One of the most common vitamin deficiencies, affecting nearly a billion people worldwide, is vitamin D.

A mutual concern for both first-world and third-world countries, it affects all age groups, from children to senior citizens.

We should ensure that children have optimum levels as low levels can affect their growth, immunity, bone health, and other parts.

In this article, we address the effect of vitamin D deficiency in children and teens, the quantity required, and the mode of treatment in case of vitamin D deficiency.

RDA Of Vitamin D In Infants, Children, And Teens

Vitamin D is a vital nutrient at all stages of life, from infancy to senility.

It plays a vital role in regulating calcium and phosphorous values in the body. It assists in developing immune cells, bone mineralization, regulating the production of inflammatory proteins, and other activities.

Its contribution to the development of the skeletal system from infancy to childhood makes it a crucial component.

There is inadequate information regarding the appropriate amount of vitamin D required for infants. So, the term Adequate Intake(AI) is used. Babies need lower values of vitamin D, and no recommended dietary allowance (RDA) value has been set as the definitive standard.

The required dietary allowance (RDA) from infancy to teenage years in India is mentioned in the chart below.

A few members of the medical fraternity may not agree with these values. The Endocrine Society, being one, claims kids and teens may require as much as 1,000 IU a day.

Affecting all age groups, it is clear that deficiency of this nutrient is quite the issue.

Sources Of Vitamin D

Very few foods like salmon, trout, egg yolks, and fortified milk contain high vitamin D levels. It makes it difficult for people, especially children, to get enough vitamin D daily. 

Though sun exposure will help meet the daily requirement of vitamin D, factors like cloud cover, use of sunscreen, weather changes, and skin pigmentation can impact vitamin D synthesis. 

Because of this, kids with dark skin tones and living in colder climates mostly tend to have low vitamin D levels.

Are Certain Groups Of Children More Prone To Vitamin D Deficiency?

Factors like complexion, body weight, and exposure to sunlight seem to contribute to an increased risk of vitamin D deficiency.

Evidence shows that kids with higher body fat are more likely to develop a deficiency in vitamin D than kids with regular body fat values.

People with a darker complexion require 15 times more exposure to the sun than lighter-skinned individuals to synthesize the same amount of vitamin D. This puts kids with duskier skin at risk of developing a deficiency.

Other factors that also contribute to this nutrient deficiency are,

• Residing in a cold environment
• Decreased sun exposure
• A select of medications, like anticonvulsants
• Disorders that can cause impaired absorption or assimilation of vitamin D, like Crohn's disease and Cystic Fibrosis

Signs And Symptoms Of Vitamin D Deficiency And Its Effect On Children

Biochemical tests can help detect vitamin D deficiency. In children, values below 20ng/mL are considered a deficiency. Values between 21-29ng/mL are also inadequate.

Though opinions regarding the sufficient amount of vitamin D needed vary, a value above 30ng/mL is enough.

Prominent symptoms usually do not arise until the deficiency gets severe. It becomes challenging to identify due to the varying symptoms. Regular tests can avoid this. 

Babies

From years 1 and 2, babies are prone to vitamin D deficiency as they have limited exposure to the sun.

Breastfed babies may not fulfill the vitamin D amount required unless supplemented.

The American Academy of Pediatrics even suggests supplementation of 400 IU every day for a few days right after birth.

Vitamin D deficiency in a baby can lead to

• Seizures
• Stunted growth
• Lack of energy
• Muscle weakness
• Recurring respiratory infections

Rickets is a skeletal disorder characterized by growth issues and joint abnormalities due to severe deficiency in vitamin D. The ages of 6-23 months and 12-15 years are usually at risk of developing this.

Children And Teens

Overweight or obese kids are more likely to develop a deficiency in vitamin D than kids with a normal BMI.

A variety of symptoms can arise due to this nutrient deficiency.

• Stunted development
• Sluggish growth
• Bone fractures
• Muscular pain

Symptoms are more prominent in younger children than teenagers since adolescents may be asymptomatic or develop indistinct symptoms.

Vague symptoms like pain in different joints and muscle pain while doing activities like running or squatting may manifest. Spasms or twitching of muscles is a rare symptom caused by vitamin D deficiency. If the deficiency continues, it can cause convulsions, fractures, and cardiac issues.

Due to several symptoms popping up, it can mistakenly be thought of as fibromyalgia or depression. 

A severe deficiency can lead to rickets in small children and osteomalacia or rickets in adolescents.

Rickets is the mineralization of bones right before the closure of the growth plates. Osteomalacia is the softening of bones right after the closure of the growth plates.

Closure of the growth plates mostly happens between the ages of 13-15 in girls and 15-17 in boys. Both of the disorders, rickets or osteomalacia, can arise in teens.

Treatment Of Vitamin D Deficiency In Kids

Depending upon the age of the kid, the treatment may vary.

Below are the recommended amounts to be supplemented in kids of different ages.

• Under three months old: 2,000 IU (50 mcg) oral supplements daily for three months
• Infants between 2 and 12 months old: 2,000 IU (50 mcg) oral supplements daily for three months or a single dose of 50,000 IU (1,250 mcg)
• Children 12 months to 12 years old: 3,000–6,000 IU (75–150 mcg) oral supplements daily for three months or a single dose of 150,000 IU (3,750 mcg)
• Children over 12 years old: 6,000 IU (150 mcg) oral supplements daily for three months or a single dose of 300,000 IU (7,500 mcg)

It is better to continue a maintenance dose of 400 IU in children and 600 IU in kids above one year after the levels have normalized. For kids with rickets, it is better to add 500 IU of calcium.

For teenagers, 300,000 IU can be given either weekly or in multiple doses daily. Additionally, a daily maintenance dose of 1,500-2,000 IU can be given after levels normalize.

Toxicity from high doses is possible, and a recommendation from a licensed medical expert is necessary. It is better to consult a physician before any supplementation, as the dosage varies depending on the severity and age group.

Maintaining Normal Levels Of Vitamin D

Apart from supplementation, we can obtain expected levels through diet and exposure to sunlight.

Foods that are child-appropriate and rich sources of vitamin D are,

• Fatty fish
• Egg yolks
• Commonly fortified foods like milk and yogurt.

Allowing your kids to play outside and bask in the sunlight can help prevent a deficiency in vitamin D.

Utilizing sunscreen during the hotter seasons can limit sunburn while still permitting enough vitamin D synthesis in kids.

Conclusion

Vitamin D deficiency affects all age groups, from infants to adolescents to adults.

The symptoms and treatment protocols vary depending on several factors, including age and severity.

With certain groups of kids being more prone to getting vitamin D deficiency, it is vital to run regular biochemical tests to avoid adverse effects caused by the deficiency.