AAP issues new guidelines on promoting bone health in kids, teens. ______________________________________________________ The American Academy of Pediatrics (AAP) has issued a new clinical report on how pediatricians can help their patients build strong bones. One motivation for issuing the report, said Dr. Neville Golden of Lucille Packard Childrens Hospital Stanford in Palo Alto, California, one of the lead authors, was to clear up confusion about testing for and treating vitamin D deficiency in children and adolescents. The AAP released Optimizing Bone Health in Children and Adolescents online September 29. It really reinforces the fact that pediatricians have a role to play in optimizing bone health, Dr. Golden told Reuters Health. Their role is really to ask about dietary intake of calcium and dietary intake of vitamin D, and also to promote weight-bearing exercise in young children. While some professional societies recommend screening healthy children who are at risk for vitamin D deficiency, such as children of color and obese children, Dr. Golden said, the AAP does not. The American Academy of Pediatrics does not support that because theres no evidence to prove that that could actually decrease the risk of fracture....the economic cost could be quite considerable, and theres no scientific evidence to show that it would make a difference. Instead, the AAP report recommends that children and adolescents with conditions that put them at risk for reduced bone mass, including certain genetic conditions, chronic illness, eating disorders, and endocrine conditions, as well as those on certain medications including glucocorticoids and anticonvulsants (all are listed in the report), should be screened for vitamin D deficiency by measuring 25-OH-D. While 20 ng/mL is considered a normal vitamin D level for healthy children, the authors note, some experts recommend bringing 25-O-HD levels above 30 ng/mL in children at risk of fracture. The report backs the Institute of Medicines (IOM) recommendations for calcium intake: 200 to 260 mg/day for infants; 700 mg/day for 1- to 3-year-olds; 1,000 mg/day for 4- to 8-year-olds; and 1,300 mg/day from ages 9 to 18. Since most adolescents dont drink a lot of milk, pediatricians should talk with them about other good dietary sources of calcium, such as cheese and yogurt, Dr. Golden said in a telephone interview. Dietary sources of calcium should be recommended in preference to calcium supplements, not only because of the improved bioavailability of dietary sources of calcium, but also primarily to encourage lifelong healthy dietary habits, he and his colleagues write. The IOM increased its recommendation for vitamin D intake in 2011, and the AAP supports those recommendations as well. Babies should get 400 IU daily (breast-fed infants usually need supplementation), with 600 IU daily recommended for young people up to age 18. Daily upper limits are 1,000 IU for infants up to six months old; 1,500 IU for infants six to 12 months old; 2,500 IU for children one to three years old; 3,000 IU for children four to eight years old; and 4,000 IU for children and adolescents ages nine through 18. While the sun is a key source of vitamin D, the authors note, children get less sun exposure today, and are likely to be wearing sunscreen when they are in the sun, so dietary sources of vitamin D become more important. These include cod liver oil, fatty fish (wild-caught salmon is a better source than farmed salmon, Dr. Golden noted) and fortified foods including milk and some juices. Other key recommendations for pediatricians in the report include: - Ask patients about their intake of calcium- and vitamin D-containing foods, use of supplements, and soda consumption. The report recommends asking these questions at the three-year-old visit, the nine-year-old visit, and at each annual adolescent health maintenance visit. - Ask patients about physical activity. Walking, jogging, jumping and dancing activities are better for promoting bone health than swimming or bicycle riding, according to the report, although too much high-impact exercise can boost fracture risk. - Dual-energy x-ray absorptiometry (DXA) scanning should be considered in children and adolescents with conditions associated with lower bone mass, or those who sustain clinically significant fractures after minimal trauma. - The authors also recommend that pediatricians be on the lookout for the female athlete triad in adolescents: low energy intake, menstrual dysfunction, and reduced bone mineral density. While adolescents with low bone mass may be prescribed oral contraceptives, Dr. Golden and colleagues note, there is no evidence that the medication builds bone mass, so this practice is not recommended. SOURCE: bit.ly/1pJl9I7 Pediatrics 2014.
Posted on: Fri, 03 Oct 2014 22:35:54 +0000
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