Preventing Symptomatic Vitamin D deficiency/Rickets among Indigenous children - CPS Statement

Question 1

What are the skeletal manifestations of severe Vitamin D deficiency/Rickets? (there are 4 main ones)

Answer 1

Lower limb deformities (e.g., bowed femurs or tibias)

Spinal deformities

Enlargement of growth plates
- wrist
- ankles
- costochondral junctions (rachitic rosary)

Craniotabes

Question 2

Severe Vitamin D deficiency can lead to seizures due to what mechanism?

Answer 2

Hypocalcemia

Question 3

What is the cardiac manifestation of severe Vitamin D deficiency?

Answer 3

Cardiomyopathy

Question 4

What is the maximum level of dietary Vitamin D intake for children < 6 months of age?

Answer 4

1000 IU/day

Question 5

What is the maximum level of dietary Vitamin D intake for children 6 - 12 months of age?

Answer 5

1500 IU/day

Question 6

What is the maximum level of dietary Vitamin D intake for children aged 1-3 and 4-8 years of age?

Answer 6

2500 and 3000 IU/day

Question 7

What are the risk factors for low maternal Vitamin D levels? (there are 5)

Answer 7

1) Low intake of VitD-rich foods (consuming <2 cups/day of milk or fortified soy beverage, low consumption of fish and sea mammals)
2) Lack of VitD supplementation during pregnancy
3) Use of certain medications (e.g., some antiretrovirals and antiepileptics)
4) Multiple pregnancies
5) Smoking

Question 8

What are general factors (i.e. include both infant and mother) for severe Vitamin D deficiency? (there are 7)

Answer 8

1) Darker skin pigmentation
2) Food insecurity
3) Obesity
4) Living in communities north of 55° latitude
5) Living in an area where VitDD is prevalent
6) Extensive use of sunblock or skin coverage by clothing, or lack of exposure to the outdoors
7) Low socio-economic conditions

Question 9

What is the Vitamin D requirement for prenatal women?

Answer 9

Dietary advice plus a daily prenatal vitamin containing 400 IU VitD, folic acid, and iron

Question 10

What is the Vitamin D requirement for high-risk prenatal women?

Answer 10

Dietary advice plus daily prenatal vitamin containing 400 IU VitD, folic acid, and iron.

Plus an additional 1000 IU/day VitD

Question 11

What is the Vitamin D requirement for infants at high risk of Vit D deficiency who are exclusively or partially breast-fed?

Answer 11

800 IU/day in the first year of life.

If the high-risk infant transitions to cow’s milk, supplement with 400 IU/day.

Question 12

What is the Vitamin D requirement for infants at high risk of Vit D deficiency who are formula fed?

Answer 12

400 IU/day in the first year of life.

Continue supplementation beyond 12 months with 400 IU/day if the infant remains at high risk.

Question 13

What is the Vitamin D requirement for children 1-5 years of age if at high risk of Vit D deficiency?

Answer 13

Dietary advice and 400 IU/day