Four common problems of vitamin D in children

Vitamin D is a fat soluble vitamin closely related to childrens health. It plays a positive role in the early development of children and the prevention and treatment of diseases. Although the diagnosis and treatment level of vitamin D deficiency has been continuously improved, the high-risk factors of vitamin D deficiency in children still exist due to the changes of modern lifestyle and environment. It is still very important to prevent vitamin D deficiency in children.

Vitamin D nutritional status is classified according to serum 25 (OH) d level, which can be divided into the following four grades:

➤ vitamin D deficiency: 25 (OH) d<30nmol/l;

➤ insufficient vitamin D: 25 (OH) d30-50nmol/l;

➤ sufficient vitamin D: 25 (OH) d>50-250nmol/l;

➤ vitamin D poisoning: 25 (OH) d>250nmol/l.

Serum 25 (OH) d level should be >50-125nmol/l. Although serum 25 (OH) d >50-250mol/l is sufficient for vitamin D, the appropriate serum 25 (OH) d level recommended by the American Institute of Medicine (IOM) is 50-125nmol/l, and it is considered that serum 25 (OH) d>125nmol/l has potential hazards, such as increased urinary calcium excretion. Therefore, the higher the serum 25 (OH) d level, the better.

➤ before vitamin D supplementation: it is not necessary to monitor the blood 25 (OH) d level before the routine recommended amount of vitamin D (400-800u/ day) is supplemented to children;

➤ vitamin D supplementation: routine detection of blood 25 (OH) d level is not recommended for children without high-risk factors of vitamin D deficiency, without clinical symptoms and signs, and who have been supplemented with the recommended amount of vitamin D;

➤ during vitamin D treatment: it is recommended to monitor the serum 25 (OH) d level every 3-4 months to evaluate the treatment response until the appropriate 25 (OH) d level is reached, and then monitor once every 6 months. After the serum 25 (OH) d reaches the target treatment level, follow-up monitoring is not necessary.

It is recommended to take the baby to outdoor activities as early as possible, gradually to 1-2h a day, and pay attention to safety during sunlight exposure. The American Academy of Pediatrics (APP) recommends that infants < 6 months of age should avoid direct sunlight and wear appropriate protective clothing and hats. It is recommended to sun at a high frequency rather than for a long time to prevent skin aging and skin cancer.

Guide children to eat foods rich in calcium, such as milk, dairy products, bean products, seafood, etc.

(1) In order to prevent rickets, it is suggested that newborns should start to supplement vitamin D as soon as possible after birth, 400-800u per day, so as to prevent vitamin D deficiency and ensure the growth and development of infants. In view of the high-risk factors, some strategies such as active sunlight exposure, vitamin D supplementation and food fortification can be adopted to increase vitamin D intake.

(2) From the first week of life, preterm infants, low birth weight infants and multiple fetuses took 800u/d vitamin D orally, which was adjusted to 400u/d after 3 months; Those who eat premature infant formula milk powder can take vitamin D preparation 400u/d orally.

(3) For children with recurrent respiratory tract infection, vitamin D can effectively improve their immune function, reduce the frequency of respiratory tract infection, and promote the recovery of respiratory tract infection symptoms. It is suggested that children with recurrent respiratory tract infection should be supplemented with vitamin D 400-800u/d every day to promote disease recovery, improve immunity and reduce the risk of recurrent respiratory tract infection.

(4) It is suggested that during the course of diarrhea, children should supplement vitamin D 400-800u/d to supplement vitamin D consumed during diarrhea, which is conducive to the recovery of diarrhea symptoms and reduce the risk of diarrhea.

(5) It is suggested that children with iron deficiency anemia and high risk of iron deficiency should supplement vitamin d400-800u/d every day to reduce the risk of iron deficiency and improve the treatment effect of iron deficiency anemia.

(6) Children with chronic diseases such as malnutrition are prone to vitamin D deficiency, and the severity of the disease is positively correlated with the degree of vitamin D deficiency. It is suggested to supplement vitamin d400-800u daily, which will help to improve the nutritional status of sick children, reduce the risk of vitamin D deficiency and improve the prognosis of chronic diseases.

Preterm infants, low birth weight infants, macrosomia, children with little outdoor activities and children growing too fast should supplement calcium as appropriate according to dietary calcium intake to meet the recommended amount of nutrients.

 

Cindy