By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

Q. Please comment about how much vitamin D children need as they are growing up. Also, does the location of where a child lives make it necessary to supplement vitamin D? My husband and I, in our early 60s, take supplemental vitamin D per the advice of our rheumatologist.

A. Last month the American Academy of Pediatrics ( doubled its recommended amount of vitamin D – necessary for bone absorption of calcium – to 400 International Units, for infants, children and adolescents:

“Breastfed and partially breastfed infants should be supplemented with 400 IU a day of vitamin D beginning in the first few days of life.”

“All non-breastfed infants, as well as older children, who are consuming less than one quart per day of vitamin D-fortified formula or milk, should receive a vitamin D supplement of 400 IU a day.”

“Adolescents who do not obtain 400 IU of vitamin D per day through foods should receive a supplement containing that amount.”

“Children with increased risk of vitamin D deficiency, such as those taking certain medications, may need higher doses of vitamin D.”

“Given the growing evidence that adequate vitamin D status during pregnancy is important for fetal development, the AAP also recommends that providers who care for pregnant women consider measuring vitamin D levels in this population.” For babies, formula should be fortified with vitamin D, but breast milk may not contain enough, even though it contains all kinds of important ingredients for health that are not in formula: antibodies, digestive enzymes, and just the right kinds and amounts of fats. Parents should ask their pediatrician to advise them about vitamin D drops for their breast-fed infants.”

As your question suggests, vitamin D requirements vary with exposure to sunlight, since sunlight is required to convert vitamin D to its active form. Children living in northern regions, who are dark skinned, or who spend every daylight hour swaddled from head to toe are more likely to need supplements.

Good dietary sources of vitamin D include fortified milk, eggs and fish. Vitamin D is sometimes added to orange juice, but dairy products other than milk are usually not fortified with vitamin D.

Vitamin D supplementation has reduced the incidence of rickets – weak, bowed bones due to poor calcium absorption that can occur with a Vitamin D deficiency – a great example of the power of prevention.

Q. Is it really at all healthy to limit fats and other caloric nutrients in otherwise healthy and growing young children?

A. Children under the age of 2 years (or 3, according to some experts) actually need the fats contained in whole milk for the rapid brain development that occurs in the first years of life. Some pediatricians are adjusting this recommendation to switch to 2 percent milk after 1 year of age when a child is already overweight or if there are risk factors for obesity, for example, overweight parents.

Calories are not bad, but necessary, in the right amounts. Children have specific caloric needs that depend on their age, size and activity level. The word “calories” is just a measure of the energy a food contains. However, foods that offer only calories and have no other nutritional value are best avoided since they run the risk of filling a child up with “empty” calories before all of her nutritional needs have been met.

Q. Are young children (age 10 and below) at risk from a high cholesterol diet – for example, from eating lots of egg and cheese sandwiches and similar foods?

A. Cholesterol and triglycerides can be a problem for children, especially if their diet is high in saturated fats, if they are obese, or if there is a family history of coronary artery disease or high triglycerides.

Eating habits and preferences do not begin in adulthood. Why start and reinforce unhealthy eating in childhood and then struggle to undo it later?

Responses to questions are not intended to constitute or to take the place of medical or psychiatric evaluation, diagnosis or treatment. If you have a question about your child’s health or well-being, consult your child’s health-care provider.

Dr. Brazelton, prior to his passing, was the founder and head of the Brazelton Touchpoints Center, which promotes and supports community initiatives that are collaborative, strength-based, prevention-focused sources of support for families raising children in our increasingly stressful world. Dr. Sparrow, a child psychiatrist, is currently the Director of the Brazelton Touchpoints Center. Learn more about the Center at

Reprinted with permission from the authors.