Rickets in infants attributable to inadequate vitamin D intake and decreased exposure to sunlight continues to be reported in the United States. There are also concerns for vitamin D deficiency in older children and adolescents. Because there are limited natural dietary sources of vitamin D and adequate sunshine exposure for the cutaneous synthesis of vitamin D is not easily determined for a given individual and may increase the risk of skin cancer, the recommendations to ensure adequate vitamin D status have been revised to include all infants, including those who are exclusively breastfed and older children and adolescents. It is now recommended that all infants and children, including adolescents, have a minimum daily intake of 400 IU of vitamin D beginning soon after birth. The current recommendation replaces the previous recommendation of a minimum daily intake of 200 IU/day of vitamin D supplementation beginning in the first 2 months after birth and continuing through adolescence. These revised guidelines for vitamin D intake for healthy infants, children, and adolescents are based on evidence from new clinical trials and the historical precedence of safely giving 400 IU of vitamin D per day in the pediatric and adolescent population. New evidence supports a potential role for vitamin D in maintaining innate immunity and preventing diseases such as diabetes and cancer. The new data may eventually refine what constitutes vitamin D sufficiency or deficiency.

This clinical report covers diagnosis and prevention of iron deficiency and iron-deficiency anemia in infants (both breastfed and formula fed) and toddlers from birth through 3 years of age. Results of recent basic research support the concerns that iron-deficiency anemia and iron deficiency without anemia during infancy and childhood can have longlasting detrimental effects on neurodevelopment. Therefore, pediatricians and other health care providers should strive to eliminate iron deficiency and iron-deficiency anemia. Appropriate iron intakes for infants and toddlers as well as methods for screening for iron deficiency and iron-deficiency anemia are presented. Pediatrics 2010;126: 1040-1050 INTRODUCTIONIron deficiency (ID) and iron-deficiency anemia (IDA) continue to be of worldwide concern. Among children in the developing world, iron is the most common single-nutrient deficiency. 1 In industrialized nations, despite a demonstrable decline in prevalence, 2 IDA remains a common cause of anemia in young children. However, even more important than anemia itself is the indication that the more common ID without anemia may also adversely affect long-term neurodevelopment and behavior and that some of these effects may be irreversible. 3,4 Because of the implications for pediatric health care providers and their patients, this report reviews and summarizes this information.This clinical report is a revision and extension of a previous policy statement published in 1999, 5 which addressed iron fortification of formulas. This report covers diagnosis and prevention of ID and IDA in infants (both breastfed and formula fed) and toddlers aged 1 through 3 years.

This clinical report replaces the 1998 policy statement from the American Academy of Pediatrics on cholesterol in childhood, which has been retired. This report has taken on new urgency given the current epidemic of childhood obesity with the subsequent increasing risk of type 2 diabetes mellitus, hypertension, and cardiovascular disease in older children and adults. The approach to screening children and adolescents with a fasting lipid profile remains a targeted approach. Overweight children belong to a special risk category of children and are in need of cholesterol screening regardless of family history or other risk factors. This report reemphasizes the need for prevention of cardiovascular disease by following Dietary Guidelines for Americans and increasing physical activity and also includes a review of the pharmacologic agents and indications for treating dyslipidemia in children. Pediatrics 2008;122:198-208 INTRODUCTION Cardiovascular disease (CVD) is the leading cause of death and morbidity in the United States. 1 Most of the clinical burden of CVD occurs in adulthood. However, research over the last 40 years has increasingly indicated that the process of atherosclerotic CVD begins early in life and is progressive throughout the life span. 2 It has also become clear that there is an important genetic component to the disease process that produces susceptibility but that environmental factors, such as diet and physical activity, are equally important in determining the course of the disease process.This statement replaces the outdated 1998 American Academy of Pediatrics (AAP) policy statement "Cholesterol in Childhood," which has been retired. 3 New data emphasize the negative effects of excess dietary intake of saturated and trans fats and cholesterol as well as the effect of carbohydrate intake, the obesity epidemic, the metabolic/insulin-resistance syndrome, and the decreased level of physical activity and fitness on the risk of adult-onset CVD. In addition, more data are now available on the safety and efficiency of pharmacologic agents used to treat dyslipidemia. Most of these data were not available at the time of the previous statement.A number of studies have identified potential risk factors for adult CVD. 4 The strongest risk factors include a high concentration of low-density lipoprotein (LDL), a low concentration of high-density lipoprotein (HDL), elevated blood pressure, type 1 or 2 diabetes mellitus, cigarette smoking, and obesity. Research in children and adolescents has demonstrated that some of these risk factors may be present at a young age, 5 and pediatricians must initiate the lifelong approach to prevention of CVD in their patients. The focus of this report is on improving lipid and lipoprotein concentrations during childhood and adolescence to lower the lifelong risk of CVD. The current obesity epidemic among children has increased the need for pediatric health care professionals to be knowledgeable of the risk factors for CVD and to implement the changes recommended in...

