Rx Nutrition Resource Center
Rx Nutrition Resource Center
June 04, 2019
3 min read

Addressing the vitamin D gap in children, teens

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Kristi King 
Kristi King
Kim Pfotenhauer 
Kim Pfotenhauer

A 2018 study in Nutrients that analyzed the dietary recall of some 6,000 children aged 2 to 5 years reported that mean daily vitamin intake of vitamin D was about 248 IU, which was below the AAP recommendation that all infants, children and teenagers consume a minimum daily intake of 400 IU.

The same study reported the daily average intake of vitamin D was even lower in children aged 6 to 18 years.

These findings suggest a continuing problem also described more than a decade ago, when Archives of Pediatrics and Adolescent Medicine reported that vitamin D deficiency is a “prevalent health problem” among children and teenagers.

There are several reasons why children must have sufficient vitamin D in their diet, an expert told Healio Primary Care.

“Vitamin D is essential for facilitating absorption and utilization of calcium, phosphorus, and magnesium in the body, all of which are vital in building strong bones. Peak bone mass is built by the mid-20s; therefore, what the child consumes when they are younger will help to determine how strong their bones are when they are elderly,” Kristi L. King, MPH, senior dietitian at Texas Children's Hospital, said in an interview.

In addition, NIH’s website indicates that sufficient vitamin D consumption, over the course of a lifetime, may help prevent breast, colorectal and prostate cancers, both types of diabetes, glucose intolerance and hypertension.

One potential solution to closing the vitamin D gap is multivitamins. However, research suggests only consuming one may not be enough.

A survey of 67 multivitamins available in the United Kingdom appearing in Archives of Disease in Childhood concluded that “few” multivitamin products supply the recommended daily vitamin intake of 400 IU.

King and Kim Pfotenhauer, DO, assistant professor of primary care at Touro University, explained the take-home message of the U.K. study as they discussed the findings.

Several studies during the past decade have found that children younger than 18 years are not meeting the AAP recommendations for vitamin D intake.


“Multi-vitamins can be tricky for both adults and children. Clinicians should be advising parents to examine the labels on their children’s multivitamins closely,” King said.

“It is important to look at the serving size for the vitamins. Often the serving size is two to four vitamins to get to that dose of vitamin D,” Pfotenhauer agreed.

A review of the labels for the three best-selling multivitamin brands for children available from an online website on May 27, 2019 — SmartyPants Kids Complete Daily Gummy Vitamins, Mama Bear Organic Kids Multivitamin and Garden of Life mykind Organics Kids Gummy Vitamins — illustrate King and Pfotenhauer’s points. Though a serving size for each of those products met or exceeded the AAP guidelines, the serving size on each of those brands was, respectfully, four gummies, two gummies and four gummies.

Michal L. Melamed, MD, was an assistant professor of medicine at Einstein Medical Center in New York when she co-authored a Pediatrics study that found 61% children and teenagers had insufficient levels of vitamin D. She provided another way that might help children meet the vitamin D recommendation.

“It would be good [for parents] to turn off the TV and send their kids outside. Just 15 to 20 minutes a day should be enough. And unless they burn easily, don't put sunscreen on them until they've been out in the sun for 10 minutes, so they get the good stuff but not sun damage,” she said in a press release.

Other ways to get to that recommended dose of vitamin D include encouraging children to eat vitamin D–fortified milk and cereals, beef livers and egg yolks as well as certain orange juices, yogurts, margarines and portobello mushrooms, according to the NIH’s website. The agency also states that the fatty flesh of salmon, tuna and mackerel and fish liver oils are among the “best sources” of vitamin D. – by Janel Miller


Gordon CM, et al. Arch Pediatr Adolesc Med. 2004;doi:10.1001/archpedi.158.6.531.

Kumar J, et al. Pediatrics. 2009;doi:10.1542/peds.2009-0051.

Moon RJ, et al. Arch Dis Child 2019;0:1–3. doi:10.1136/archdischild-2018-316339.

NIH. “Vitamin D fact sheet for professionals.” https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/. Accessed May 27, 2019.

O'Neil CE, et al. Nutrients. 2018;doi:10.3390./nu10081050.

Wagner CL, et al. Pediatrics. 2008;doi:10.1542/peds.2008-1862.

Disclosures: Healio Primary Care was unable to determine relevant financial disclosures prior to publication.