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How Much Vitamin D Does Your Child Need?

Tanya Altmann, MD

It’s been a little while since I had a “blonde moment” during an expert interview, but this one was pretty funny. I was in the middle of a podcast with Dr. Tanya Altmann, media personality and spokesperson for the American Academy of Pediatrics, about vitamin D – when I thought I heard her say that there were now special formulas of vitamin D for incense.

I knew that Dr. Altmann practiced medicine in Southern California, so I wasn’t terribly surprised about this new method of vitamin delivery. However, I hadn’t heard about vitamin D inhalation previously, so I asked her to explain how this new incense formula worked.

She paused to gather her thoughts and then corrected me: “No, I was saying that there’s a new formula for INFANTS…”

Oh. My bad.

So here’s the rest of our delightful interview. You may want to listen to the podcast, though I did edit out the awkward “incense” section so as not to start a new cult. One doesn’t want to give others too many ideas on the Internet! I hope that Dr. Tanya won’t think less of me for that misunderstanding.

Dr. Val: What is vitamin D, and why do we need it?

Dr. Tanya: Vitamin D is an essential nutrient for your entire body. Although it’s called a vitamin it actually functions as more of a hormone, playing an important role in the immune system. Vitamin D can help to protect people against illness, diabetes, and even cancer, though its role in helping to build strong bones (and protect infants from rickets) is probably its best known attribute.

Dr. Val: Tell me about the new AAP guidelines for infants, children and adolescents. Why did they change?

Dr. Tanya: Based on data collected in several recent research studies, the American Academy of Pediatrics issued new guidelines last month which essentially doubled the recommended daily amount of vitamin D (from 200 to 400 IUs) for infants, children, and adolescents. Historically people were able to get sufficient amounts of vitamin D through sun exposure (the body can create vitamin D when the skin is exposed to sunlight), but now that we need to protect kids from sun’s harmful rays due to future skin cancer risk, vitamin D levels have dropped significantly. Sunscreen, of course, blocks the sun from stimulating the creation of vitamin D in the skin.

Dr. Val: How can kids get enough Vitamin D? (Are there supplements that can be given? Which ones can be trusted?)

Dr. Tanya: Milk is the best food source of vitamin D. It’s really quite difficult to get enough vitamin D without consuming dairy products. One cup of milk has about 100 IUs of vitamin D. We recommend that all children over age 1 get 3 servings of dairy products a day, or the equivalent of 4 cups of milk a day. If they aren’t getting that much, we do recommend a vitamin supplement.

Dr. Val: What kind of supplements are safe and effective?

Dr. Tanya: Parents need to ask their pediatricians for specific recommendations. However, most infant formulas of vitamin D contain 400 IUs of vitamin D per milliliter. It’s easy to just squirt it into your baby’s mouth once a day just prior to nursing or giving them their bottle. I have two young boys and have tried a few different formulations of the vitamin D liquid. Some taste better than others, and some kids are pickier than others about flavor, so you have to find one that your child likes.

Dr. Val: What’s the most important “take home message” you’d like to get across to my readers (and listeners) about vitamin D?

Dr. Tanya: Parents should ask for advice from their pediatricians regarding the best source of vitamin D for their child. If you’re nursing, or if your infant is not taking in at least 32 ounces of formula a day, it’s important to start them on a vitamin D supplement beginning in the first four days of life.

Toddlers seem to really enjoy the chewable vitamin D supplements – but parents should make sure that they keep the bottle out of their reach since they may mistake them for candy. Teens and adults need to make sure they get 3 servings of dairy products a day, or else they should consider a vitamin D supplement as well.

Dr. Val: Tell me about your new book.

Dr. Tanya: Mommy Calls answers the most common questions that parents ask their pediatricians in their child’s first three years of life. Questions like “It’s 3am in the morning and my child has a fever of 103, what should I do?” or “My child hasn’t pooped for three days, what do I do?” It’s a fun, humorous little book that you can carry in your baby bag and it contains the exact advice I tell parents every day and night when they call me.

**Listen to the podcast of our interview here.**

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2 Responses to “How Much Vitamin D Does Your Child Need?”

