Infants, children, and teens should get at least 400 international units per day of vitamin D, according to new guidelines from the American Academy of Pediatrics. x��=k�7��S��П�F��6���rM�=~�W��s�{����F���H�H�䲿����g���2��lA �ً����ru̞?��x\�n�7٧gw{�������_����n{u��|u�����W��Ь�>~��+��?�q�T�Bd7_ErIX��x��W� Q��է�l���GZ-��}����zm�{(͉h�A͋6.�����ot����:{� ������Ӂ�t`e�I���BĕzNhQ^��?ׄ�WW��|�&���W���L_�c.�y���A(a�����K�/�/���m�_�6�]��^�F�oW��>'�^jx {�/,0H:���]ӫK�ph �/���*��6�)sR6�֞#x�jkf��f��8���2�&�Nc"/h�d��H-K)ޤ�0���K����ť��[���������%��-.��~������X�g�� View the collection | Find AAP resources here. In 2008, the American Academy of Pediatrics (AAP), with the primary intention of preventing rickets, increased their recommended intake of vitamin D for infants <1 year of age from 200 to 400 IU daily.1 Specifically, the recommendations stated that exclusively or partially breastfeeding infants should be supplemented with 400 IU daily and that nonbreastfeeding infants should consume at least 1 L of formula daily. We do not capture any email address. 2. Ten micrograms of vitamin D (vitamins D2 and D3) supplement was considered to be equivalent to 400 IU vitamin D.20 Vitamin D obtained from other sources (eg, cow’s milk, dairy food) was not reviewed for vitamin D content for this analysis because the AAP guidelines for infants <1 year of age only recommended formula intake or supplementation to meet guidelines1; in addition, cow’s milk is not recommended as a beverage for children until 1 year of age.21, Analyses were conducted across all infants 0 to 11 months of age as well as stratified by breastfeeding status. National Osteoporosis Society. However, differences observed in the unadjusted analysis by family income and health insurance status were no longer statistically significant. Position statement on vitamin D deficiency. Patients’ response to medical advice, Maternal preferences for vitamin D supplementation in breastfed infants, A systematic review of implementation frameworks of innovations in healthcare and resulting generic implementation framework, Vitamin D in newborns. E-mail: Copyright © 2020 by the American Academy of Pediatrics. Poisson regression with robust variances was used rather than logistic regression because logistic regression would have overestimated associations for common events.25,26 In addition, we examined whether the distribution of infants meeting the vitamin D recommendation varied by 2-year cycle using the Rao-Scott χ2 test. Since 2012, trends in vitamin D intake among infants at a national level have not been well described. December 2018. Breastfeeding infants in families with a head of household who was a college graduate were more likely than those in families with a head of household with less than a high school education to meet guidelines (26.2% vs 10.7%; P < .05), and breastfeeding infants with private insurance were more likely than those with other insurance (ie, government programs) to meet guidelines (24.4% vs 13.1%; P < .05). Also, in our study, we examined adherence with vitamin D intake guidelines for infants rather than serum 25 hydroxy vitamin D levels, which were not collected in the NHANES for participants <1 year of age. Vitamin D and bone health: A practical clinical guideline for patient management in children … 2017, On simple adjustments to chi-square tests with survey data, A modified Poisson regression approach to prospective studies with binary data, Model-based estimation of relative risks and other epidemiologic measures in studies of common outcomes and in case-control studies, No adjustments are needed for multiple comparisons, Vitamin D supplementation of Canadian infants: practices of Montreal mothers, Very high vitamin D supplementation rates among infants aged 2 months in Vancouver and Richmond, British Columbia, Canada, Rickets and vitamin D deficiency in Alaska native children, Vitamin D in childhood and adolescence: an expert position statement, Vitamin D supplementation in primary allergy prevention: systematic review of randomized and non-randomized studies, Vitamin D: an evidence-based review [published correction appears in J Am Board Fam Med. Nonbreastfeeding infants were more likely to meet guidelines than breastfeeding infants (31.1% [95% CI: 27.6%–34.5%] vs 20.5% [95% CI: 15.4%–25.5%], respectively; P < .01). Time trends were analyzed by using Poisson regression with robust variances, with a 2-year survey cycle as the independent variable (coded as a continuous variable). Unadjusted Percentage of US Infants Meeting the 2008 AAP Recommended Vitamin D Intake Guideline by Breastfeeding Status and Selected Demographic Characteristics, 2009–2016. Less than 40% of infants met guidelines in nearly all demographic subgroups. October 2013. In addition, in our analysis, we did not take into account food or cow’s milk sources of vitamin D. Despite AAP recommendations that cow’s milk not be given before 1 year of age,21 an analysis of NHANES data from 2003 to 2010 revealed that nearly 13% of infants <1 year of age drank regular nonformula milk products.46 Although accounting for cow’s milk consumption may have resulted in an increase in the percentage of infants meeting an intake of at least 400 IU per day, particularly as they age closer to one year, these same infants would be at risk for iron-deficiency anemia, lack of ideal nutritional intake, and a possible increase in risk for type 1 diabetes mellitus.47 In addition, they would not be adherent to the AAP guideline to introduce cow’s milk beverages after 1 year of age.21 Another limitation of our study was that parents may have inaccurate recall, and recall bias could exist because of the social desirability of adhering to guidelines. Additionally, although <40% of infants met guidelines in nearly all demographic subgroups, among breastfeeding infants, lower socioeconomic status was associated with increased risk of failing to meet the vitamin D intake guidelines. Among breastfeeding infants, those in families ≥400% of FPL were approximately twice as likely to meet guidelines compared with those in any other income group (30.5% vs 15.5% for 200%–<400%, 13.8% for 100%–<200%, and 14.2% for <100%; P < .05 for all pairwise comparisons). This recommendation is based on expert opinion and recent clinical trials … Are You Getting Enough Vitamin D and Calcium. A cohort study of infants born at a hospital in Montreal in 2007–2008 revealed that 74% of breastfeeding infants met vitamin D intake guidelines (400 IU per day),30 and a more recent larger study from Vancouver revealed that nearly 90% of breastfeeding infants received vitamin D supplementation.31 These rates are far above those found for the United States in our study. Of these, dietary recall information, including information on breastfeeding status, was available for the 1435 infants who made up our analytic sample. In contrast, among nonbreastfeeding infants, meeting intake guidelines did not differ by socioeconomic factors. Funded by the National Institutes of Health (NIH). Breastfeeding infants were also less likely to have received WIC benefits (P<0.01). Indeed, the overall rate of meeting the guidelines in 2015–2016 is only 28.2%, with 20.8% of breastfeeding infants and 35.3% of nonbreastfeeding infants meeting guidelines.