Vitamin D Supplementation in Infants, Children, and Adolescents

Clinic A/P, Peds, MUSCULOSKELETAL

400 IU vitamin D supplementation for ALL infants (both breast and formula fed) and children beginning in the first few days of life.
Note that 400 IU of Vitamin = 10 mcg of Vitamin D
Supplementation can be stopped if:
-taking >1000ML formula daily
->1 year and taking Vit-D fortified milk at >32 oz/day

Vitamin D supplementation at 400 IU daily starting at birth (goal about 800 total)
Change to Vitamin D plus iron supplementation at 4-6 months
Continue both until 5 years
Consider ongoing Vitamin D supplementation (along with Calcium ) for older children and adolescents at 400-800 IU/day

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-supplementation with 400 IU/day of vitamin D is recommended beginning in the first few days of life and continuing until the child is consuming at least 1000 mL/day of formula or milk containing vitamin D. –The purpose of supplementation is to prevent rickets

 

Important Vitamin D Pearls and Links

 

SUMMARY GUIDELINES FROM THE AAP, 2008

“To prevent rickets and vitamin D deficiency in healthy infants, children, and adolescents, a vitamin D intake of at least 400 IU/day is recommended. To meet this intake requirement, we make the following suggestions:

  1. Breastfed and partially breastfed infants should be supplemented with 400 IU/day of vitamin D beginning in the first few days of life. Supplementation should be continued unless the infant is weaned to at least 1 L/day or 1 qt/day of vitamin D–fortified formula or whole milk. Whole milk should not be used until after 12 months of age. In those children between 12 months and 2 years of age for whom overweight or obesity is a concern or who have a family history of obesity, dyslipidemia, or cardiovascular disease, the use of reduced-fat milk would be appropriate.

  2. All nonbreastfed infants, as well as older children who are ingesting <1000 mL/day of vitamin D–fortified formula or milk, should receive a vitamin D supplement of 400 IU/day. Other dietary sources of vitamin D, such as fortified foods, may be included in the daily intake of each child.

  3. Adolescents who do not obtain 400 IU of vitamin D per day through vitamin D–fortified milk (100 IU per 8-oz serving) and vitamin D–fortified foods (such as fortified cereals and eggs [yolks]) should receive a vitamin D supplement of 400 IU/day.

  4. On the basis of the available evidence, serum 25-OH-D concentrations in infants and children should be ≥50 nmol/L (20 ng/mL).

  5. Children with increased risk of vitamin D deficiency, such as those with chronic fat malabsorption and those chronically taking antiseizure medications, may continue to be vitamin D deficient despite an intake of 400 IU/day. Higher doses of vitamin D supplementation may be necessary to achieve normal vitamin D status in these children, and this status should be determined with laboratory tests (eg, for serum 25-OH-D and PTH concentrations and measures of bone-mineral status). If a vitamin D supplement is prescribed, 25-OH-D levels should be repeated at 3-month intervals until normal levels have been achieved. PTH and bone-mineral status should be monitored every 6 months until they have normalized.

  6. Pediatricians and other healthcare professionals should strive to make vitamin D supplements readily available to all children within their community, especially for those children most at risk.” Pediatrics 2008

 

References and Further Reading
Pediatrics November 2008, Volume 122 / Issue 5. Prevention of Rickets and Vitamin D Deficiency in Infants, Children, and Adolescents. http://pediatrics.aappublications.org/content/122/5/1142.full

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