Optimizing Bone Health in Children and Adolescents
Pediatrics, Clinical Report Published online September 29, 2014
From the American Academy of Pediatrics
Neville H. Golden, MD, Steven A. Abrams, MD, COMMITTEE ON NUTRITION
VitaminDWiki: What paper should have said
- Vitamin D3 is far better than D2
D2 has been shown many times to DECREASE levels of D3 in the blood
D2 has been banned for use in mammals by vets for over a decade
D2 is OK for rodents (initial research), but not for mammals (research from recent decades)
98% of US cow milk is fortified with vitamin D – but unfortunately it is often D2, not D3
Note: There are many sources of vegan D3
Note: D3 has been available for prescription in the US since about 2009 - RDA for vitamin D should be proportional to weight
Note: As the child increases in weight
Calcium RDA for increases 650% (200 == 1300 mg)
Vitamin D needs increase only 50% (400 ==> 600 IU - to age 65!)
Many international groups recommend increasing vitamin D with weight – especially if obese
– but the US IoM and this paper do not acknowledge the increased need with increased weight - Cost-effective to supplement children with vitamin D
Paper stated that not cost effective to test unless child already has bone problems
Paper ignores the possibility of supplementing those at high risk
Obese
dark skin
shut-in,39 items
future/past surger or long hospitalization124 items
avoid the sun (the doctor can see very light skin)
live far from the equator (e.g. Alaska for the US)124 items
wear concealing clothing
tender shinbone, etc
Infant had been premature or had low birth weight- Vitamin D is important to non-bone portions of the body too
Examples of proof of vitamin D intervention with children include
T1 Diabetes, Influenza, Respiratory tract infections, TB, Congestive Heart Failure, Asthma
Expect proof soon that the huge increases in some child health problems relate to low vit D
Obesity, Autism, Concussions, Peanut allergy, Bipolar disorder, Chronic disease- Vitamin D is important during pregnancy
Pregnancy was outside of the scope of the paper- Exercise outdoors in the sun is far better than indoor exercise
Paper ignored difference between outdoor and indoor exercise- Magnesium, etc. is also important for bone health – not just Calcium and Vitamin D
- Should decrease Caclum intake as vitamin D levels exceed 20 ng
This paper continues the mistake made by the Institute of Medicine in 2010- Infants do not tolerate some brands of Vitamin D – additives, color, etc no mention in this paper
- Infants probably need 1,600 IU, not just 400
Download the PDF from VitaminDWiki.
ABSTRACT
The pediatrician plays a major role in helping optimize bone health in children and adolescents. This clinical report reviews normal bone acquisition in infants, children, and adolescents and discusses factors affecting bone health in this age group. Previous recommended daily allowances for calcium and vitamin D are updated, and clinical guidance is provided regarding weight-bearing activities and recommendations for calcium and vitamin D intake and supplementation. Routine calcium supplementation is not recommended for healthy children and adolescents, but increased dietary intake to meet daily requirements is encouraged. The American Academy of Pediatrics endorses the higher recommended dietary allowances for vitamin D advised by the Institute of Medicine and supports testing for vitamin D deficiency in children and adolescents with conditions associated with increased bone fragility. Universal screening for vitamin D deficiency is not routinely recommended in healthy children or in children with dark skin or obesity because there is insufficient evidence of the cost–benefit of such a practice in reducing fracture risk. The preferred test to assess bone health is dual-energy x-ray absorptiometry, but caution is advised when interpreting results in children and adolescents who may not yet have achieved peak bone mass. For analyses, z scores should be used instead of T scores, and corrections should be made for size. Office-based strategies for the pediatrician to optimize bone health are provided. This clinical report has been endorsed by American Bone Health.
See also VitaminDWiki
- Bone - Health
- Infant-Child
- Vitamin D (40-70 ng) in Children’s Health – review Sept 2014
- Primate Nutrient Requirements – 2003 US Govt
(Note: 11 years ago the US govt declared that ALL primates must have D3, but not D2: are humans not primates?) - Several papers on Vitamin D for critically ill children in Journal of Pediatrics – Aug 2012
This earlier paper, in a Pediatrics journal, was not even referenced.
Perhaps because it disagreed with the current authors - saying that vitamin D screening was needed sometimes - Recommend 100 IU of vitamin D per kg of infant weight in Poland – July 2011 which has the following
- The Red line is the average weight of children at that age.
