Amanda Ursell, renowned TV nutritionist, answers
questions for healthcare and nursery practitioners
on toddler diets and the importance of early years nutrition

Why is vitamin D so important for toddlers?
Vitamin D is an essential vitamin for everyone because without enough of it our bodies cannot absorb the mineral calcium.
Calcium is crucial for the building and maintenance of strong bones. The knock-on-effect of too little vitamin D can result in the strength of our bones being adversely affected. This is a particular problem during the toddler years because during this time in a little person’s life their bones are growing at an astonishing rate of knots. Toddlers gain on average 40% of their height and weight during these few years.1 Therefore, it is now easier to understand the need for vitamin D, especially when in some cases a lack of it can lead to the deficiency disease rickets.

Once thought to be consigned to the history books here in the UK, experts have been alarmed to discover a resurgence of rickets in recent years,2 which in children causes a softening and weakening of the bones, a bowing of the legs and curving of the spine.

Currently it is estimated that one in four toddlers are failing to meet their recommended daily intake of vitamin D.3,4
In addition many toddlers appear to be spending too little time in the sun. This affects vitamin D levels in our bodies because this essential nutrient is predominantly made through the action of ultraviolet rays on our skin.

It is not just bones which can suffer in toddlers not getting enough vitamin D from food and sunlight. Vitamin D does other things in our bodies too, including helping control the growth rate of cells and the way our muscles and immune systems work. Too little vitamin D may adversely affect all of these important roles, as well as affecting toddler bone health.2
 
What are your top tips to help toddlers get enough vitamin D?
One of the simplest ways for toddlers to get enough vitamin D is for them to have a moderate amount of time outside in the sunshine every day but being careful to avoid turning red or burning. Just 15 minutes of sun on the hands, face and arms two to three times a week (without a high factor sunscreen) from April through to September, is enough to keep vitamin D levels up while keeping the risk of sun damage low.

Parents and carers of toddlers from an Asian or Afro-Caribbean background must take extra care to meet these guidelines, because skin pigmentation combined with a tendency culturally to spend less time out of doors with skin uncovered, can reduce vitamin D production.2 Unfortunately the sun doesn’t shine all year round so it’s essential to include a dietary source of vitamin D as well.

The next important tip is to bone up on which foods give us vitamin D. The only really good natural source of vitamin D in foods is oily fish. One serving of fish a week, such as salmon or sardines, can boost dietary intakes. So too can some breakfast cereals fortified with this vital nutrient. Eggs also contain vitamin D, but in smaller amounts than oily fish.

Many spreads, and all margarines, contain vitamin D. Small amounts of these and butter will also help a little to improve intakes, as will having eggs regularly in a toddler’s meal plan but it’s hard to get enough vitamin D from food alone.
The Department of Health recommends that all children over six months that are breast fed and having less than 500 ml infant formula per day should be given vitamin drop supplements that contain vitamins A, D and C,5 something that parents and carers may not be aware of. These should be taken until toddlers turn five. Research shows that in spite of this advice, less than a fifth of toddlers are actually taking them.4 Free vitamin drops are available to any family who qualify for the Healthy Start scheme, and reasonably priced versions are also available from all good chemists.

It is worth knowing that a daily 300 ml drink of toddler milk is not only an effective way of increasing vitamin D on a regular basis, but also provides other nutrients like iron, bone building calcium as well as helping toddlers to meet their vitamin A and C needs.

References
1.     WHO Multicentre Growth Reference Study Group. WHO Child Growth Standards based on length/height, weight and age. Acta Paediatr Suppl 2006;450:76–85.
2.     Shaw NJ, Pal BR. Vitamin D deficiency in UK Asian families: activating a new concern. Arch Dis Child 2002;86:147–9.
3.     The Reference Nutrient Intake of vitamin D for a toddler 1-3 years is 7μg per day. Department of Health. Dietary Reference Values for Food Energy and Nutrients for the United Kingdom. London: TSO, 1991.
4.     Bates B et al. National Diet and Nutrition Survey. Headline results from years 1 and 2 (combined) of the rolling programme, 2008/09 – 2009/10. London: HMSO, 2011.
5.     Department of Health. Birth to Five. London: HMSO, 2009.