Prevention and Management of Vitamin D Deficiency in Children: Part II. Vitamin D Supplementation: Dosing Recommendations
The current recommendation from both the AAP and the Lawson Wilkins Pediatric Endocrine Society is a minimum dietary intake of 400 International Units/day (10 mcg/day) for neonates, children, and adolescents.[3,4]
If this amount cannot be achieved through their normal diet, a vitamin D supplement should be administered.
Exclusively breastfed infants and those consuming less than 1 L of infant formula/day should receive 400 International Units/day of an oral liquid vitamin D product.[3,4]
The Lawson Wilkins Pediatric Endocrine Society recommends that preterm infants should receive 400 to 800 International Units of vitamin D (10 to 20 mcg) per day to compensate for decreased placental transfer in utero and decreased gastrointestinal absorption after birth.
For treatment of documented vitamin D deficiency, infants may be given 1,000 to 2,000 International Units/day (25 to 50 mcg) and older children may be given up to 5,000 International Units/day (125 mcg) for 2 to 3 months.[4,8]
A variety of alternative dosing regimens have been published over the past decade.
A high-dose short-course regimen providing a total of 100,000 to 600,000 International Units (2.5 to 15 mg) over 1 to 5 days has been suggested for patients who might not adhere to longer regimens.
Vitamin D dosing in children with kidney disease or other chronic illnesses should be based on serum 25(OH)D levels. Table 1 provides general recommendations for these patients. Table 2 lists dosing recommendations for children with severe or chronic deficiency states.[3–7]
Vitamin D supplements may be taken with or without food.
Administration with food may be useful to reduce stomach upset.
Calcium supplementation (30 to 75 mg/kg/day oral elemental calcium) is often necessary to maximize response in patients with vitamin D deficiency.
Patients receiving vitamin D supplementation beyond the recommended daily dietary intake should undergo periodic monitoring of serum 25(OH)D levels, using an assay for both 25(OH)D2 and 25(OH)D3, as well as serum calcium, phosphorus, and alkaline phosphatase at one and three months or until stabilized, followed by annual reassessment. Parathyroid and bone mineralization studies should be conducted as needed.[3–7]