Vitamin D and Why Pediatricians in Northern States Recommend It for Almost Every Child

Names and identifying details of every student here are changed, as they are everywhere on the blog.

Inga moved here from Minnesota in July with a baby of 7 months and a boy of 5. In Minneapolis the pediatrician put both of them on vitamin D drops without any discussion, the way you hand somebody a receipt. Now she is in California, the sun is on all the time, and she wants to know whether the drops were a northern thing she can stop. Short answer, no. Longer answer is more interesting, and it is the reason this goes to almost every child up north in the first place. H2: Why the north gives it to everyone Skin makes vitamin D from sunlight, and in the northern half of the country the winter sun is too weak for months at a time. Add the rest of it. Children are indoors, they are dressed, and the ones with more melanin in their skin make less of it from the same amount of light. For a pediatrician in Minnesota that is not three groups of patients, it is all of them, so the drops go to everybody and nobody argues. Immigrant families carry one more layer, and it is the part Inga had never heard. The food here is not the food at home. American milk and formula are fortified with vitamin D, and a family that drinks tea, eats differently, or skips dairy entirely does not get that fortification at all. H2: Two numbers worth remembering The guidance itself is short. Under 12 months, 400 international units a day, IU on the bottle. From a year old through the teens, 600 IU. A breastfed baby starts on the supplement in the first days of life, because breast milk simply does not carry enough, whatever the mother takes herself. With formula, and with older children, the rule works around the milk. While a child drinks less than about 32 ounces a day of fortified formula or milk, the supplement stays.

These are the same numbers in Minnesota and in Los Angeles. The latitude changes the risk, not the recommendation.

H2: What actually changes in California Less than families expect. The sun is here, but the child is in school from 8 to 3, and wears sunscreen, which is the right thing for skin. In theory sunscreen lowers how much vitamin D the skin makes, though in practice almost nobody puts on enough for that to be what decides it. A teenager who goes from the car to the classroom to the bedroom is not getting much from that sun either. So the honest answer for Inga was to keep both children on the drops and to ask the pediatrician here, who will know their diet and their risk factors, which I do not. H2: Whether to test the blood Her second question. Testing every healthy child is not the usual recommendation, and a test gets ordered when there are reasons, not as a routine. The reasons are things a pediatrician asks about anyway, how much milk, how much sun, what medicines, whether there are problems with absorbing fat. Which means the conversation at the visit is short and specific, and does not have to involve a lab at all. H2: My own version of this In Rosario I was outside constantly and nobody said the words vitamin D to me once. In my first year here a doctor ran a panel, told me my level was low, and I remember being insulted by it, as if the sun I grew up in had been taken away from me. Now I take mine in the winter and forget it in the summer, which my doctor says is a very Argentine way to follow instructions. H2: How it ended Both children stayed on the drops. The pediatrician here looked at the baby’s formula, did the arithmetic on the ounces, and changed nothing. Inga said she had been expecting a debate and got a shrug. Moving changes the food, the light and the doctor, and the other thing it changes quietly is the language the children answer in. Palme School teaches children from four years old, online, in small groups, 40 minutes a lesson, and every family starts with two free sessions, a conversation with a methodologist and then a trial lesson in a group. A child who follows Russian and answers back in English belongs in Russian for bilingual children. When the speech is fine and the page is where everything stops, that is the reading school.

Frequently asked questions

How much vitamin D does a child need?

Pediatric guidance sets 400 international units (IU) a day for babies under 12 months and 600 IU a day for children from one year through adolescence.

Does a breastfed baby need a supplement?

Yes. Breastfed and partially breastfed infants are advised to receive 400 IU a day beginning in the first days of life, because breast milk does not provide enough vitamin D on its own.

What about formula-fed babies and older children?

Infants who are not breastfed, and older children, are advised to take a 400 IU supplement if they consume less than about 32 ounces a day of vitamin D-fortified formula or milk.

Who is at higher risk of deficiency?

Children with more melanin in their skin, those living at northern latitudes or spending little time outdoors, and children with conditions affecting fat absorption or taking certain medications.

Should my child have a blood test for vitamin D?

Routine testing of healthy children without risk factors is not generally recommended. A pediatrician decides based on diet, sun exposure, medications and medical history.

Palme School: Russian for bilingual children · Reading school · Free materials for families

Monica Perez is from Rosario, Argentina. These days she does nails in Los Angeles, and her regulars are mostly Russian-speaking, which is how these stories reach her before they reach anybody else.