Materials for this week:
- Case discussion
- Pediatrics 2014 – Optimizing Bone Health in Children
- IOM Vitamin D and Calcium Intake references
- www.bestbonesforever.org has resources for girls and bone health (insider tip from Dr. Celeste Quitiquit, our sports med doc extraordinaire!)
- What are the optimum levels for intake of calcium and vitamin D? Recommended daily allowances (RDA) for vitamin D for children are 400 IU 0-12 months, 600 IU >1 year. Calcium RDAs also increase with age: 700mg for 1-3 yo, 1000 mg for 4-8 yo, and 1300mg for 9-18.
- Why are we concerned about these nutrients? In addition to rickets, low Vit D and calcium intake is linked to increased fractures later in childhood/adolescence (and adulthood). Despite the many studies linking low vit D to a host of other conditions, we do not have reliable evidence that they are in fact causally linked.
- Who is at highest risk for low levels? Children at higher risk for low vit D include youth with darker pigmented skin, overweight youth, inadequate dietary intake, living in northern latitudes (>33 degrees -that’s us!), taking certain medications (anticonvulsants, steroids, antiretrovirals). Those at high risk for low bone density include children who do not do bone-density strengthening exercise, particularly children who require wheelchairs.
- Who should be screened with blood tests? Testing for Vit D levels is not routinely indicated; AAP recommends only for conditions associated with reduced bone mass (malabsorption syndromes, CP, taking medications that interfere with absorption), or recurrent low-impact fractures. (*note Endocrine society also recommends for children with dark skin or with obesity).
- When should we recommend supplements? It’s better to receive Vit D and calcium in dietary sources, but there are few sources of vit D in the diet: mainly fortified milk (and some orange juice and yogurts). Supplements are indicated for breastfed babies (until drinking at least 1L per day of fortified formula/milk), and those with low dietary sources or high risk for low bone density. Among children who do not drink much milk (including one of my own kids), I recommend a multi-vitamin supplement with calcium and vitamin D.