What is the recommended dose and duration of vitamin D3 (cholecalciferol) supplementation for a 13-year-old with a vitamin D level of 33.2 nmol/L?

From the Guidelines

For a 13-year-old with a vitamin D level of 33.2 nmol/L, I recommend a treatment dose of vitamin D3 (cholecalciferol) of 400-600 IU daily, as suggested by the ESPGHAN Committee on Nutrition 1. This dose is recommended for children and adolescents, and it is essential to monitor the child's vitamin D levels periodically to ensure they have reached the target range of at least 50 nmol/L. The supplement should be taken with food containing some fat to enhance absorption. In addition to supplementation, encourage regular safe sun exposure (about 15-30 minutes several times weekly without sunscreen on arms and legs) and include vitamin D-rich foods in the diet such as fatty fish, egg yolks, and fortified dairy products. If symptoms of severe deficiency are present or levels don't improve with this regimen, consult a healthcare provider for potential adjustment. It is also important to note that the Institute of Medicine recommends a daily dietary vitamin D intake of 600 IU for individuals from 1 to 70 years of age 1. However, the ESPGHAN Committee on Nutrition provides more specific guidance for children and adolescents, making it the preferred recommendation for this age group. The child's vitamin D levels should be rechecked after the initial treatment period to ensure they have reached the target range, and the maintenance dose can be adjusted as needed to maintain adequate vitamin D status. Regular monitoring and adjustments to the treatment plan will help ensure the best possible outcome for the child's bone health, immune function, and overall health. Key points to consider include:

• The recommended treatment dose of 400-600 IU daily is based on the ESPGHAN Committee on Nutrition guidelines 1
• Regular monitoring of vitamin D levels is essential to ensure the child reaches the target range
• Safe sun exposure and a balanced diet that includes vitamin D-rich foods are also important for maintaining adequate vitamin D status
• The Institute of Medicine recommends a daily dietary vitamin D intake of 600 IU for individuals from 1 to 70 years of age 1, but the ESPGHAN Committee on Nutrition provides more specific guidance for children and adolescents.

From the FDA Drug Label

DOSAGE AND ADMINISTRATION DOSAGE MUST BE INDIVIDUALIZED UNDER CLOSE MEDICAL SUPERVISION. The FDA drug label does not answer the question.

From the Research

Vitamin D Supplementation for a 13-Year-Old

The recommended dose and duration of vitamin D3 (cholecalciferol) supplementation for a 13-year-old with a vitamin D level of 33.2 nmol/L can be determined based on the following factors:

• The World Health Organization recommends lifelong, regular vitamin D prophylaxis 2
• The frequency of vitamin D deficiency and insufficiency was found to be 42.9% in healthy children, and the frequency significantly increased with age 2
• A study found that daily oral dosing with up to 60,000 international units (IU) of vitamin D3 for 2 to 6 years in adult males was safely tolerated 3
• Another study found that sublingual vitamin D3 may be an effective alternative mode of vitamin D supplementation in patients who demonstrate poor oral vitamin D absorption despite adequate supplementation 4

Recommended Dose and Duration

Based on the available evidence, the following can be considered:

• The American Academy of Pediatrics recommends a daily intake of 600-1000 IU of vitamin D for children and adolescents 5
• A study found that plasma 25-hydroxyvitamin D [25(OH)D] concentrations were suboptimal in more than 93% of youth in each age and sex group, with a prevalence of 25(OH)D deficiency increasing with age in both sexes 5
• The size of the exposed body surface area, skin erythema, and body mass index predict skin production of vitamin D, with larger skin areas and higher UVB doses resulting in greater cholecalciferol production 6

Key Considerations

Some key considerations for vitamin D supplementation in a 13-year-old with a vitamin D level of 33.2 nmol/L include:

• The need for regular monitoring of vitamin D levels to adjust the dose and duration of supplementation as needed
• The importance of considering individual factors such as skin type, body mass index, and exposure to UVB radiation when determining the dose and duration of supplementation
• The potential benefits of sublingual vitamin D3 supplementation in patients who demonstrate poor oral vitamin D absorption despite adequate supplementation 4