What is Vitamin D Deficiency?
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| Vitamin D deficiency in children symptoms |
As the name implies, a low level of vitamin D in the body is termed as vitamin D deficiency. So what is vitamin D deficiency? In fact, the level of vitamin D in the blood serum is measured in the form of 25-hydroxy-vitamin D (calcidiol) which determines it. A deficit is considered to be below 25 nml / L and deficiency is considered to be insufficient if it is below 25-50 nml / L. When the level is above 50 nml / L, there is evidence of benefits in bone, muscle, immunity and insulin secretion.
Why is vitamin D important for children?
Nutrition is very complex and requires a perfect balance for its optimal benefits. The body can fill a small deficit and many times, even an additional deficit, but only in small amounts, especially in the case of growing children. It is vitamin D that will enable your baby to play around without difficulty and with good strength and power. Bone needs calcium and phosphorus to carry energy, war and tears and weight. Vitamin D ensures that the bones are not deprived of either. Vitamin D enables the intestinal lining to absorb calcium from food, process it in the blood and store it in the bones. Calcium is important for the functioning of every cell in the body. It is needed to open the door of the cell to get molecules to produce energy and to supply energy to your muscles to start the contraction of each muscle fiber. It helps us understand why vitamin D is important for children and how its deficiency will affect them.
Types of Vitamin D You Should Give Your Child
There are two vitamin D supplements, vitamin D2 (calciferous) and D3 (cholecalciferol). Although both D2 and D3 are traditionally considered to be equally strong, studies have shown that D3 can be at least 3 times stronger than D2. So D3 supplements are the preferred type. In fact, in most countries today, it is the only commercially available form of vitamin D.
Causes of Vitamin D Deficiency
The most important cause of vitamin D deficiency is limited or no exposure to sunlight. However, even in countries like India where there is plenty of sunlight, it is still quite common. Why is this? To understand other factors, you need to understand how vitamin D is produced, processed, stored and used by the body.
Upon exposure to UV B in the sun's rays, the epidermis (the upper layer of the skin) converts cholesterol into provitamin D3, which enters the bloodstream and is transferred to the liver. Vitamin D also comes from foods / supplements, absorbed from the stomach and sent to live. The liver converts it to a more potent form, which is calcidiol, which is still inactive. It is then transferred to the kidneys where it is converted to calcitriol - this form is actively ready to work. So now it is easier to understand that vitamin D deficiency can be created in the following situations even after being in good sunlight.
Low vitamin D synthesis: dark skin, ultraviolet rays, sunscreen lotions and clothing, latitude (UVB is not very effective in sunlight in the UK for example), seasons, air pollution, limiting the time spent outside of children and adolescents Vitamin D synthesis is reduced as a result of air-conditioned housing, colored glasses, light sensitive skin conditions, etc.
Decreased acceptability of vitamins in food: Strict vegan diet, dietary habits (low intake of vitamin-rich foods), elimination diet (e.g. milk allergies), etc.
Decreased Maternal Vitamin D Storage: Exclusive breastfeeding where the mother does not store enough vitamin D in her body to nurture the child.
Malaabsorption: pancreatic insufficiency, celiac disease, biliary obstruction that impedes proper absorption of vitamins.
Impaired synthesis: Chronic liver disease, kidney disease, etc. can lead to impaired function of the organs necessary for the production and absorption of vitamin D.
Increasing Depletion: Drugs such as anticonvulsants, anti-tuberculosis, steroids that may interfere with the process of vitamin D production or absorption.
Signs and symptoms of vitamin D deficiency in children
Signs and symptoms vary with age:
Vitamin D deficiency in baby:
1. Stagnant growth and developmental delays: Even if there are no known health problems and even after eating well, your baby may not be identified according to height, weight and other developmental milestones.
2. Agility, laziness: The child is no longer restless and attentive and most of the time is abnormally wheezing and annoyed for no reason.
Signs and symptoms of vitamin D deficiency in children
3. Convulsions: One of the causes of convulsions in children is vitamin D deficiency and requires immediate treatment.
4. Tetany: This is a stage of hypocalcemia that refers to low levels of calcium in the blood. There are many causes of calcium deficiency such as poor diet, poor absorption, vitamin D deficiency, abnormal parathyroid hormone secretion, kidney abnormalities, apneal spells (sudden episodes of shortness of breath), odor, muscle weakness and muscle cramps.
5. Cardiomyopathy: Low vitamin D affects all the muscles in the body so the heart muscles also become weak.
Vitamin D deficiency in children:
1. Pain and suffering: They are frequent pains in the hands, feet, body in proportion to the child's physical development milestone which is not accurate.
2. Muscle Weakness: Muscle weakness is due to delay in walking, difficulty in climbing stairs etc.
3. Rickets: Injured knee, growing deformity of the foot, bent gate, abnormally curved knee deformity, swelling of the wrist and costochondral junction, prolonged bone pain (> 3 months duration).
4. Bad growth: Despite a healthy diet, active lifestyle and any previous medical problems, bad growth may not indicate vitamin D deficiency.
5. Easy to break: Lack of vitamin D indicates that calcium is not absorbed properly. Minor injuries can easily lead to fractures.
