In 2008, the American Academy of Pediatrics revised its Vitamin D intake guidelines by recommending breastfed infants be given a supplement of 400 IU as should formula-fed infants who take in < 1 liter of vitamin-D fortified formula per day. How well do pediatricians follow these guidelines? Not too well according to a new study by Drs. Simon and Ahrens (10.1542/peds.2019-3574) being early released this month by our journal. The authors evaluated the National Health and Nutrition Examination Surveys for infants in their first eleven months from 2009 to 2016. Over this period of time, about 27% of infants met the vitamin D intake guidelines. While there were a few subgroups who met the recommended guidelines, such as those who were 400% above the federal poverty level, parents with college education, or enrolled in private insurance—these were a small percentage of overall children identified. In fact, less than 40% of infants in most other subgroups met adequate intake and there were no significant improvements in these trends over time leading to the overall 27% rate of meeting the recommended vitamin D guidelines during the 7 years studied.
Why are infants not getting adequate vitamin D in in their first year? We posed that question to Drs. Jaspreet Loyal and Annette Cameron from Yale (10.1542/peds.2020-0504), who provide a number of possibilities while also noting how some other countries in the world have succeeded in getting adequate vitamin D levels in infants, focusing on what we can learn from those successes. The authors point out how the electronic health record with a reminder, or key points of contact with a family such as the newborn nursery, pharmacies, and even the Supplemental Nutrition for Women, Infants and Children (WIC) program can help assure that infants get the recommended vitamin D. They also note the role we can play in stressing the importance of vitamin D. There is plenty to milk out of both the study and commentary—don’t D-lay and check both out so your patients get the vitamin D they need for optimal growth.
