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Catherine M. Gordon, MD, MSc; Henry A. Feldman, PhD; Linda Sinclair, BA; Avery LeBoff Williams, BA; Paul K. Kleinman, MD; Jeannette Perez-Rossello, MD; Joanne E. Cox, MD

Arch Pediatr Adolesc Med. 2008;162(6):505-512.

Objectives  To determine the prevalence of vitamin D deficiency and to examine whether 25-hydroxyvitamin D (25OHD) concentration varies as a function of skin pigmentation, season, sun exposure, breastfeeding, and vitamin D supplementation.

Design  Cross-sectional sample.

Setting  Urban primary care clinic.

Participants  Healthy infants and toddlers (N = 380) who were seen for a routine health visit.

Outcome Measures  Primary outcomes were serum 25OHD and parathyroid hormone levels; secondary measures included data on sun exposure, nutrition, skin pigmentation, and parental health habits. Wrist and knee radiographs were obtained for vitamin D–deficient participants.

Results  The prevalence of vitamin D deficiency (20 ng/mL) was 12.1% (44 of 365 participants), and 146 participants (40.0%) had levels below an accepted optimal threshold (30 ng/mL). The prevalence did not vary between infants and toddlers or by skin pigmentation. There was an inverse correlation between serum 25OHD and parathyroid hormone levels (infants: r  = –0.27, P < .001; toddlers: r = –0.20, P = .02). In multivariable models, breastfeeding without supplementation among infants and lower milk intake among toddlers were significant predictors of vitamin D deficiency. In vitamin D–deficient participants, 3 participants (7.5%) exhibited rachitic changes on radiographs, whereas 13 (32.5%) had evidence of demineralization.

Conclusions  Suboptimal vitamin D status is common among otherwise healthy young children. Predictors of vitamin D status vary in infants vs toddlers, information that is important to consider in the care of these young patients. One-third of vitamin D–deficient participants exhibited demineralization, highlighting the deleterious skeletal effects of this condition.

Author Affiliations: Divisions of Adolescent Medicine (Dr Gordon and Mss Sinclair and Williams) and Endocrinology (Drs Gordon and Feldman), Clinical Research Program (Dr Feldman), Department of Radiology (Drs Kleinman and Perez-Rossello), and Division of General Pediatrics (Dr Cox), Children's Hospital Boston, Boston, Massachusetts.

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RELATED LETTERS

Vitamin D and Rickets Beyond America
Philip R. Fischer, Tom D. Thacher, and John M. Pettifor
Arch Pediatr Adolesc Med. 2008;162(12):1193.
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Vitamin D and Rickets Beyond America—Reply
Catherine M. Gordon, Henry A. Feldman, and Joanne E. Cox
Arch Pediatr Adolesc Med. 2008;162(12):1194.
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