What is the recommended treatment for vitamin D deficiency in infants?

Treatment of Vitamin D Deficiency in Infants

For vitamin D deficiency in infants, supplementation with 400 IU/day of vitamin D is the recommended standard treatment to prevent deficiency and improve bone health. 1

Recommended Dosage by Age

Healthy Term Infants

• Standard dose: 400 IU/day for all exclusively or partially breastfed infants 1
• Formula-fed infants consuming ≥28 ounces of formula daily receive adequate vitamin D from formula alone 1
• Formula-fed infants consuming <28 ounces daily should receive supplementation of 400 IU/day 1

Preterm Infants

• Higher dosing range: 200-1000 IU/day (or 80-400 IU/kg/day) 1

Treatment Protocol for Vitamin D Deficiency

Administration

• Available as drops that can be given directly into the infant's mouth
• Should be administered once daily, preferably after the first feeding at the breast 1
• Vitamin D supplements should be given daily when possible 2

Duration

• Begin shortly after birth and continue throughout the breastfeeding period for exclusively breastfed infants 1
• Continue supplementation until the infant is consuming adequate vitamin D from other dietary sources

Monitoring

• Target serum 25(OH) vitamin D concentration should be >50 nmol/L (20 ng/mL) 1
• Routine monitoring is not necessary for healthy term infants receiving appropriate supplementation 1
• Periodic monitoring is recommended for high-risk infants or those on long-term supplementation 2, 1

Efficacy of Supplementation

• 400 IU/day has been shown to be more effective than 200 IU/day in preventing vitamin D deficiency 3
• At 400 IU/day, no infants had serum 25-hydroxyvitamin D levels below 30 mcg/L at 4 months of age, while 21.3% of infants receiving 200 IU/day had levels below this threshold 3

Safety Considerations

• Vitamin D supplementation at 400 IU/day has a long history of safety in infants 1
• Tolerable upper intake levels according to the Institute of Medicine:
  • 0-6 months: 1000 IU/day
  • 7-12 months: 1500 IU/day 1
• Monitor for hypercalcemia in infants receiving supplementation, though this is rare at recommended doses

Special Considerations

• Children with chronic kidney disease may require different supplementation regimens 1
• Higher-risk populations include:
  • Infants with limited sun exposure
  • Infants with darker skin pigmentation
  • Infants born to vitamin D-deficient mothers 1

Clinical Importance

• Vitamin D is essential for calcium absorption and bone mineralization
• Deficiency can lead to rickets and poor bone development
• Consistent daily supplementation is more important than intermittent high doses 1

Vitamin D supplementation at 400 IU/day is a safe, effective, and evidence-based approach to prevent and treat vitamin D deficiency in infants, with strong support from multiple guidelines and clinical studies.