This is the current release of the guideline.

This guideline updates a previous version: Gartner LM, Greer FR, American Academy of Pediatrics, Section on Breastfeeding and Committee on Nutrition. Prevention of rickets and vitamin D deficiency: new guidelines for vitamin D intake. Pediatrics 2003 Apr;111(4 Pt 1):908-10. [20 references]

All clinical reports and policy statements from the American Academy of Pediatrics automatically expire 5 years after publication unless reaffirmed, revised, or retired at or before that time.

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, children, and adolescents

Infants, children, and adolescents

Vitamin D supplements

Rates of rickets and vitamin D deficiency

Searches of Electronic Databases

The Clinical Report, "Prevention of rickets and vitamin D deficiency: new guidelines for vitamin D intake" was based on a literature search including new references since the American Academy of Pediatrics (AAP) 2003 statement on this subject. Various sources were used including a PubMed search, reference list of related studies, reviews, editorials and a recent systematic review from the Agency for Healthcare Research and Quality (AHRQ) "Effectiveness & Safety of Vitamin D" in which one of the authors of the AAP clinical report participated. No specific inclusion/exclusion criteria were used for the literature report for this clinical report. Search terms included vitamin D, 25-hydroxy vitamin D, children, pediatric and were designed to identify appropriate observational studies, clinical trials, meta-analysis, and systemic reviews.

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, children, and adolescents, a vitamin D intake of at least 400 IU/day is recommended. To meet this intake requirement, American Academy of Pediatrics (AAP) makes the following suggestions:

1. Breastfed and partially breastfed infants should be supplemented with 400 IU/day of vitamin D beginning in the first few days of life. Supplementation should be continued unless the infant is weaned to at least 1 L/day or 1 qt/day of vitamin D–fortified formula or whole milk. Whole milk should not be used until after 12 months of age. In those children between 12 months and 2 years of age for whom overweight or obesity is a concern or who have a family history of obesity, dyslipidemia, or cardiovascular disease, the use of reduced-fat milk would be appropriate (Daniels & Greer, 2008).
2. All nonbreastfed infants, as well as older children who are ingesting < 1000 mL/day of vitamin D–fortified formula or milk, should receive a vitamin D supplement of 400 IU/day. Other dietary sources of vitamin D, such as fortified foods, may be included in the daily intake of each child.
3. Adolescents who do not obtain 400 IU of vitamin D per day through vitamin D–fortified milk (100 IU per 8-oz serving) and vitamin D–fortified foods (such as fortified cereals and eggs [yolks]) should receive a vitamin D supplement of 400 IU/day.
4. On the basis of the available evidence, serum 25-hydroxyvitamin D (25-OH-D) concentrations in infants and children should be > 50 nmol/L (20 ng/mL).
5. Children with increased risk of vitamin D deficiency, such as those with chronic fat malabsorption and those chronically taking antiseizure medications, may continue to be vitamin D deficient despite an intake of 400 IU/day. Higher doses of vitamin D supplementation may be necessary to achieve normal vitamin D status in these children, and this status should be determined with laboratory tests (e.g., for serum 25-OH-D and parathyroid hormone (PTH) concentrations and measures of bone-mineral status). If a vitamin D supplement is prescribed, 25-OH-D levels should be repeated at 3-month intervals until normal levels have been achieved. PTH and bone-mineral status should be monitored every 6 months until they have normalized.
6. Pediatricians and other health care professionals should strive to make vitamin D supplements readily available to all children within their community, especially for those children most at risk.

None provided

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

These revised guidelines for vitamin D intake for healthy infants, children, and adolescents are based on evidence from new clinical trials and the historical precedence of safely giving 400 IU of vitamin D per day in the pediatric and adolescent population.

Appropriate prevention of rickets and vitamin D deficiency in healthy infants, children, and adolescents

Some forms of vitamin D contain 400 IU per drop, but such preparations must be prescribed with caution; explicit instruction and demonstration of use are essential because of the greater potential for a vitamin D overdose if several drops are administered at once.

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 circumstances, may be appropriate.

An implementation strategy was not provided.

Staying Healthy

Effectiveness

Not applicable: The guideline was not adapted from another source.

2003 Apr (revised 2008 Nov)

American Academy of Pediatrics - Medical Specialty Society

American Academy of Pediatrics

Section on Breastfeeding

Committee on Nutrition

Committee on Nutrition, 2007-2008: *Frank R. Greer, MD, Chairperson; Jatinder J. S. Bhatia, MD; Stephen R. Daniels, MD, PhD; Marcie B. Schneider, MD; Janet Silverstein, MD; Nicolas Stettler, MD, MSCE; Dan W. Thomas, MD

Liaisons: Donna Blum-Kemelor, MS, RD, US Department of Agriculture; Laurence Grummer-Strawn, PhD, Centers for Disease Control and Prevention; Rear Admiral Van S. Hubbard, MD, PhD, National Institutes of Health; Valerie Marchand, MD, Canadian Paediatric Society; Benson M. Silverman, MD, US Food and Drug Administration

Staff: Debra L. Burrowes, MHA

Section on Breastfeeding Executive Committee, 2007-2008: Arthur J. Eidelman, MD, Policy Committee Chairperson; Ruth A. Lawrence, MD, Chairperson; Lori B. Feldman-Winter, MD; Jane A. Morton, MD; Audrey J. Naylor, MD, DrPH; Lawrence M. Noble, MD; Laura R. Viehmann, MD; *Carol L. Wagner, MD

Liaisons: Jatinder J. S. Bhatia, MD, Committee on Nutrition; Alice Lenihan, MPH, RD, LDN, National Association of WIC Directors; Sharon Mass, MD, American College of Obstetrics and Gynecology; Julie Wood, MD, American Academy of Family Physicians

Staff: Lauren Barone, MPH

*Lead Authors

Not stated

This is the current release of the guideline.

This guideline updates a previous version: Gartner LM, Greer FR, American Academy of Pediatrics, Section on Breastfeeding and Committee on Nutrition. Prevention of rickets and vitamin D deficiency: new guidelines for vitamin D intake. Pediatrics 2003 Apr;111(4 Pt 1):908-10. [20 references]

All clinical reports and policy statements from the American Academy of Pediatrics automatically expire 5 years after publication unless reaffirmed, revised, or retired at or before that time.

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 was updated by ECRI Institute on June 8, 2009. The updated information was verified by the guideline developer on June 9, 2009.

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.