American Academy of Pediatrics – Section on Endocrinology

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October 2, 2017

Avoid ordering Vitamin D concentrations routinely in otherwise healthy children, including children who are overweight or obese.

Although a 25-hydroxyvitamin D concentration, reflecting both vitamin D synthesis and intake, is the correct screening lab to monitor for vitamin D deficiency, current evidence is not sufficient to suggest that screening in otherwise healthy including children who are overweight or obese is necessary or safe.

Global consensus recommendations caution against population-based screening for vitamin D deficiency (1). The US Preventive Services Task Force also has noted that variability of current assays and unclear cutoffs for deficiency may lead to “misclassification” of persons as having vitamin D deficiency, and that this misclassification “could outweigh any benefits if there are harms” (2). The American Academy of Pediatrics report on Optimizing Bone Health in Children and Adolescents advises screening for vitamin D deficiency only in patients with disorders associated with low bone mass such as rickets and/or a history of recurrent, low-trauma fractures (3).

It has been shown that children who are overweight or obese have a greater likelihood of having low vitamin D levels (4). If the history suggests an obese child has insufficient dietary intake of vitamin D (e.g., little milk intake), a vitamin D supplement should be recommended, which is more cost-effective than 25-hydroxyvitamin D measurements for both screening and monitoring therapy.


These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.

How The List Was Created

The American Academy of Pediatrics’ Section on Endocrinology (SOEn) consists of pediatric endocrinologists, pediatricians, and allied health care professionals who are actively involved in some aspect of the study of endocrinological disease in infants, children and adolescents. SOEn strives to inform pediatricians, parents, communities and policy makers on endocrinological disease in children. Thus, the Executive Committee of SOEn was queried to develop a list of on diagnostic and management decisions that have resulted in patient harm either from a misdiagnosis or inappropriate therapy. The list was shared with membership of the Section on Endocrinology for feedback and then finalized by the SOEn Executive Committee. These five clinical issues are the result. Consensus on the items was received from 20 AAP expert groups. The list was critically reviewed and approved by the AAP Executive Committee.

AAP’s disclosure and conflict of interest policy can be found at www.aap.org.

Sources

Munns CF, Shaw N, Kiely M, Specker BL, Thacher TD, et al. Global Consensus Recommendation on Prevention and Management of Nutritional Rickets. J Clin Endocrinol Metab. 2016 Feb;101(2):394-415. Co-Published in Horm Res Paediatr. 2016;85(2):83-106.

LeBlanc E, Chou R, Zakher B, et al. Screening for Vitamin D Deficiency: Systematic Review for the U.S. Preventive Services Task Force Recommendation [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2014 Nov. (Evidence Syntheses, No. 119.)

Optimizing Bone Health in Children and Adolescents Golden N, Abrams S, COMMITTEE ON NUTRITION Pediatrics Sep 2014, 2014-2173.

Turer CB, Lin H, Flores G. Prevalence of vitamin D deficiency among overweight and obese US children. Pediatrics December 2012;doi:10.1542/peds2012-1711