Issues in establishing vitamin D recommendations for infants and children

In 1963, the American Academy of Pediatrics Committee on Nutrition recommended 400 IU of vitamin D per day for all infants and children. After the late 1970s, this became an inconsistent recommendation, particularly for breast-feeding infants. In 2003, however, the Committee on Nutrition of the American Academy of Pediatrics recommended 200 IU/d vitamin D for all infants and children. This was in response to the vitamin D adequate intake recommendations made by the Institute of Medicine in 1997, the increasing number of reports of nutritional rickets in certain populations of American infants, and the Healthy People 2010 goal of having 75% of infants breast-fed for the first 6 mo of life. In making these recommendations, many issues were taken into consideration, including the following. 1) Vitamin D deficiency is more than rickets, which is the final stage of the deficient state among growing children. 2) Adequate sunlight exposure cannot be determined exactly for every subject. 3) There is new awareness of the hazards of ultraviolet-B light exposure in childhood and the subsequent development of skin cancer in adulthood. 4) There is decreasing intake of vitamin D-fortified foods among older children and adolescents. More research is needed in the pediatric population to determine the recommended dietary allowance of vitamin D. A new definition of vitamin D deficiency that would make use of normal serum concentrations of 25-hydroxyvitamin D-3 in a given population is needed. The recommended intake of 200 IU/d may not be enough. More data are needed to support the adequacy of the present and possibly even higher recommended vitamin D daily intakes.