- This article recommends this amount up to age 12 months, others recommend it for up to age 12 years
The TOP articles in Infant-Child and Vitamin D are listed here:
- COVID 5.5 X more likely to be severe if low Vitamin D (children in this case) – Oct 2022
- COVID children helped by Vitamin D, trial terminated: unethical to not give Vitamin D to all: – RCT July 2022
- Vitamin D levels in new borns are so low that they are considering supplementing to prevent Rickets (Japan) – July 2022
- Problems after childhood vaccinations - many studies
- Remdesivir approved to treat COVID in Infants, yet Vitamin D is 3000 X more cost effective and widely used - April 2022
- High-dose Vitamin D safe for children (10,000 IU daily, 600,000 IU bolus) – meta-analysis April 2022
- 16,000 Physicians and Scientists Agree Kids Shouldn’t Get COVID Vaccine - Dec 15, 2021
- Childhood cancers – give Vitamin D loading dose if low – Oct 2021
- 36X more likely for an infant to be low vitamin D if exclusively breastfed (Hong Kong) – March 2021
- Vitamin D loading dose was as effective as daily dosing (rickets in this case) – RCT July 2021
- Vitamin D toxicity is extremely rare, accidental, and very mild in Iranian children – July 2020
- Breastfeeding a child without adding vitamin D increases risk of many food allergies (egg whites in this case) – Jan 2020
- Vitamin D compliance 3X higher when children with fractures actually knew their low vitamin D level – March 2019
- Vitamin D levels have been crashing since 1995 (Polish Children, Elite Military, etc)
- Infant Vitamin D – JAMA said 1600 IU, Europe says 1,000 IU upper limit – June 2018
- Children no longer get much vitamin D from milk - fortify at home
- 10 Reasons why children no longer have healthy levels of Vitamin D
- Only 1 in 6 infants got even 400 IU of vitamin D daily – June 2018
- Vitamin D supplementation by only 1 in 60 US Children – JAMA June 2018
- Adding Vitamin D, Omega-3, etc to children’s milk improved memory (yet again) – RCT June 2018
- Child Asthma increased 2.1 X by antibiotics, Child milk allergy increased 4.4 X by PPI – April 2018
- Growth Hormone treatment raised vitamin D levels by 16 ng – 2018
- Major increases in childhood health problems
- Micronutrients (such as Vitamin D) for critically ill children – review Oct 2017
- Vitamin D guidelines of American Academy of Pediatrics said none should be even tested, yet 91 percent had less than 30 ng – June 2017
- Five times less mite allergy when vitamin D added in mid pregnancy and to infant – RCT April 2016
- Obese children – 71 percent had low vitamin D– Jan 2016
- Bone fractures in children requiring surgery were 55X more likely with low vitamin D – June 2015
- 3X more kids were vitamin D deficient when entering UK hospitals than 4 years before – Oct 2014
- Preschool children with low vitamin D visited their doctor more often – April 2014
- 5 out of 6 children who died in pediatric critical care unit had low vitamin D – May 2014
- Fewer pre-infants were vitamin D deficient when they got 800 IU – RCT Feb 2014
- The Vitamin Deficiency Signs That Can Send You to Prison – Feb 2014
- Severe tooth decay in children unless supplemented with Vitamin D drops – Oct 2013
- Presentation: pre and post natal vitamin D, with audience comments – Manchester UK Sept 2013
- 100,000 IU of vitamin D every 90 days was not frequent enough to prevent Diarrhea – Sept 2013
- Most European infants get vitamin D supplements, vs only 1 in 50 in US – June 2013
- Breastfed infants: 90 percent had less than 20 ng of vitamin D, formula-fed: 15 percent – May 2013
- Group is giving only 200 IU of Vitamin D to 70 million women and children to prevent Rickets
- Middle ear infection (Otitis Media) and Vitamin D – many studies
- Third study found that Infants needed 1600 IU of vitamin D – JAMA RCT May 2013
- 75 percent of unexplained sudden infant deaths had inadequate level of vitamin D – April 2013
- Half of children with chronic illness had low levels of vitamin D – April 2013
- Symptoms of vitamin D deficiency vary with the age of the child – Feb 2013
- Vitamin D DRI for children lowered to 200 IU in Korea – Jan 2013
- Metabolic Syndrome in children is associated with low vitamin D – review Jan 2013
- UVB added in classroom reduced cavities, increased height, increased academics. etc
- Vitamin D Deficiency is a Strong Predictor (4X) of Asthma in Children – Oct 2012
- Early Puberty if low vitamin D - many studies
- Infants born early had low vitamin D levels – Oct 2012
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