Choosing Wisely:

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

Rationale and Comments: 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 children who are overweight or obese is necessary or safe. Global consensus recommendations caution against population-based screening for vitamin D deficiency The U.S. 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. The AAP 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. It has been shown that children who are overweight or obese have a greater likelihood of having low vitamin D levels. 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.
Sponsoring Organizations:
  • American Academy of Pediatrics – Section on Endocrinology
  • Sources:
  • Systematic review
  • Disciplines:
  • Endocrinologic
  • Pediatric
  • References: • 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.

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