Child Bone health – (incorrect) recommendations by US Pediatric and Bone Health groups

Created September 2014

Optimizing Bone Health in Children and Adolescents

Pediatrics, Clinical Report Published online September 29, 2014

From the American Academy of Pediatrics

Neville H. Golden, MD, Steven A. Abrams, MD, COMMITTEE ON NUTRITION

1. Vitamin D3 is far better than D2 * D2 has been shown many times to DECREASE levels of D3 in the blood * D2 has been banned for use in mammals by vets for over a decade * D2 is OK for rodents (initial research), but not for mammals (research from recent decades) * 98% of US cow milk is fortified with vitamin D – but unfortunately it is often D2, not D3 * Note: There are many sources of vegan D3 * Note: D3 has been available for prescription in the US since about 2009 1. RDA for vitamin D should be proportional to weight * Note: As the child increases in weight *      Calcium RDA for increases 650% (200 == 1300 mg) *      Vitamin D needs increase only 50% (400 ==> 600 IU - to age 65!) * Many international groups recommend increasing vitamin D with weight – especially if obese *      – but the US IoM and this paper do not acknowledge the increased need with increased weight 1. Cost-effective to supplement children with vitamin D * Paper stated that not cost effective to test unless child already has bone problems * Paper ignores the possibility of supplementing those at high risk *      Obese *      dark skin *      shut-in, items *      future/past surger or long hospitalization items *       avoid the sun (the doctor can see very light skin) *      live far from the equator (e.g. Alaska for the US) items *      wear concealing clothing *      tender shinbone, etc *      Infant had been premature or had low birth weight 1. Vitamin D is important to non-bone portions of the body too * Examples of proof of vitamin D intervention with children include *      T1 Diabetes, Influenza, Respiratory tract infections, TB, Congestive Heart Failure, Asthma * Expect proof soon that the huge increases in some child health problems relate to low vit D *      Obesity, Autism, Concussions, Peanut allergy, Bipolar disorder, Chronic disease 1. Vitamin D is important during pregnancy * Pregnancy was outside of the scope of the paper 1. Exercise outdoors in the sun is far better than indoor exercise * Paper ignored difference between outdoor and indoor exercise 1. Magnesium, etc. is also important for bone health – not just Calcium and Vitamin D 1. Should decrease Caclum intake as vitamin D levels exceed 20 ng * This paper continues the mistake made by the Institute of Medicine in 2010 1. Infants do not tolerate some brands of Vitamin D – additives, color, etc no mention in this paper 1. Infants probably need 1,600 IU, not just 400

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ABSTRACT

The pediatrician plays a major role in helping optimize bone health in children and adolescents. This clinical report reviews normal bone acquisition in infants, children, and adolescents and discusses factors affecting bone health in this age group. Previous recommended daily allowances for calcium and vitamin D are updated, and clinical guidance is provided regarding weight-bearing activities and recommendations for calcium and vitamin D intake and supplementation. Routine calcium supplementation is not recommended for healthy children and adolescents, but increased dietary intake to meet daily requirements is encouraged. The American Academy of Pediatrics endorses the higher recommended dietary allowances for vitamin D advised by the Institute of Medicine and supports testing for vitamin D deficiency in children and adolescents with conditions associated with increased bone fragility. Universal screening for vitamin D deficiency is not routinely recommended in healthy children or in children with dark skin or obesity because there is insufficient evidence of the cost–benefit of such a practice in reducing fracture risk. The preferred test to assess bone health is dual-energy x-ray absorptiometry, but caution is advised when interpreting results in children and adolescents who may not yet have achieved peak bone mass. For analyses, z scores should be used instead of T scores, and corrections should be made for size. Office-based strategies for the pediatrician to optimize bone health are provided. This clinical report has been endorsed by American Bone Health.

See also VitaminDWiki

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  • The Red line is the average weight of children at that age.

  • This article recommends this amount up to age 12 months , others recommend it for up to age 12 years

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Tags: Bone Infant-Child