is a condition considered outdated at least in industrialized countries, it is actually still widely present in various areas of the world. Furthermore, even in the richest countries it has not completely disappeared, and may particularly affect children of migrants or those from international adoptions.

Building solid bones during childhood and adolescence is not only important to reduce the risk of bone fragility and rickets at these times in life, but also to ensure long-term skeletal health. "The prevention ofOsteoporosis it starts from very young, and that is why it is very important to have good levels of vitamin D in this age group "underlines the pediatrician Alberto Ferrando, president of the Association of Ligurian pediatricians.

But that is not all. "In recent years - explains Di Mauro - it has become increasingly evident that vitamin D works like a real one hormone capable of regulating other functions of the organism and in particular various ones activity of the immune system and respiratory system functionality".

Indeed, some studies have pointed out that there is an association between low vitamin D levels and the frequency or severity of respiratory infections, allergic asthma and other allergic conditions. Although it is still early to draw operational conclusions from these studies, these are still important observations, which will need to be better investigated with targeted studies.

Read also: 10 tips to strengthen the immune defenses of children

Vitamin D, where it is found

The main source of vitamin D is endogenous, in the sense that we produce it ourselves in the skin following theexposure to the sun.

In practice, when we are in the sun, exposed to UVB rays, the absorption of these rays involves the transformation of a substance normally present in the skin into a precursor of vitamin D, which in turn is quickly transformed into a real vitamin.

In theory, it is said that it is enough to expose the face, hands and arms to the Sun for 15-20 minutes a day (or at least three times a week) to produce a sufficient quantity of vitamin D. But be careful, in reality the efficiency of this process can be hindered in various ways by various factors, including:

• la geographical latitude. For example, the sunlight to which we can be exposed in the city is, on average, different from that to which we can be exposed in the Po Valley;
• la season. In our latitudes in autumn and winter there is obviously less sun than in spring and summer;
• whether to use or not sun protection. Protective creams are very important to avoid skin damage, but at the same time reduce the possibility of vitamin production;
• the level of skin pigmentation. Lighter skins are more efficient in terms of vitamin D synthesis than darker ones;
• habits in terms of clothing. Cultures and religious traditions that involve very opaque clothes and veils limit the possibility of exposing oneself to light;
• pollution. When the atmosphere is polluted, UVB rays are further blocked, and with them the skin's production of vitamin D.

Read also: Sun creams, everything you need to know

Le food sources they are all in all rather limited: even in the best of hypotheses it is difficult to reach half the daily requirement of vitamin D with the diet alone. In any case, the foods that are richer in it are:

• some fish like blue fish (mackerel, sardines, herring) and salmon;
• fish oil;
• dairy product (especially butter, yogurt and cheeses);
• egg yolk;
• liver.

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Vitamin D, in which foods it is found

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Vitamin D is essential in various stages of life and is so important that supplementation with specific supplements is often recommended. Obviously the sources ...

How much do the children need

According to the latest indications of the Del Paesena Society of human nutrition, issued in 2022, the daily requirement of vitamin D is equal to:

• 400 IU (international units) for children under 12 months;
• 600 IU for later age groups.

They are quantities in accordance with the recommendations of other international scientific and health organizations, such as the World Society of Endocrinology, which speaks of 400-1000 IU under 12 months and 600-1000 IU over the year and in adolescence.

However, it is difficult to really reach these levels. Various population studies conducted among Del Paeseni children and adolescents, for example, have shown that Vitamin D deficiency is quite common and it affects more than one in two children and almost eight out of ten adolescents, also due to the tendency to do things little outdoor life, preferring indoor hobbies and activities instead, even in extra-school hours.

Read also: Get them out! Because at the nursery and nursery, children should be out every day, even in winter

When a supplement is needed in children

We said it: vitamin D is very important for the development of the child, in particular for his skeleton, but not only. Ensuring an adequate supply is essential for one balanced growth.

This is why there are particular moments and situations in life in which the supplementation with a supplement. Let's see which ones, taking as reference a consent document published by Del Paesena Society of Preventive and Social Pediatrics in collaboration with the Del Paesena Society of Paediatrics and the Federation of Paesena pediatricians. In addition to presenting its own indications, the document takes stock of those proposed by the international scientific community.

Children up to one year of age

For babies who are breastfed, there is no doubt: given that they are generally not very exposed to the sun and that breast milk contains low levels of vitamin D (especially if the mother is deficient), supplementation is considered essential to guarantee a nutritional level. optimal e prevent the risk of rickets.

Both nationally and internationally, the administration of 400 IU of vitamin D per day for all breastfed full term infants. The position is somewhat more nuanced compared to children who take artificial milk: it is true that the formulas contain vitamin D, but at levels that do not guarantee an adequate intake of this substance unless a certain amount is taken. The estimate is about one liter per day, which certainly does not occur in the first weeks of life, nor after the introduction of complementary nutrition. For this, the Del Paeseno document recommends supplementation with 400 IU per day of vitamin D even for bottle-fed babies.

For the premature babies, instead, there is a few more distinctions: the recommendation is 200-400 IU per day for children under 1500 grams in weight and 400-800 IU per day for children over 1500 grams.

Children over one year and adolescents: risk of vitamin D deficiency?

The first thing to say is that there may be particular situations that represent a specific risk of vitamin D deficiency. For instance:

• dark-colored skin;
• obesity;
• vegan diet;
• diseases that involve abnormalities in the absorption of vitamin D, such as kidney or liver disease, cystic fibrosis, chronic intestinal diseases;
• Assumption of medicines that hinder the absorption of vitamin D (antiepileptics, some antifungals, systemic glucorticoids, antiretroviral therapy for HIV);

In all these cases, the international indication is to administer a daily supplement of vitamin D, at the dosage of 600-1000UI. Alternatively, if there is a risk that the vitamin is not taken every day (this can happen with adolescents, who are often refractory to follow therapies continuously), higher doses may be preferred once a week or every day. month.

Read also: From pediatrician to family doctor, 4 tips for a peaceful transition

What if there aren't such glaring risk factors? In this case the experts remember first the importance of lifestyle, insisting on healthy and proper nutrition and life in the open air. Secondly, the pediatrician will decide, on a case by case basis, whether or not supplementation is needed.

“To decide it, you don't necessarily need to make some blood tests to measure the levels of vitamin D ”, explains Di Mauro. “These are only recommended if there are multiple risk factors for a deficiency. Otherwise, it is sufficient to evaluate together with the child or youngster and his family what kind of life he leads, how much time he spends outdoors, in what conditions (if completely covered, if protected with sunscreen or not) what he eats and so on ".

Also in consideration of the fact that the studies conducted so far show a fairly high frequency of deficiency in the population, the recommendation of Del Paeseni pediatricians is in any case to administer a supplement with 600 IU of vitamin D per day in the autumn and winter months (from November to April) for all children who have limited exposure to sunlight even in the summer months.

Sources for this article: consensus document by Sipps, Sip and Fimp published in Del Paesen Journal of Pediatrics, 2022; American Pediatricians Association recommendations; global consensus document on recommendations for the prevention and management of rickets.

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• supplements
• Vitamins