Just this past week, I had to make the trip to the local pharmacy for another bottle of children’s multivitamin and I was amazed at the options available! I think we all probably realize that multivitamins can be purchased with and without iron, but now there are ones for immunity support, bone health, and even children’s supplements to add to these multivitamins.
As an endocrinologist who treats rickets (a disease of the bones due to low vitamin D) and decreased bone density in children, I immediately began checking the level of vitamin D in these choices. What I found was in some cases was surprising! For instance, the bone health variety of some vitamins had less vitamin D than the standard complete varieties of the same brand.
So when looking at these choices, how much Vitamin D do you need? Well, that depends on your age and diet. Current recommendations for vitamin D intake for bone health are:
- Less than 12 months old and breastfed: 400 IU daily
- Less than 12 months old, but consuming more than 30 ounces of fortified formula daily: no supplement needed
- One year old-70 years old: 600 IU daily
- Over 70 years old: 800 IU daily
Other than a multivitamin, Vitamin D can be found in some foods and can even be made in the skin with exposure to direct sunlight. Unfortunately, there are few sources of adequate vitamin D in our diet with the highest amount being found in fatty fish (not something commonly ingested by children due to high toxin levels). In addition, many cereals, milk and some orange juices have been fortified with vitamin D to help increase dietary intake. Vitamin D production in the skin occurs with direct sunlight exposure. This can be a good source of Vitamin D in the summer when sun exposure is at its highest, but it’s not likely to be a good source in the winter time when skin is covered and protected from direct rays and when daytime sunlight is limited. In addition, increased awareness of the harmful effects of the sun’s rays has led to increased sun block usage and protective clothing, which is good for our skin but has led to lower vitamin D production.
How do you know if you are getting enough? Vitamin D levels can be checked in the blood to determine if your intake is adequate. For the vitamin D 25-OH test, the current national institute of health recommends a level of greater than 20 (12-20 being insufficient and less than 12 being deficient) with some groups (such as endocrinologists!) recommending 30 for an adequate level. These levels, just as the above recommended daily dosages, are based on Vitamin D’s role in bone health….but it’s yet to be determined if higher levels are needed for immune health, cancer prevention, blood pressure regulation, etc.
What should you do if you were found insufficient/deficient? Not to worry, added supplementation can bring vitamin D levels back to normal. Per the endocrine society guidelines on vitamin D supplementation, the following are maximum amounts that can be added without medical supervision:
- 1000 IU/day for infants up 6 months old
- 1500 IU/day for infants 6 months to 1 year old
- 2500 IU/day for children 1 to 3 years old
- 3000 IU/day for children 4 to 8 years old
- 4000 IU/day for everyone older than 8 years
It should be noted, however, that children who are deficient in Vitamin D should be evaluated formally and will need medically supervised doses to bring levels back to normal.
After this long, rough winter in Ohio, it may be time for all of us to start a multivitamin with vitamin D…
Dr. Meyer is a pediatric endocrinologist at Dayton Children’s Hospital. She is the mother of two boys who she lovingly refers to as “Busy Bee” and “Sprout!” As part of the “Dr. Mom Squad,” Dr. Meyer blogs about her experiences as both as doctor and a mom and hopes to share insight to other parents on issues related to both parenting and kids health. Learn more about Dr. Meyer!