Low concentration of vitamin D in breast milk, and the recommendation of keeping newborns and infants out of direct sun exposure are all factors that contribute to the risk of vitamin D deficiency in infants. However, several factors such as cultural practices and sun protection for prevention of cancer has conditioned vitamin D deficiency and rickets to reappear as a global health problem. Vitamin D from the diet is limited, the main natural source of vitamin D being from the action of the sunlight on the skin. Vitamin D is essential in the metabolism of calcium and phosphate, skeletal growth and bone health, but is also involved in other functions such as the modulation of the function of activated B and T lymphocytes, insulin production, the secretion of thyroid stimulating hormone and myocardial contractility. In this article, we looked at existing recommendations and supporting evidence on the effectiveness of vitamin D supplementation in reducing vitamin D deficiency and in preventing rickets and infections.
This article is part of a series of reviews, which aim to summarize the existing recommendations and the most recent evidence on preventive interventions applied to children under 5 years of age to inform the WHO editorial group to make recommendations for health promotion in primary health care. The World Health Organization (WHO) European Region is developing a new pocket book for primary health care for children and adolescents in Europe. Beyond 12 months of age vitamin D supplementation is recommended only in groups of children at risk. Universal vitamin D supplementation starting shortly after birth, regardless of the mode of feeding and until 12 months of age, is strongly recommended. Adequate levels of vitamin D might not be achieved with lower daily doses. Higher doses have not shown to add benefit while it could potentially cause toxic blood levels and hypercalcemia. Vitamin D supplementation is well tolerated, and not associated with toxicity. Evidence is more robust in groups of infants and children at risk.
We summarized the main findings of systematic reviews with the certainty of the evidence as reported.Ī daily dose of 400 international units of vitamin D in infants has shown to be effective for improving bone health and preventing rickets. We summarized the recommendations and the strength of the recommendation when and as reported by the authors. We conducted a literature search up to the 17th of July 2019 by using key terms and manual search in selected sources.
We also looked at optimal dose of vitamin D and the age until which vitamin D supplementation is beneficial.
We looked at existing recommendations and supporting evidence on the effectiveness of vitamin D supplementation in infancy for reducing vitamin D deficiency and for preventing rickets and infections.
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