New pediatric guidelines still fall short of the ideal, but may help redress a major nutritional deficiency

by Craig Weatherby

The American Academy of Pediatrics (AAP) is doubling the amount of vitamin D it recommends for infants, children, and adolescents.

The new stance stems from a new AAP clinical report that recommends giving all children 400 IU a day of supplemental vitamin D, beginning in the first few days of life (Wagner CL et al. 2008).

Fish fit the vitamin D bill; Sockeye salmon stand out

Certain fish rank among the very few substantial food sources of vitamin D, far outranking milk and other D-fortified foods.

Among fish, wild Sockeye Salmon may be the richest source of all, with a single 3.5 ounce serving surpassing the US RDA of 400 IU by about 70 percent:

Vitamin D per 3.5 ounce serving*

Sockeye Salmon687 IU

Albacore Tuna544 IU

Silver Salmon430 IU

King Salmon236 IU

Sardines222 IU

Sablefish169 IU

Halibut162 IU

*For our full test results, click here.

The current recommended daily allowance (RDA) from birth through age 50 is only 200 IU of vitamin D.

The previous AAP recommendation, issued in 2003, called for 200 IU per day beginning in the first two months of life.

But most experts say that the minimum daily allowance from adolescence onand probably earliershould be 1,000 to 2,000 IU per day.

(To see our reports on vitamin D research in children and adults, search our newsletter archive for “vitamin d”.)

The AAP change comes after reviewing new clinical trials on vitamin D and the historical precedence of safely giving kids 400 IU per day from infancy on.

The Boston Globe quoted vitamin D researcher Dr. Catherine Gordon, director of the bone health program at Children's Hospital Boston, on the science behind the AAP's change of course:

“I don't know of another vitamin that has effects on multiple tissues like vitamin D… we're still doing research on health outcomes, (and) the relation between vitamin D deficiency … and outcomes later in life like osteoporosis, cancer risk, and risk of multiple sclerosis. But there are compelling data in adults suggesting an association” (Hopper L 2008).

Sadly, the soft-bones disorder called ricketswhich is caused by vitamin D deficiency continues to occur in American children, with the greatest risk for rickets found among exclusively breastfed infants who are not given 400 IU of daily vitamin D.

Clinical research results show that 400 units of vitamin D a day both prevents and treats rickets.

Adequate vitamin D throughout childhood may reduce the risk of osteoporosis later in life. In adults, new evidence suggests that vitamin D plays a role in strengthening the immune system and may help prevent infections, auto-immune diseases, cancer, and diabetes.

As Frank Greer, M.D., co-author of the report, said, “We are doubling the recommended amount of vitamin D children need each day because evidence has shown this could have life-long health benefits. Supplementation is important because most children will not get enough vitamin D through diet alone.”

Co-author Carol Wagner, M.D., made these key points:

“Breastfeeding is the best source of nutrition for infants. However, because of vitamin D deficiencies in the maternal diet, which affect the vitamin D in a mother's milk, it is important that breastfed infants receive supplements of vitamin D.”

“Until it is determined what the vitamin D requirements of the lactating mother-infant dyad are, we must ensure that the breastfeeding infant receives an adequate supply of vitamin D through a supplement of 400 IU per day.”

The new vitamin D recommendations, in detail

The AAP now makes these recommendations:

  • Breastfed and partially breastfed infants should be supplemented with 400 IU a day of vitamin D beginning in the first few days of life.
  • All non-breastfed infants, as well as older children, who are consuming less than one quart per day of vitamin D-fortified formula or milk, should receive a vitamin D supplement of 400 IU a day.
  • Adolescents who do not obtain 400 IU of vitamin D per day through foods should receive a supplement containing that amount.
  • Children with increased risk of vitamin D deficiency, such as those taking certain medications, may need higher doses of vitamin D.
  • Health professionals who care for pregnant women should consider measuring vitamin D levels in this population.

These new recommendations form part of a rising tide of research and awareness about vitamin D that could improve people's health immeasurably, while cutting health-care costs.


  • American Academy of Pediatrics (AAP).  New guidelines double the amount of recommended vitamin D. Accessed online October 13, 2008 at
  • Hopper L. Doctors double vitamin D for children. The Boston Globe. October 13, 2008. Accessed online October 13, 2008 at
  • Wagner CL, Greer FR, Section on Breastfeeding and Committee on Nutrition. Prevention of Rickets and Vitamin D Deficiency in Infants, Children, and Adolescents Accessed online October 13, 2008 at