Vitamin D deficiency is high among British children and has been linked to numerous health concerns in later life. We report on how the Vitamin D Mission campaign hopes to tackle the problem, and the other vitamins children can’t do without

As many people are aware, vitamin D – known as the ‘sunshine vitamin’ because of its primary source being the sun’s UV rays – is important for their health. However, living in the UK means sunny days are few and far between, so it’s no wonder that many children are lacking in this vital nutrient. In fact, a 2011 national diet and nutrition survey revealed that on average toddlers aged between 18 months and three years of age are getting only 27 per cent of their daily recommended nutrient intake (RNI) of 7-8.5mcg.

Vitamin D Mission is a national campaign featuring the Royal National Orthopedic Hospital, Kellogg’s, Cow & Gate and BetterYou DLux as its partners. The campaign aims to raise awareness of the importance of vitamin D and hopes to eradicate deficiency in children under five in the UK. The campaign’s recent report, Generation D, revealed that in particular, parents seem confused by the recommended vitamin D levels for children. The report showed that 77 per cent of parents were unaware of their child’s vitamin D requirements, while 35 per cent said they had never been told about their child’s specific needs.

Gloomy effects

Vitamin D is considered so important for the healthy development of children’s bones and teeth that the Department of Health recommends all children aged six months to five years take a daily supplement.

Vitamin D aids calcium absorption from the gut, which helps with the formation and maintenance of bones. The bone softening condition rickets is directly linked to vitamin D deficiency and causes skeletal deformities such as curvature of the spine, bowed legs and thickened wrists and ankles. Dr Benjamin Roberts, consultant paediatrician and clinical advisor for the Vitamin D Mission, said: “Rickets is still rare, but even a single case is unacceptable as it is a preventable disease.”

Research also suggests that vitamin D deficiency may be linked to the development of multiple sclerosis, osteoporosis, type 1 diabetes and even some cancers. However, these diseases can have many causes and vitamin D deficiency may just be one factor in their onset.

A challenging target

Reaching vitamin D targets can be a challenge. Our bodies cannot produce much, if any, between October and March because the UK’s geographical position means UV rays are too weak to have an affect. And, during any occasional sunny spells we do enjoy, many parents rightfully put sunscreen on their children, reducing the skin’s ability to absorb vitamin D.

Food sources are a good way to top up levels but can rarely provide the recommended daily intake. A child would have to eat an adult-sized portion of oily fish, such as salmon, or five eggs every day to meet their requirement. Other food sources include:

• Mushrooms grown with UV exposure
• Fortified dairy products
• Fortified cereal.

Infant and follow-on formula milks are also a source of vitamin D – in fact, it is a legal requirement that formula milks are fortified with the nutrient. The NHS recommends exclusive breastfeeding for the first six months of a baby’s life. However, mothers who cannot or choose not to breastfeed can be confident that formula milk will fulfill their baby’s vitamin D requirements. And most growing up milks (for infants aged 12 months plus) contain an increased amount of vitamin D to ensure that older children are getting the benefits too.

Breastfeeding mums should take a 10mcg vitamin D supplement throughout their pregnancy and while breastfeeding to ensure their baby gets a sufficient amount of the nutrient. From six months of age, all breastfed babies should be given vitamin D drops. Babies fed infant formula milk will not need supplements until they have less than 500ml a day, according to the NHS.

What’s supp?

Supplements are an easy and efficient way to ensure children are getting enough vitamin D, with some providing at least 100 per cent of the recommended intake. Babies and young children can have specially formulated oral sprays and drops, while older children could try syrups or chewable vitamins.

For lower income families, the NHS Healthy Start initiative offers free weekly vouchers for vitamins, as well as fresh and frozen fruit and vegetables and infant formula milk. Women may qualify if they’re at least 10 weeks pregnant or have a child under four years old and are on some form of income support or tax credits. Women younger than 18 and pregnant may also qualify. For details, see: healthystart.nhs.uk 

Vitamin D deficiency may be linked to the development of multiple sclerosis, osteoporosis, type 1 diabetes and even some cancers

Too much of a good thing

Sun exposure, fortified food and supplements may guarantee children meet their vitamin D requirements, but some research suggests excessive amounts can carry risks. Excess vitamin D may result in more calcium being absorbed than is excreted, causing it to be deposited in the kidneys, which can result in damage. It can also cause calcium to be removed from bones, making them soft and brittle.

However, the results are inconclusive and most experts agree that the body can process large amounts of vitamin D without causing harm. Leanne Olivier, doctor of nutrition and senior medical affairs manager at Cow & Gate, said: “Vitamin D is a safe vitamin; the benefits of increasing children’s supplies far outweigh the risk of having too much.”

Our bodies only produce as much vitamin D as they need, making it impossible to overdose from sun exposure. However, overdosing from dietary sources is almost equally as unlikely. The recommended daily intake for toddlers is 7-8.5mcg, while the safe upper limit is 25mcg for infants younger than 12 months and 50mcg for children aged one to 10 years. As vitamin D is found naturally in few foods, it’s very hard to meet a child’s RNI from their diet, and even harder to overdose from it, adds Dr Oliver.

But that’s not all…

As well as a daily dose of vitamin D, the Department of Health advises that children aged six months to five years are given daily vitamin A and C supplements. Vitamin A is important for young children as it strengthens the immune system, maintains healthy skin and helps with vision. Food sources include:

• Animal products such as liver, cheese and butter
• Orange coloured vegetables including sweet potatoes, carrots and butternut squash
• Green, leafy vegetables like spinach and kale

Some research suggests that having more than 1.5mg/day of vitamin A over many years can make bones more likely to fracture. Therefore liver and liver products like pâté, which are particularly high in vitamin A, should only be eaten once a week. Eleana Papadopoulou, nutrition scientist at the British Nutrition Foundation, commented: “It is possible for children who are taking vitamin A supplements and eating vitamin A-rich foods such as liver to get too much vitamin A, so it might be important to consider balancing the two out.”

Vitamin C is important for children’s general health as it protects cells, maintains protective tissue and helps heal wounds. Vitamin C is not stored in the body, so it’s important to include it in the daily diet. All fruit and vegetables contain some vitamin C, but the best sources are:

• Citrus fruits
• Peppers
• Berries
• Green, leafy vegetables
• Potatoes

Some research suggests that having more than 1,000mg/day can cause stomach pain, diarrhoea and flatulence. However, excess amounts are mainly excreted in the urine, so overdosing isn’t a concern.

Keeping the balance

Skin should be unprotected for maximum vitamin D absorption, but being sun safe should always be the priority when outdoors in warm weather. Parents should:

• Cover children’s exposed skin with a broad-spectrum sunscreen of at least SPF30
• Reapply sunscreen regularly
• Dress children in loose-fitting clothing, a wide-brim hat and British standard, ‘CE’ marked sunglasses

Babies under six months should be kept out of direct sunlight, but the Vitamin D Mission recommends that older children have a few minutes a day in the sun without protection before applying sunscreen, although not when the sun is at its strongest. The time required for the body to make vitamin D varies, but is typically short and does not require skin to redden or burn. As a rough guide, vitamin D is made when the shadow is shorter than the person.