Vitamin D and calcium supplementation 'vital from birth': New Indian Paediatrics Academy guidelines
Vitamin D deficiency is growing in India among all age groups, and Indian children in general have been reported to consume insufficient calcium.
This, in addition to Indians’ changing lifestyles and lack of fortification, led the IAP to create a practice guideline for paediatricians in order to better prevent and treat vitamin and calcium deficiency in Indian children and adolescents.
The academy compiled a list of recommendations for vitamin D and calcium intake for different age groups, from premature infants to adolescents.
The IAP said that “calcium and phosphorus in breast milk do not meet the needs of rapidly growing premature infants, who have missed some of the critical period of intrauterine bone growth”, which increases their risk of metabolic bone disease.
Other contributors to the risk of metabolic bone disease in premature infants include exposure to medications that alter mineral levels, immobilisation, and long-term parenteral nutrition.
In order to prevent rickets in premature babies, the academy recommended 400 IU of vitamin D, and between 150mg/kg and 220mg/kg of calcium daily, as well as phosphorous intake of 75mg/kg to 140mg/kg daily.
Newborn babies and infants up to one year old
Financial and logistical limitations in India often lead to vitamin D deficiency even in adults, and expectant mothers who are vitamin D-deficient pass it on to their babies. Hence, the IAP recommended 600 IU of vitamin D daily for pregnant and lactating women.
Furthermore, breast milk is not an adequate source of vitamin D, and formula milk can provide the daily recommended amount of vitamin D only if close to a litre is consumed.
400 IU of vitamin D supplementation a day for breastfed babies was recommended, from the first few days of their lives until they reach one year old.
In terms of calcium, “absorption is high in neonates, to the tune of around 60% (facilitated by lactose from breast milk)”. As such, the adequate calcium intake — based on the amount of calcium in breast milk — is 200mg a day.
The IAP added that if dietary calcium intake is insufficient in the first year of an infant’s life, 250mg to 500mg of calcium supplementation a day, depending on age, is warranted.
Children above one year old, and adolescents
Growth spurts and more time spent indoors, along with a diet low in milk and other calcium-rich food and drink, often lead to vitamin D and calcium deficiency.
The IAP recommended a daily 600 IU of vitamin D supplementation and 600mg to 800 mg of calcium for children above the age of one, as well as adolescents.
It concluded: “As a long-term policy, fortifying everyday staple foods with calcium and vitamin D is the solution to the problem. Till the time this can be implemented, supplementation...with adequate calcium intake for (the) prevention of deficiency is necessary.”
Source: Indian Academy of Pediatrics (IAP) Guidelines
“Prevention and Treatment of Vitamin D and Calcium Deficiency in Children and Adolescents: Indian Academy of Pediatrics (IAP) Guidelines”
Authors: Anuradha Khadilkar, et al.