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

VitaminDWiki: What paper should have said
  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
  2. 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
  3. 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
       dark skin
        shut-in, 39 items
       future/past surger or long hospitalization 124 items
        avoid the sun (the doctor can see very light skin)
        live far from the equator (e.g. Alaska for the US) 124 items
       wear concealing clothing
       tender shinbone, etc
       Infant had been premature or had low birth weight
  4. 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
  5. Vitamin D is important during pregnancy
    Pregnancy was outside of the scope of the paper
  6. Exercise outdoors in the sun is far better than indoor exercise
    Paper ignored difference between outdoor and indoor exercise
  7. Magnesium, etc. is also important for bone health – not just Calcium and Vitamin D
  8. Should decrease Caclum intake as vitamin D levels exceed 20 ng
    This paper continues the mistake made by the Institute of Medicine in 2010
  9. Infants do not tolerate some brands of Vitamin D – additives, color, etc no mention in this paper
  10. Infants probably need 1,600 IU, not just 400

 Download the PDF from VitaminDWiki.

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

1000 IU per 25 lbs.jpg

  • 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

The TOP articles in Infant-Child and Vitamin D are listed here:

Attached files

ID Name Comment Uploaded Size Downloads
4422 Optimizing Bone Health in Children and Adolescents.pdf admin 29 Sep, 2014 784.14 Kb 3945