This is the current release of the guideline.

American Academy of Pediatrics (AAP) Policies are reviewed every 3 years by the authoring body, at which time a recommendation is made that the policy be retired, revised, or reaffirmed without change. Until the Board of Directors approves a revision or reaffirmation, or retires a statement, the current policy remains in effect.

Rickets and vitamin D deficiency

Prevention

Family Practice
Nutrition
Pediatrics

Physicians

To provide recommendations for the prevention of rickets and vitamin D deficiency in infants and children

Infants and children

Vitamin D supplements

Rates of rickets and vitamin D deficiency

Searches of Electronic Databases

Not stated

Not stated

Not stated

Not applicable

Review

Not stated

Expert Consensus

Not stated

Not applicable

A formal cost analysis was not performed and published cost analyses were not reviewed.

Peer Review

Not stated

To prevent rickets and vitamin D deficiency in healthy infants and children and acknowledging that adequate sunlight exposure is difficult to determine, we reaffirm the adequate intake of 200 IU per day of vitamin D by the National Academy of Sciences and recommend a supplement of 200 IU per day for the following:

1. All breastfed infants unless they are weaned to at least 500 mL per day of vitamin D-fortified formula or milk.
2. All nonbreastfed infants who are ingesting less than 500 mL per day of vitamin D-fortified formula or milk.
3. Children and adolescents who do not get regular sunlight exposure, do not ingest at least 500 mL per day of vitamin D-fortified milk, or do not take a daily multivitamin supplement containing at least 200 IU of vitamin D.

None provided

The type of supporting evidence is not specifically stated for each recommendation.

These new vitamin D intake guidelines for healthy infants and children are based on the recommendations of the National Academy of Sciences: Institute of Medicine, Food and Nutrition Board, Standing Committee on the Scientific Evaluation of Dietary Reference Intakes. Vitamin D. In: Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride. Washington, DC: National Academy Press; 1997:250-287.

The new National Academy of Sciences (NAS) guidelines for infants are based on data primarily from the United States, Norway, and China, which show that an intake of at least 200 IU per day of vitamin D will prevent physical signs of vitamin D deficiency and maintain serum 25-hydroxyvitamin D at or above 27.5 nmol/L (11 ng/mL).

Populations at increased risk of developing rickets and vitamin D deficiency include those with increased skin pigmentation and decreased sunlight exposure.

Not stated

The guidance in this report does not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstance, may be appropriate.

An implementation strategy was not provided.

Staying Healthy

Effectiveness

2003 Apr

American Academy of Pediatrics - Medical Specialty Society

American Academy of Pediatrics

Committee on Nutrition, Section on Breastfeeding

Section on Breastfeeding, 2002-2003: Lawrence M. Gartner, MD (Chairperson); Linda S. Black, MD; Ruth A. Lawrence, MD; Audrey J. Naylor, MD, DrPH; Donna O’Hare, MD; Richard J. Schanler, MD

Arthur I. Eidelman, MD (Policy Committee Chairperson)

Liaisons: Alice Lenihan, MPH, RD, LDN; John Queenan, MD

Staff: Betty Crase, IBCLC

Committee on Nutrition, 2002-2003: Nancy F. Krebs, MD (Chairperson); Robert D. Baker, Jr, MD, PhD; Frank R. Greer, MD; Melvin B. Heyman, MD; Tom Jaksic, MD, PhD; Fima Lifshitz, MD

Liaisons: Donna Blum-Kemelor, MS, RD; Margaret Patricia Boland, MD; William Dietz, MD, PhD; Van S. Hubbard, MD, PhD; Elizabeth Yetley, PhD

Consultant: Susan Baker, MD, PhD

Staff: Pamela Kanda, MPH

Not stated

This is the current release of the guideline.

American Academy of Pediatrics (AAP) Policies are reviewed every 3 years by the authoring body, at which time a recommendation is made that the policy be retired, revised, or reaffirmed without change. Until the Board of Directors approves a revision or reaffirmation, or retires a statement, the current policy remains in effect.

None available

None available

This NGC summary was completed by ECRI on August 18, 2003. The information was verified by the guideline developer on September 8, 2003.

This NGC summary is based on the original guideline, which is subject to the guideline developer's copyright restrictions. Please contact the Permissions Editor, American Academy of Pediatrics (AAP), 141 Northwest Point Blvd, Elk Grove Village, IL 60007.