Prevention of Rickets and Vitamin D Deficiency in Infants, Children, and Adolescents

American College of Obstetrics and Gynecology.
PEDIATRICS (Impact Factor: 5.3). 12/2008; 122(5):1142-52. DOI: 10.1542/peds.2008-1862
Source: PubMed

ABSTRACT Rickets in infants attributable to inadequate vitamin D intake and decreased exposure to sunlight continues to be reported in the United States. There are also concerns for vitamin D deficiency in older children and adolescents. Because there are limited natural dietary sources of vitamin D and adequate sunshine exposure for the cutaneous synthesis of vitamin D is not easily determined for a given individual and may increase the risk of skin cancer, the recommendations to ensure adequate vitamin D status have been revised to include all infants, including those who are exclusively breastfed and older children and adolescents. It is now recommended that all infants and children, including adolescents, have a minimum daily intake of 400 IU of vitamin D beginning soon after birth. The current recommendation replaces the previous recommendation of a minimum daily intake of 200 IU/day of vitamin D supplementation beginning in the first 2 months after birth and continuing through adolescence. 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. New evidence supports a potential role for vitamin D in maintaining innate immunity and preventing diseases such as diabetes and cancer. The new data may eventually refine what constitutes vitamin D sufficiency or deficiency.

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    ABSTRACT: Vitamin D features immunomodulatory effects on both the innate and adaptive immune systems, which may explain the growing evidence connecting vitamin D to allergic diseases. A wealth of studies describing a beneficial effect of vitamin D on atopic dermatitis (AD) prevalence and severity are known. However, observations linking high vitamin D levels to an increased risk of developing AD have also been published, effectively creating a controversy. In this paper, we review the existing literature on the association between AD and vitamin D levels, focusing on childhood. As of today, the role of vitamin D in AD is far from clear; additional studies are particularly needed in order to confirm the promising therapeutic role of vitamin D supplementation in childhood AD.
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    ABSTRACT: To provide primary care clinicians with practice recommendations for the safe, individualized, effective, efficient evaluation, and treatment of vitamin D status for maximum health promotion and disease prevention. A review and synthesis of current scientific literature on vitamin D was conducted related to the physiologic impact of vitamin D, topics of debate, research and recommendations, adequate serum levels, daily supplementation, and deficiency treatment. Inadequate vitamin D levels are not isolated to any one geographic, ethnic, or socioeconomic population, and exist without regard to gender, age, or health status. Conflicting vitamin D evidence and recommendations may leave patients vulnerable to vitamin D inadequacy, deficiency, or excess, and in turn, avoidable negative outcomes. Nurse practitioners (NPs) must actively assess patient vitamin D status and educate patients in order to prevent negative health outcomes. Maintaining adequate vitamin D levels is an easy and cost-efficient adjunct to other health promotion and disease prevention measures. NPs who neglect the physiologic roles of vitamin D and potential patient vulnerability miss an opportunity to make an impact in both patient health and the economic healthcare burden related to acute and chronic disease.
    03/2013; 25(3):109-18. DOI:10.1111/1745-7599.12005
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    ABSTRACT: Vitamin D deficiency rickets is a childhood osteomalacia, with impaired skeletal development and potentially skeletal deformities. The radiographic findings of rickets are many but include widening, fraying, and cupping of the metaphysis. Developmental delay and related complications of seizure and tetany have also been reported. This medical entity is often thought of as a classic medical disease of the past. However, it persists, and the recognition of rickets is on the rise. The reemergence of rickets correlates with the increase in the number of children exclusively breastfed and with the frequent use of sun block in the pediatric population. We present two cases of rickets, diagnosed through a visit to the Emergency Department made for unrelated symptoms. These two cases illustrate the importance of diagnosing rickets as an "incidental" finding. With early detection, dietary supplementation can be initiated potentially sparing the patient symptomatic disease.
    Case Reports in Medicine 10/2012; 2012:163289. DOI:10.1155/2012/163289


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