FDA warns against overdosing infants with vitamin D

The Food and Drug Administration on Tuesday warned parents about the dangers of giving infants more than 400 international units (IU) of vitamin D, a risk that is exacerbated by the spread of supplement containers with droppers that hold larger amounts of the vitamin. At the same time, the agency sent a letter to manufacturers urging them to mark droppers more clearly and to use droppers that hold only the recommended amount of the vitamin.

Vitamin D promotes calcium absorption in the gut and plays a key role in the development of strong bones. Supplementation is recommended for some infants, especially those being breast-fed, because a deficiency can lead to bone problems such as thinning, soft and misshapen bones, such as those found in rickets.  Overdoses of the vitamin, however, can cause nausea and vomiting, loss of appetite, excessive thirst, frequent urination, constipation, abdominal pain, muscle weakness, muscle and joint aches, confusion and fatigue, as well as more serious consequences such as kidney disease. The American Academy of Pediatrics thus recommends that infants receive no more than 400 IU of vitamin D per day.

The problem, the agency said, is that many droppers in supplement bottles are not clearly marked with the correct amount, or are excessively large, increasing the likelihood that a parent can inadvertantly give an overdose. If a parent is unable to determine the dose of vitamin delivered by the dropper, he or she should contact their pediatrician or pharmacist for guidance.

-- Thomas H. Maugh II

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Comments

[Michael P. Doyle, M. D.]

It cannot be correct that the AAP recommends that infants receive "no more than 400 IU of vitamin D per day." They should not receive more than 400 IU as a supplement per day. If babies are getting some vitamin D in breast milk and taking a 400 IU supplement, they are getting more than 400 units, and that's great. Based on all the research demonstrating the alarming incidence of vitamin D deficiency and insufficiency, this is not a good time to be scaring people away from vitamin D.

[James Gern MD]

What dosage of vitamin D has been associated with the side effects that were listed by the FDA? This newsbrief is lacking some important information.

[Tim Cooper, M.D.]

Follow the link on the word 'recommends' and you will see that in fact the the AAP does *not* reccommend that children receive *no more than* 400 IU of vitamin D per day. The AAP recommends that "all infants and children, including adolescents, have a minimum daily intake of 400 IU of vitamin D beginning soon after birth." Wagner CL, Greer FR, and the Section on Breastfeeding and Committee on Nutrition [AAP]. Prevention of Rickets and Vitamin D Deficiency in Infants, Children, and Adolescents. Pediatrics. 2008;122:1142-1152.

[Chump]

Fairly suspicious that 3 MDs posted similar responses to this article. Sock puppets and astroturfers for supplement companies? Proceed with caution with their advice.

[Dad]

I am much more likely to heed the advice of a doctor than a CHUMP, chump. But of course you should ask your personal doctor and not get medical advice from a news blog.

[Lolita Alcocer, M.D.]

Parents should make sure they are dispensing medication correctly any time they are giving medication to a child. As opposed to adults, drug dosages for children are specifically based on their weight. Traditional measurements like a "teaspoon" or "tablespoon" are not encouraged because these can vary widely.

Instead, ask your pharmacist to clarify the dosage or better yet, as your doctor!

As for Vitamin D, the AAP (American Academy of Pediatrics) urges for a minimum of 400 units so the article was incorrect. This again highlights how important dosage specifications are and if you have any questions please ask your pediatrician!

[Gordon L Klein MD MPH FAAP]

What is not clear from what you write is the amount of vitamin D to be consumed by an infant that will produce these symptoms you describe. While your point of excessive dropper size is taken the amount of vitamin D that is toxic to infants needs to be defined.