Daily Vitamin D Requirements for Pediatric Patients
The recommended daily vitamin D intake for children is 400 IU/day for infants up to 12 months of age and 400-600 IU/day for older children and adolescents. 1
Age-Specific Recommendations
Infants (0-12 months)
- Preterm infants: 200-1000 IU/day (or 80-400 IU/kg/day) 1
- Term infants up to 12 months: 400 IU/day (or 40-150 IU/kg/day) 1
- All infants, including exclusively breastfed ones, should receive vitamin D supplementation beginning soon after birth 2
Children and Adolescents (1-18 years)
- Children 1-18 years: 400-600 IU/day 1
- This recommendation is consistent across multiple guidelines and supported by strong evidence 1
Monitoring and Special Considerations
Monitoring
- For children receiving long-term parenteral nutrition, periodic monitoring for vitamin D deficiency is recommended 1
- Serum 25(OH)D concentration >50 nmol/L (20 ng/mL) indicates sufficiency 1
Risk Factors for Vitamin D Deficiency
- Winter season (reduced sunlight exposure)
- Darker skin pigmentation
- Limited outdoor activity
- Obesity
- Low milk consumption
- Older age/advanced puberty stage 3
Special Populations
- Children with chronic kidney disease: May require higher doses (200-1000 IU/day) with monitoring 1
- Children with cystic fibrosis: May need supplementation to maintain 25(OH)D levels above 20 ng/mL (50 nmol/L) 1
Safety Considerations
Upper Limits
- Infants 0-6 months: 1000 IU/day
- Infants 7-12 months: 1500 IU/day
- Children 1-3 years: 2500 IU/day
- Children 4-8 years: 3000 IU/day
- Children and adolescents 9-18 years: 4000 IU/day 1
Vitamin D Toxicity
- Prolonged daily intake up to 10,000 IU or serum 25(OH)D concentrations up to 240 nmol/L appears safe
- Serum concentrations >375 nmol/L are associated with acute hypercalcemia and hyperphosphatemia 1
Implementation
- For infants who are exclusively breastfed, supplementation is essential as breast milk contains insufficient vitamin D 4
- For older children, consider both dietary sources and sunlight exposure when determining supplementation needs
- In patients with vitamin D deficiency (25(OH)D <50 nmol/L), additional supplementation should be provided 1
- Oral supplementation should be considered for patients on partial parenteral nutrition and during weaning from parenteral nutrition 1
The evidence strongly supports vitamin D supplementation in pediatric populations not only for bone health but potentially for immune function, respiratory health, and prevention of chronic diseases 3, 2. While the exact optimal level remains under discussion, maintaining the recommended daily intake is essential for proper growth and development in children.