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Vitamin D and health in pregnancy, infants, children and adolescents in Australia and New Zealand: a position statement

Georgia A Paxton, Glyn R Teale, Caryl A Nowson, Rebecca S Mason, John J McGrath, Melanie J Thompson, Aris Siafarikas, Christine P Rodda and Craig F Munns
Med J Aust 2013; 198 (3): 142-143. || doi: 10.5694/mja11.11592
Published online: 18 February 2013

Summary

  • The recommended level for serum 25-hydroxyvitamin D (25(OH)D) in infants, children, adolescents and during pregnancy and lactation is ≥ 50 nmol/L. This level may need to be 10–20 nmol/L higher at the end of summer to maintain levels ≥ 50 nmol/L over winter and spring.

  • Sunlight is the most important source of vitamin D. The US recommended dietary allowance for vitamin D is 600 IU daily in children aged over 12 months and during pregnancy and lactation, assuming minimal sun exposure.

  • Risk factors for low vitamin D are: lack of skin exposure to sunlight, dark skin, southerly latitude, conditions affecting vitamin D metabolism and storage (including obesity) and, for infants, being born to a mother with low vitamin D and exclusive breastfeeding combined with at least one other risk factor.

  • Targeted measurement of 25(OH)D levels is recommended for infants, children and adolescents with at least one risk factor for low vitamin D and for pregnant women with at least one risk factor for low vitamin D at the first antenatal visit.

  • Vitamin D deficiency can be treated with daily low-dose vitamin D supplements, although barriers to adherence have been identified. High-dose intermittent vitamin D can be used in children and adolescents. Treatment should be paired with health education and advice about sensible sun exposure. Infants at risk of low vitamin D should be supplemented with 400 IU vitamin D3 daily for at least the first year of life.

  • There is increasing evidence of an association between low vitamin D and a range of non-bone health outcomes, however there is a lack of data from robust randomised controlled trials of vitamin D supplementation.

  • Georgia A Paxton1,2
  • Glyn R Teale3,4
  • Caryl A Nowson5
  • Rebecca S Mason6
  • John J McGrath7,8
  • Melanie J Thompson1
  • Aris Siafarikas9,10
  • Christine P Rodda11,12
  • Craig F Munns13,14

  • 1 Department of General Medicine, Royal Children’s Hospital, Melbourne, VIC.
  • 2 Department of Medicine, University of Melbourne, Melbourne, VIC.
  • 3 Division of Women’s and Children’s Services, Western Health, Melbourne, VIC.
  • 4 North West Academic Centre, University of Melbourne, Melbourne, VIC.
  • 5 Centre for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, VIC.
  • 6 Bosch Institute, University of Sydney, Sydney, NSW.
  • 7 Queensland Brain Institute, University of Queensland, Brisbane, QLD.
  • 8 Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Brisbane, QLD.
  • 9 School of Paediatrics and Child Health, University of Western Australia, Perth, WA.
  • 10 Department of Endocrinology and Diabetes, Princess Margaret Hospital for Children, Perth, WA.
  • 11 Monash Children’s Hospital, Southern Health, Melbourne, VIC.
  • 12 Department of Paediatrics and School of Psychology and Psychiatry, Monash University, Melbourne, VIC.
  • 13 Discipline of Paediatrics and Child Health, University of Sydney, Sydney, NSW.
  • 14 The Children’s Hospital at Westmead, Sydney, NSW.

Correspondence: georgia.paxton@rch.org.au

Acknowledgements: 

We thank Paul Hofman, Tania Winzenberg, Signe Beck-Nielsen and Margaret Zacharin for their expert comments on the manuscript, and the Cancer Council Australia for providing advice on sun protection.

Competing interests:

No relevant disclosures.

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