14 In addition, studies have shown that adolescents consume insufficient levels of dietary vitamin D 15, 16 and that supplementation increases 25-hydroxyvitamin D levels and bone mineral density. These concerns are supported by studies showing that vitamin D deficiency can occur early in life 12 that serum 25-hydroxyvitamin D concentrations tend to be lower in breastfed infants 13 and that 400 IU of vitamin D supplementation in these infants maintains higher concentrations of 25-hydroxyvitamin D. 11 Since then, there have been concerns that these dosages may be insufficient. 10 This expert consensus statement was supported by studies of breastfed infants in the United States, Norway, and China and suggested that infants who ingest 100 or 200 IU of supplemental vitamin D daily were less likely to develop rickets. In 2003, the American Academy of Pediatrics (AAP) published a guideline recommending that all children older than two months receive 200 IU of supplemental vitamin D daily. Physicians should help parents choose the appropriate vitamin D supplement for their child. However, vitamin D may reduce the risk of certain infections and chronic diseases. No randomized controlled trials assessing patient-oriented outcomes have been performed on universal vitamin D supplementation.

Although the American Academy of Pediatrics recommends keeping infants out of direct sunlight, decreased sunlight exposure may increase children's risk of vitamin D deficiency. In addition to dietary sources, exposure to ultraviolet B sunlight provides children and adults with additional vitamin D. It is also based on the precedent of preventing and treating rickets with 400 IU of vitamin D. This recommendation is based on expert opinion and recent clinical trials measuring biomarkers of vitamin D status. Infants who are breastfed and children and adolescents who consume less than 1 L of vitamin D–fortified milk per day will likely need supplementation to reach 400 IU of vitamin D per day. In 2008, the American Academy of Pediatrics increased its recommended daily intake of vitamin D in infants, children, and adolescents to 400 IU. Vitamin D deficiency in children can have adverse health consequences, such as growth failure and rickets.

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