  1. Jacqueline says:

    I enjoyed your pod cast — you should have left in the incense bit – that’s funny! As I read more and more and try to figure out how best to make sure my 2 and 6-year old kids receive enough vitamin D, I’m waking up to the fact that vitamin D deficiency is really something that affects the entire family. I really wish in the warnings for parents about what to do for their children, it could be mentioned what adults can do for their own health. I read somewhere that the reason why breastfed babies don’t get enough vitamin D from breastmilk is because their mothers don’t get enough vitamin D. Is this true? And FYI, my signature link has an article I especially liked from a holistic women’s health site on the topic of vit D and women.

  2. Allison says:

    I have a three yr old and she has always had a problem with constipation. Sometimes she will go a week without a bowl movement! I always worry about her. She has milk with her cereal every mourning. I think it's the milk causing her problem. How can I make sure she gets enough vitiman D?

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Richmond, VA – In an effort to simplify inpatient medical billing, one area hospitalist group has determined that “altered mental status” (ICD-9 780.97) is the most efficient code for use in any patient work up.

“When you enter a hospital, you’re bound to have some kind of mental status change,” said Dr. Fishbinder, co-partner of Area Hospitalists, PLLC. “Whether it’s confusion about where your room is located in relationship to the visitor’s parking structure, frustration with being woken up every hour or two to check your vital signs, or just plain old fatigue from being sick, you are not thinking as clearly as before you were admitted. And that’s all the justification we need to order anything from drug and toxin screens, to blood cultures, brain MRIs, tagged red blood cell nuclear scans, or cardiac Holter monitoring. There really is no limit to what we can pursue with our tests.”

Common causes of mental status changes in the elderly include medicine-induced cognitive side effects, disorientation due to disruption in daily routines, age-related memory impairment, and urinary tract infections.

“The urinalysis is not a very exciting medical test,” stated Dr. Fishbinder. “It doesn’t matter that it’s cheap, fast, and most likely to provide an explanation for strange behavior in hospitalized patients. It’s really not as elegant as the testing involved in a chronic anemia or metabolic encephalopathy work up. I keep it in my back pocket in case all other tests are negative, including brain MRIs and PET scans.”

Nursing staff at Richmond Medical Hospital report that efforts to inform hospitalists about foul smelling urine have generally fallen on deaf ears. “I have tried to tell the hospitalists about cloudy or bloody urine that I see in patients who are undergoing extensive work ups for mental status changes,” reports nurse Sandy Anderson. “But they insist that ‘all urine smells bad’ and it’s really more of a red herring.”

Another nurse reports that delay in diagnosing urinary tract infections (while patients are scheduled for brain MRIs, nuclear scans, and biopsies) can lead to worsening symptoms which accelerate and expand testing. “Some of my patients are transferred to the ICU during the altered mental status work up,” states nurse Anita Misra. “The doctors seem to be very excited about the additional technology available to them in the intensive care setting. Between the central line placement, arterial blood gasses, and vast array of IV fluid and medication options, urosepsis is really an excellent entré into a whole new level of care.”

“As far as medicine-induced mental status changes are concerned,” added Dr. Fishbinder, “We’ve never seen a single case in the past 10 years. Today’s patients are incredibly resilient and can tolerate mixes of opioids, anti-depressants, anti-histamines, and benzodiazepines without any difficulty. We know this because most patients have been prescribed these cocktails and have been taking them for years.”

Patient family members have expressed gratitude for Dr. Fishbinder’s diagnostic process, and report that they are very pleased that he is doing everything in his power to “get to the bottom” of why their loved one isn’t as sharp as they used to be.

“I thought my mom was acting strange ever since she started taking stronger pain medicine for her arthritis,” says Nelly Hurtong, the daughter of one of Dr. Fishbinder’s inpatients. “But now I see that there are deeper reasons for her ‘altered mental status’ thanks to the brain MRI that showed some mild generalized atrophy.”

Hospital administrators praise Dr. Fishbinder as one of their top physicians. “He will do whatever it takes to figure out the true cause of patients’ cognitive impairments.” Says CEO, Daniel Griffiths. “And not only is that good medicine, it is great for our Press Ganey scores and our bottom line.”

As for the nursing staff, Griffiths offered a less glowing review. “It’s unfortunate that our nurses seem preoccupied with urine testing and medication reconciliation. I think it might be time for us to mandate further training to help them appreciate more of the medical nuances inherent in quality patient care.”

Dr. Fishbinder is in the process of creating a half-day seminar on ‘altered mental status in the inpatient setting,’ offering CME credits to physicians who enroll. Richmond Medical Hospital intends to sponsor Dr. Fishbinder’s course, and franchise it to other hospitals in the state, and ultimately nationally.


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