John C Kim and International Adoption Video

Thursday, December 10, 2009

dosing Prevention and Management of Vitamin D Deficiency in Children: Part I: Vitamin D Requirements: New Recommendations

Prevention and Management of Vitamin D Deficiency in Children: Part I: Vitamin D Requirements: New Recommendations



New Recommendations

An extensive review on vitamin D deficiency in children, with new recommendations for supplementation, was published in the August 2008 issue of Pediatrics by Misra and colleagues on behalf of the Drug and Therapeutics Committee of the Lawson Wilkins Pediatric Endocrine Society.[16] This paper provides an excellent resource for pediatric health care providers on topics ranging from biomarkers of vitamin D deficiency to dietary sources and dosing of vitamin D products.

Based on a review of the literature, the group recommended that serum 25 (OH)D levels be maintained at least above 20 ng/mL and that daily supplementation with 400 International Units (10 mcg) of vitamin D be initiated within days of birth for all breastfed infants and in formula-fed infants and children who do not ingest at least 1 L of vitamin D-fortified milk each day. Premature infants, dark-skinned children, and children who live at higher latitudes may require larger doses of vitamin D, up to 800 International Units (20 mcg) per day. Supplementation for vitamin D insufficient or deficient children should be dosed according to the chart below:

Patient Age Dose (International Units/day)
< 1 month 1,000
1–12 months 1,000 to 5,000
> 12 months > 5,000

In addition to their recommendations, the authors also highlighted the need for additional studies to determine if higher levels of 25 (OH)D (> 32 ng/mL) should be considered, as well as to determine the appropriate balance of the benefits and risks of sunlight exposure.[16]

In November 2008, the American Academy of Pediatrics (AAP) released a guidance paper on the prevention of rickets and vitamin D deficiency in infants, children, and adolescents.[6] This new report replaces their 2003 statement which recommended a daily intake of 200 International Units. As in the Lawson Wilkins Society article, the 2008 AAP statement recommends that the daily vitamin D intake for all pediatric patients be increased to 400 International Units (10 mcg), with a goal 25 (OH)D level of at least 20 ng/mL. The AAP statement also recommends that breastfed infants receive a vitamin D supplement at a dose of 400 International Units/day beginning shortly after birth and continuing until they are weaned and consuming at least 1 L of vitamin D-fortified formula or milk per day.

Daily supplementation is also recommended for older children and adolescents who do not consume at least 400 International Units of vitamin D with their usual diet. The AAP guidelines were based on studies documenting the safety of vitamin D at this higher dose as well as new evidence suggesting a possible role for vitamin D in preventing cancer, cardiovascular disease, and diabetes.[6]

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I am a pediatrician specializing in General Pediatrics, International Adoption Medicine, and in the diagnosis and coaching of families pursuing joy.