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- 1 Department of General Medicine, Royal Children’s Hospital, Melbourne, VIC.
- 2 Department of Medicine, University of Melbourne, Melbourne, VIC.
- 3 Division of Women’s and Children’s Services, Western Health, Melbourne, VIC.
- 4 North West Academic Centre, University of Melbourne, Melbourne, VIC.
- 5 Centre for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, VIC.
- 6 Bosch Institute, University of Sydney, Sydney, NSW.
- 7 Queensland Brain Institute, University of Queensland, Brisbane, QLD.
- 8 Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Brisbane, QLD.
- 9 School of Paediatrics and Child Health, University of Western Australia, Perth, WA.
- 10 Department of Endocrinology and Diabetes, Princess Margaret Hospital for Children, Perth, WA.
- 11 Monash Children’s Hospital, Southern Health, Melbourne, VIC.
- 12 Department of Paediatrics and School of Psychology and Psychiatry, Monash University, Melbourne, VIC.
- 13 Discipline of Paediatrics and Child Health, University of Sydney, Sydney, NSW.
- 14 The Children’s Hospital at Westmead, Sydney, NSW.
Correspondence: georgia.paxton@rch.org.au
Acknowledgements:
We thank Paul Hofman, Tania Winzenberg, Signe Beck-Nielsen and Margaret Zacharin for their expert comments on the manuscript, and the Cancer Council Australia for providing advice on sun protection.
Competing interests:
No relevant disclosures.
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Summary
The recommended level for serum 25-hydroxyvitamin D (25(OH)D) in infants, children, adolescents and during pregnancy and lactation is ≥ 50 nmol/L. This level may need to be 10–20 nmol/L higher at the end of summer to maintain levels ≥ 50 nmol/L over winter and spring.
Sunlight is the most important source of vitamin D. The US recommended dietary allowance for vitamin D is 600 IU daily in children aged over 12 months and during pregnancy and lactation, assuming minimal sun exposure.
Risk factors for low vitamin D are: lack of skin exposure to sunlight, dark skin, southerly latitude, conditions affecting vitamin D metabolism and storage (including obesity) and, for infants, being born to a mother with low vitamin D and exclusive breastfeeding combined with at least one other risk factor.
Targeted measurement of 25(OH)D levels is recommended for infants, children and adolescents with at least one risk factor for low vitamin D and for pregnant women with at least one risk factor for low vitamin D at the first antenatal visit.
Vitamin D deficiency can be treated with daily low-dose vitamin D supplements, although barriers to adherence have been identified. High-dose intermittent vitamin D can be used in children and adolescents. Treatment should be paired with health education and advice about sensible sun exposure. Infants at risk of low vitamin D should be supplemented with 400 IU vitamin D3 daily for at least the first year of life.
There is increasing evidence of an association between low vitamin D and a range of non-bone health outcomes, however there is a lack of data from robust randomised controlled trials of vitamin D supplementation.