Vitamin D: Still a topical matter in children and adolescents. A position paper by the Committee on Nutrition of the French Society of Paediatrics

• Published in: Archives de pédiatrie : organe officiel de la Société française de pédiatrie Vol. 19; no. 3; pp. 316 - 328
• Main Authors: Vidailhet, M., Mallet, E., Bocquet, A., Bresson, J.-L., Briend, A., Chouraqui, J.-P., Darmaun, D., Dupont, C., Frelut, M.-L., Ghisolfi, J., Girardet, J.-P., Goulet, O., Hankard, R., Rieu, D., Simeoni, U., Turck, D.
• Format: Journal Article
• Language: English
• Published: Paris Elsevier SAS 01-03-2012; Elsevier
• Subjects: Adolescent; Adult; Age Factors; Biological and medical sciences; Bone Development - physiology; Calcium - administration & dosage; Calcium - physiology; Child; Child development; Child, Preschool; Developmental psychology; Female; Fundamental and applied biological sciences. Psychology; General aspects; Humans; Infant; Infant, Newborn; Male; Medical sciences; Miscellaneous; Nutrition Policy; Nutritional Requirements; Pediatrics; Pregnancy; Psychology. Psychoanalysis. Psychiatry; Psychology. Psychophysiology; Public health. Hygiene; Public health. Hygiene-occupational medicine; Reference Values; Seasons; Societies, Medical; Vitamin D - administration & dosage; Vitamin D - physiology; Vitamin D Deficiency - drug therapy; Vitamin D Deficiency - etiology; France; Europe; Human; Pediatrics; Nutrition; Position; Feeding; Retinol; Local administration; French; Vitamin D; Adolescent; Paper; Society; Child; Public health
• ISSN: 0929-693X; 1769-664X
• DOI: 10.1016/j.arcped.2011.12.015

The aims of the present position paper by the Committee on Nutrition of the French Society of Paediatrics were to summarize the recently published data on vitamin D in infants, children and adolescents, i.e., on metabolism, physiological effects, and requirements and to make recommendations on supplementation after careful review of the evidence. Scientific evidence indicates that calcium and vitamin D play key roles in bone health. The current evidence, limited to observational studies, however, does not support other benefits for vitamin D. More targeted research should continue, especially interventional studies. In the absence of any underlying risk of vitamin D deficiency, the recommendations are as follows: pregnant women: a single dose of 80,000 to 100,000IU at the beginning of the 7th month of pregnancy; breastfed infants: 1000 to 1200IU/day; children less than 18 months of age, receiving milk supplemented with vitamin D: an additional daily dose of 600 to 800IU; children less than 18 months of age receiving milk not supplemented with vitamin D: daily dose of 1000 to 1200IU; children from 18 months to 5 years of age: 2 doses of 80,000 to 100,000IU every winter (November and February). In the presence of an underlying risk of vitamin D deficiency (dark skin; lack of exposure of the skin to ultraviolet B [UVB] radiation from sunshine in summer; skin disease responsible for decreased exposure of the skin to UVB radiation from sunshine in summer; wearing skin-covering clothes in summer; intestinal malabsorption or maldigestion; cholestasis; renal insufficiency; nephrotic syndrome; drugs [rifampicin; antiepileptic treatment: phenobarbital, phenytoin]; obesity; vegan diet), it may be justified to start vitamin D supplementation in winter in children 5 to 10 years of age as well as to maintain supplementation of vitamin D every 3 months all year long in children 1 to 10 years of age and in adolescents. In some pathological conditions, doses of vitamin D can be increased. If necessary, the determination of 25(OH) vitamin D serum concentration will help determine the level of vitamin D supplementation.
L’objectif de cette mise au point du Comité de nutrition de la Société française de pédiatrie est de résumer les connaissances récemment acquises chez l’enfant et l’adolescent et de proposer des recommandations de prescription. En l’absence de risque particulier, les recommandations sont les suivantes : femme enceinte : dose de charge unique de 80 000 à 100 000UI au début du 7emois de grossesse ; nourrisson allaité : 1000 à 1200UI/j ; enfant moins de 18 mois, recevant un lait enrichi en vitamine D : complément de 600 à 800UI/j ; enfant moins de 18 mois recevant un lait de vache non enrichi en vitamine D : 1000 à 1200 UI/j ; enfant de 18 mois à 5 ans et adolescent de 10 à 18ans : 2 doses de charge trimestrielle de 80 000 à 100 000 UI en hiver (novembre et février). En présence d’un risque particulier (forte pigmentation cutanée ; absence d’exposition au soleil estival ; affection dermatologique empêchant cette exposition ; port de vêtements très couvrants en période estivale ; malabsorption digestive, cholestase, insuffisance rénale, syndrome néphrotique ; certains traitements [rifampicine ; traitement antiépileptique: phénobarbital, phénytoine] ; obésité ; régime aberrant [végétalisme]), il peut être justifié de poursuivre la supplémentation toute l’année chez l’enfant de 1 à 5ans et chez l’adolescent, et de la maintenir entre 5 et 10ans. Dans certaines situations pathologiques, les doses peuvent être augmentées. Si nécessaire, le dosage de la 25(OH) vitamine D guidera la prescription de vitamine D.