Vitamin D Deficiency: More Common Than You Think

Rickets.  You do not hear about that condition very much these days and yet, it is on the rise.

You would think that as a pediatric health care provider I would have been on top of things.  However, I missed this.  Oh how I missed it and I am kicking myself.  Bad mama!  Thankfully, Ellie's endocrinologist had the foresight to perform a routine screen of not only Ellie's thyroid hormones (children with Ds are at a higher risk of hypothyroidism and should be screened annually), but also her Vitamin D levels.

She has very low levels of Vitamin D.  Low enough that it warranted a 6pm phone call from the endocrinologist to urge us to start therapy ASAP even though our appointment is actually in just a few weeks.



The Bear is now at risk for:

• Brittle bones and fractures
• Delayed growth
• Dental anomalies
• Bowed legs
• Insulin resistance and diabetes-Type 1 & Type 2
• Seizures-due to low calcium levels
• Suppressed immunity (i.e. decreased ability to fight off infections)
• Heart rhythm anomalies (related to low calcium levels)
• Muscle weakness and cramps
• Possibly some cancers

Now I am even more paranoid about her breaking a bone.

Why should we care?  What exactly does our body do with Vitamin D?

Vitamin D and Calcium have a symbiotic relationship.  Vitamin D helps bones absorb calcium in the gastrointestinal system.  With low levels of Vitamin D, approximately only 15% of dietary calcium may be absorbed.  If you think about how young children are trying to grow and thus form sturdy bones, poor vitamin D intake (either from skin absorption from the sun or by dietary intake) can lead to poor calcium absorption and therefore weaker bones.  Hence, the increase in fractures or bowing of the legs.

Calcium is not only for our skeletal structure. It is, infact, involved in how our heart operates and muscle contractions.  Again, low Vitamin D leads to poor calcium absorption which leads to heart problems, low muscle tone, and muscle spasms.

Vitamin D also plays huge roles in cellular growth, the neuromuscular system, and in immune function.




Why are Vitamin D deficiencies on the rise?

You would think that since we have access to many sources of fortified foods such as milk and orange juice that proper levels of Vitamin D would be easy to obtain.  The Bear, however, has a milk intolerance as do many children these days.  She also does not eat fatty fish or eggs.  (she is rather picky!).  While breast feeding in the U.S. is increasing (whoo hoo!), mama's milk is not fortified with Vitamin D and therefore supplementation is recommended.

Still not getting enough Vitamin D: cloudy, legs covered, not outside long enough

Skin exposure to the sun can lead to the formation of Vitamin D .  However, many of us slather our children with sunscreen and fully cover them in clothing/hats/sunglasses (and with good reason!  Bye-bye skin cancer!).  Rainy climates or those like Texas where it is triple digits for many months can limit opportunities to soak up the sun.  Cloud coverage and even smog can affect the skin's ability to produce an adequate amount of Vitamin D.  To receive enough UVB rays to synthesis Vitamin D, a person would have to be mostly exposed (legs, arms, face, and possibly back) to the sun during peak hours of 10am to 3pm (school/daycare hours) for anywhere from 5-30 minutes without sunscreen!  I don't know about you, but I am not a big fan of skin cancer.  Additionally, in 2003, The American Academy of Pediatrics recommended limiting sun exposure due to the risk for skin cancer, even for the purpose of receiving Vitamin D.

Those at higher risk include: breast-fed infants, those with darker skin, low exposure to sun light, poor dietary intake or Vegan diet, stomach ailments that decrease Vitamin D absorption such as celiacs disease or crohn's disease, kidney problems that prevent the conversion of Vitamin D to its active form.



What are the symptoms of low levels of Vitamin D?

• Bowed Legs
• Slowed Growth or Failure to Thrive
• Delayed tooth formation 
• Frequent cavities
• Low muscle tone
• Muscle cramps
• Muscle spasms

Notice that some of these symptoms are similar to Down syndrome-slower growth, delayed tooth formation, low muscle tone. . .

A vitamin deficiency seems so innocuous, especially when many kids are asymptomatic.  A simple blood test can tell if your little bambino is deficient in this important vitamin.

Bowed Legs

I really didn't think about Vitamin D.  I figured that I had Ellie covered because, while a picky eater, I sometimes gave her vitamins and Fish Oil.  However, that may not be enough!

In fact, the American Academy of Pediatrics recently (actually in 2008), updated their recommendations:  all children should be taking supplemental Vitamin D--up to 400 IU daily.  The previous recommendation was 200 IU daily.  This is in addition to eating foods fortified with Vitamin D such as milk, tuna, salmon, fortified cereals and orange juice, fatty omega acids, eggs, yogurt, and cheese.

Lil' Critters Fish Oil contains 100 IU of Vitamin D
Lil Critters Multiple Vitamins contain 400 IU of Vitamin D
If you combine these together, the Vitamin D intake is over the recommended dosage.  However, look at the Lil' Critters serving size--it is not one, but TWO gummies of each.  If you use regular fish oil and not a gummy, like we occasional do, there may be no Vitamin D.

Additionally, if getting vitamins into your little picky toddler (i.e. Ellie Bear) is rather inconsistent, your child could be at risk.


If your child is already showing below normal levels, supplemental vitamin D is needed.  For instance, the Bear will be taking 2,000 IU daily of Vitamin D3 plus a prescription of 10,000 IU weekly!   Wish me luck in getting all of that into her.  My hope is that, in 3 months, we shall see her levels trend more towards normal.

Right now, I am very fortunate that my Climbing Monkey has not broken any of her "brittle" bones given her propensity to climb.


Please, at your next well-child check, ask her provider to measure her Vitamin D levels.  I do wonder just how long The Bear has been strutting around with low levels and poorly-forming bones.





References:
American Academy of Pediatrics: Guidelines for Vitamin D In-take. (2008)
Mayo Clinic: Nutrition & Healthy Eating.
NIH: Rickets. (updated 2012)
NIH: Health Professional Dietary Fact Sheet: Vitamin D
John' Hopkins Children's Center: Memo to Pediatricians: Screen All Children for Vitamin D Deficiency, Test Those at High Risk (2012)