This clinical report reviews the nutritional options during pregnancy, lactation, and the first year of life that may affect the development of atopic disease (atopic dermatitis, asthma, food allergy) in early life.

Soy protein-based formulas have been available for almost 100 years. Since the first use of soy formula as a milk substitute for an infant unable to tolerate a cow milk protein-based formula, the formulation has changed to the current soy protein isolate. Despite very limited indications for its use, soy protein-based formulas in the United States may account for nearly 25% of the formula market. This report reviews the limited indications and contraindications of soy formulas. It will also review the potential harmful effects of soy protein-based formulas and the phytoestrogens contained in these formulas.T HE AMERICAN ACADEMY of Pediatrics (AAP) is committed to the use of human milk as the ideal source of nutrition for infant feeding. However, by 2 months of age, the majority of infants in North America are receiving at least some formula. Soy-based infant formulas have been available for almost 100 years. 1 Despite limited indications, soy protein-based formula accounts for approximately 20% of the formula market in the United States. Because an infant formula provides a source of nutrition for an extended interval, its nutritional adequacy must be proven, and the indications for its use must be substantiated and well understood. This statement updates the 1998 AAP review of soy protein-based formulas and addresses the ongoing concern of phytoestrogens in soy formulas. COMPOSITIONIsolated soy protein-based formulas currently on the market are all free of cow milk protein and lactose and provide 67 kcal/dL. All are iron-fortified and meet the vitamin, mineral, and electrolyte specifications addressed in the 2004 guidelines from the AAP for feeding term infants 2 and established by the US Food and Drug Administration. 3 The protein is a soy isolate supplemented with L-methionine, L-carnitine, and taurine to provide a protein content of 2.45 to 2.8 g per 100 kcal or 1.65 to 1.9 g/dL. The fat content of soy protein-based formulas is derived primarily from vegetable oils. The quantity of specific fats varies by manufacturer and is usually similar to those in the manufacturer's corresponding cow milk-based formula. The fat content ranges from 5.02 to 5.46 g per 100 kcal or 3.4 to 3.6 g/dL. The oils used include soy, palm, sunflower, olein, safflower, and coconut. Docosahexaenoic and arachidonic acids now are added routinely.In formulas, carbohydrate sources are corn maltodextrin, corn syrup solids, and sucrose, with content ranging from 10.26 to 10.95 g per 100 kcal or 6.9 to 7.4 g/dL. Until 1980, mineral absorption from soy formulas was erratic because of poor stability of the suspensions and the presence of excessive soy phytates. 4 Because soy protein isolate formulas still contain 1.5% phytates, and up to 30% of the total phosphorus is phytate bound, they contain 20% more calcium and phosphorus than cow milk-based formulas and maintain the ratio of calcium to available phosphorus of 1.1 to 2.0:1. With the current formulations, bone mineralization, serum concentrations of calcium and phosphorus, and alka...