Vitamin D in children and infants

Whether in adults or children, vitamin D is essential for the proper functioning of the body .
However, for parents, it is not always easy to navigate among the different sources and information on this subject.
In this article, we have decided to review the key information to know about vitamin D and its importance in children and infants.

A little reminder before reading:

• The newborn: refers to the child from birth to the ^1st month,
• The infant: from one month until the weaning period.

Role and benefits of Vitamin D in children

As we detailed in our article on the benefits and properties of vitamin D , Vitamin D (D2 or D3) is a fat-soluble vitamin that has multiple functions in the body.
In children, we mainly remember its essential influence for the fixation of calcium , itself essential for growth and bone strength.

Vitamin D requirements in children and infants

Recommendations regarding Vitamin D requirements in children are currently being updated, with general consensus among all health agencies around the following recommendations.
As mentioned in an extract from the letter “vitamin D prescription alert in pediatrics”, published in November 2020 by Professors Justine BACCHETTA, and Professor Agnès LINGLART:

“…The recommendations on vitamin D supplementation in France are being updated: in conjunction with European recommendations, we are going to propose daily supplementation of 400 to 800 IU per day for ALL children aged 0 to 18 years. vitamin D , with a target of 400 IU (i.e. 10 micrograms µg) per day for children without risk factors.

Daily dosage: neither too much nor too little.

If the vitamin is essential for the child's growth, its daily dosage should neither be too low, otherwise it could cause rickets, nor be too high.

Vitamin D deficiency in children

Vitamin D is an essential nutrient for the growth of children because it promotes the absorption of calcium by the body . Its action is therefore particularly important during growth and adolescence for bone and dental health.
Also, when diet, exposure to the sun, or illness do not provide sufficient intake, this can cause a deficiency or deficiency in vitamin D that is truly harmful in the child.
The risks to the child's health may be:

• A disruption of bone development: rickets is the most serious expression
• Hyperparathyroidism: an endocrine disease which disrupts the level of calcium in the blood.

These serious consequences, however, are very rare in Western countries, when pediatric monitoring is well carried out.

Does the risk of vitamin D overdose in children really exist?

The letter from Professors Bacchetta and Linglart also alerts pediatricians to cases of renal hypercalcification observed in very young children, the result of excessive doses of vitamin D having led to an overload of calcium in the kidneys.

This warning follows 3 cases of overdose observed in infants following the taking of ultra-dose food supplements.
In the 3 cases reported to ANSES as part of the nutrivigilance system, the parents administered vitamin D dosed at 10,000 IU per drop to their child . Which represents a dose 20 times higher than the recommended one (400 to 800 IU per day)!

We therefore sought to quantify and identify more precisely the cases of vitamin D overdose problems identified by doctors and/or scientists.

The team from the Mayo specialized clinic in Rochester, USA (Kornela Galor et al.) notably published a study in 2018 in the journal Nutrients ( see ref at the bottom of the article ) to identify the causes and conditions of toxicity of vitamin D following supplements.

It appears that problems occur in young children with :

• Doses of more than 50,000 IU/day . More than 100 times the recommended daily dose.
• For long periods (several weeks). This leads to a very high level of vitamin D in the blood (more than 150ng/ml) and which triggers hypercalcemia.

The origin of the problems being either errors in product labeling or inappropriate administration.

Vitamin D intake through food supplements: our advice

Pediatricians suggest reserving the administration of vitamin D to doctors, to avoid any risk of incorrect administration by parents, or to avoid poorly dosed supplements.

This recommendation must nevertheless be modulated, to the extent that today, many food supplements have dosages and dosages identical to the drugs generally prescribed.

You can nevertheless follow the following 5 rules to ensure that the chosen supplement is well suited to your child:

1. Choose only supplements produced in France: according to Good Manufacturing Practices which increase the number of controls to eliminate any risk of dosage error (the tolerance thresholds are less than ±. 5% of the dosages announced).
   
2. Check that the supplement is declared to the DGCCRF (the 'fraud repression'), which particularly controls the wording of the labels, and specifically the conditions and precautions of use. The risks of errors and non-compliance are insignificant, if not non-existent.
   
3. Inform the pediatrician if you are giving Vitamin D supplements to your child or infant.
   
4. Exclude any supplementation if your child has received a Vitamin D injection (or is taking any medication including this).
   
5. Respect the recommended dosages (400 to 500 IU/day are sufficient), and keep the product out of the reach of children. .

It would be a shame if a good general recommendation (supplementation of infants and young children with vitamin D ) was called into question by rare, exceptional risks occurring following obvious errors over long periods and with massive doses. .

Vitamin D in Argalys children's supplements.

• Vega kid (gel capsule) : from one year old, provides 400 IU of vegetable vitamin D3 , (+ calcium 22% of the RDI, iodine and selenium)
• The vegetable Vitamin D3 Spray provides 500 IU per squeeze, i.e. a daily dose suitable for all children, including infants, while scrupulously respecting the precautionary principles mentioned above.

In practice, when using Argalys type Vitamin D3 spray , there is no risk of overdose if the dosage is respected.
Only the administration of several dozen sprays each day for several weeks would do entering a 'risk zone' as observed by American researchers, an obviously improbable situation.

Bibiographic references :

• Letter from pediatricians: https://www.sfpediatrie.com/actualites/alarme-prescription-vitamine-pediatrie

• Nutrients. 2018 Aug; 10(8): 953. Published online 2018 Jul 24. doi: 10.3390/nu10080953
• Development of Vitamin D Toxicity from Overcorrection of Vitamin D Deficiency: A Review of Case Reports https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6115827/

• Lancet Diabetes Endocrinol. 2017 Dec;5(12):986-1004. Effect of vitamin D supplementation on non-skeletal disorders: a systematic review of meta-analyses and randomized trials https://pubmed.ncbi.nlm.nih.gov/29102433/

• ANSES opinion relating to vitamin D poisoning in infants: https://www.anses.fr/fr/system/files/NUT2020VIG0186.pdf