6. Frequent lower respiratory infections: Vitamin D plays an important role in the development of pulmonary function and immunity and frequent infections can be caused by the same deficiency.
7. Delayed anterior-fontanel closure: The anterior-fontanel is a diamond-shaped open portion at the front of the head. It is a gap in the skull that gradually closes at the age of 18-24 months. Due to the functionality of the disabled bone, it will be delayed.
8. Delayed Teething: Like other milestones, lack of adequate calcium can lead to delayed or brittle teeth.
9. Abnormal bone profile or X-ray: X-ray of the wrist or ankle or chest causes swelling of the bones and abnormal curvature of the long bones due to low calcium levels.
10. Abnormal blood tests: low plasma calcium or phosphate levels, raising alkaline phosphate.
Treatment for vitamin D deficiency
It takes a long time for vitamin D to be stored in the body after the synthesis is reduced or stopped. So naturally, it will also take a long time to replenish. The goal of treatment is to restore and maintain vitamin D levels of ≥ 50 nml / L.
The various options are:
1. Complementary:
Complement the low dose daily
High-dose therapy once a week
2. Make sure you get enough calcium
For babies who dislike cow's milk, yogurt, cheese and fortified soy milk are useful sources of calcium. Consider medicinal supplements if the intake is low.
3. Revealed in sunlight
Dark-skinned children and adolescents can tolerate sunlight and do not need sunscreen. Hats and sunglasses can be used. Encourage them to do outdoor activities.
Supplements: Who should take supplements?
1. Infants who are exclusively breastfed without any signs or symptoms.
2. Breastfeeding mothers with vitamin D deficiency have at least one or more risk factors for infants.
3. Absolutely formula-fed babies who cannot get enough vitamin D from formula milk. It is recommended to check the levels of vitamin D in children at risk or add daily supplements.
How to give vitamin D to a child:
Vitamin D is available in tablet and liquid form and is also available in a combination of calcium. You can grind the tablet or open the capsule and mix it with food.
How to prevent vitamin D deficiency in children?
In general, supplementation with adequate sunshine and vitamin D-rich foods in addition to supplements if necessary will help to increase prevention strategies rather than just supplements. 5-15 minutes of exposure to sunlight for light skinned children and 30-45 minutes for dark skinned children will be helpful and it is also natural. Early morning sunlight is better because it has lower levels of harmful UV rays.
Maternal Vitamin D
- The most important aspect that determines vitamin D levels in children is the amount of vitamin D in the mother. Pregnant women should have their vitamin D levels checked in the first trimester of pregnancy. If it seems low, it is best to treat with 3000-5000 IU daily until it does not exceed> 20 ng / dl.
- High doses of vitamin D (400-6400 IU) are recommended for breastfeeding mothers daily to protect their babies from vitamin D deficiency without any poisoning.
Premature baby
It is important to give a supplement of 400-600 IU / day from birth, as the baby is more likely to receive insufficient vitamin D transfer from the mother.
-One of the problems related to premature birth such as poor feeding ability, affects the absorption of immature gastrointestinal tract and in some cases can lead to liver and kidney weakness and the problem should be solved accordingly.
Newborn
Make sure your baby has enough vitamin D. It is generally advisable to start supplementation without testing only breastfed infants with at least one other risk factor without signs / symptoms. Most infant formula milk contains 400 IU / L. Thus, formula-fed infants may need supplements until they are given at least 1 liter of formula per day.
Children and adolescents
Children who are at risk, such as dark-skinned children, children who are exposed to sunlight, children who have little or no exposure to sunlight, or who have an underlying medical problem, for which they are given 400 IU per day to prevent vitamin D deficiency Should.
Vitamin D is the best food for children
Although plants synthesize vitamin D, that form of vitamin cannot be used by the human body. So the only source of vitamin D is animal food. Unfortunately, the only animal food that children consume is milk (cow's milk: 3–40 IU / L). In fact it is not a rich source of vitamin D, it has the role of fortification (adding extra nutrients to the diet).
Fortified foods rich in vitamin D.
- Fortified milk 400 / L
- Fortified infant formula milk 400 / L
- Fortified orange juice 400 / L
- Fortified soy milk 400 / L
- Fortified rice milk 400 / L
- Fortified margarine 80 / tbsp
- Fortified serial 40 IU / per serving
- Fortified tofu (1/5 block) 120
- Fortified oil
The foods that older children can eat are:
1. Oily fish such as salmon, mackerel and sardines, cod liver oil, liver. Fried fish reduces the active vitamin D content by 750%, but does not affect the amount of vitamin D in baked fish.
2. The flesh of the limbs
3. Egg yolk (20-25 IU per yolk)
Is there a risk if I give my baby too much vitamin D?
Yes. Too much vitamin D can cause toxicity. Vitamins B and C are water soluble (excess amount is excreted from the body). Vitamins A, D, E and K are fat soluble, accumulate in the body and cause problems if in excess.
Conclusion: Even in tropical countries like India, there is growing evidence of vitamin D deficiency among adults and children. With adequate advice from a pediatrician, it is best to fight the problem with proper care in the beginning by adding vitamin D to the baby's diet so that no problem is prevented later on.
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