Ensuring Sufficient Vitamin D Intake in Children

Even though Malaysia is a tropical country and receives sunlight all year long, almost half (47.5%) of the children here suffer from vitamin D insufficiency, according to the Nutrition Survey of Malaysian Children (SEANUTS Malaysia).

Vitamin D is essential for development of strong bones and a healthy immune system in children. Being deficient in this nutrient can predispose them to serious health risks like rickets, and also delay their growth and development.

Vitamin D functions
Vitamin D acts as a hormone that regulates calcium and phosphorus levels in the body. The balance of these minerals is crucial for healthy mineralisation of bones and teeth. This is important in children as they have rapid growth spurts, especially in the first few years of their lives. Adequate levels of vitamin D are necessary for the proper development of their skeletal system.

Besides that, vitamin D also has other non-skeletal roles, such as in the modulation of the immune and neuromuscular systems. Children with sufficient levels of this nutrient will experience better muscle strength and coordination, enhanced immune function, and an overall reduction in the risk of getting infections.

Sources of vitamin D
The sun, or more specifically the ultraviolet B (UVB) radiation, is the most abundant source of this vital nutrient. UVB penetration into the skin aids in the synthesis of vitamin D. However, lifestyle choices, such as spending more time indoors and wearing protective clothing or sunscreen, can reduce the body’s ability to produce sufficient vitamin D in children.

To address this limitation, parents must include foods rich in vitamin D in their child’s diet. Some of the essential dietary sources of this nutrient include:

• Natural foods: Fatty fish like mackerel and tuna, cod liver oil, and egg yolk
• Fortified foods: Milk, cereals, and margarine that are fortified with vitamin D
• Supplements: Vitamin D supplements are available in liquid or chewable form, and should be given to your child only after consultation with a paediatrician

Consequences of vitamin D deficiency
In infants and young children, vitamin D deficiency can lead to rickets. Rickets is a condition in which the bones become soft and weak due to impaired mineralisation. Common symptoms that children will present with are bone pain, muscle weakness, and cramps. If left untreated, rickets can lead to serious complications like bone fractures, slow dental development, and permanent bone deformities, including bowed legs and a hunched back (kyphosis).

In addition to the skeletal issues, children with deficient vitamin D are also at risk of delayed growth and development, weakened immune system that makes them susceptible to infections, and a higher chance of developing metabolic and autoimmune conditions like diabetes mellitus, multiple sclerosis, allergies, and eczema.

Ways to prevent vitamin D deficiency
Due to the serious manifestations of vitamin D deficiency in children, it is crucial for parents to ensure that their child receives a sufficient amount of this nutrient from an early age. Several strategies that can be followed include:

• Encourage your child to play outside around mid-morning or mid-afternoon for adequate UVB exposure. Exposing the skin for a shortburst of time on multiple days per week allows for greater vitamin D production. Conversely, dark skin tone, cloud cover, sunscreen, or protective clothing may limit the penetration of UVB into the skin.
• Provide a balanced and varied diet, which includes vitamin D-rich foods such as mackerel, tuna, and egg yolk.
• Choose foods and beverages that are fortified with vitamin Dsuch as milk, margarine, and fortified cereals.
• Consider vitamin D supplements, especially for infants who are exclusively breastfed. Consult with your child’s physician for the age-appropriate dose of vitamin D to prevent overdose and toxicity.

Vitamin D deficiency is a serious health concern in children, as it not only affects their normal growth and development but also predisposes them to a range of health conditions. Children should be encouraged to play outside to promote natural vitamin D production in their bodies, while parents must ensure their child gets adequate amounts of this nutrient through their diet. Talk to a nutritionist or dietitian to learn more on how you can increase your child’s vitamin D levels with the right foods and supplements.