Vitamin D Dosage for Children with Vitamin D Insufficiency
For children with vitamin D insufficiency (25(OH)D levels 16-30 ng/mL), the recommended dosage is 2,000 IU/day or 50,000 IU every 4 weeks for 12 weeks. 1
Diagnosis and Classification
Vitamin D status is determined by measuring serum 25-hydroxyvitamin D [25(OH)D] levels, with the following classifications:
- Severe deficiency: <5 ng/mL
- Mild deficiency: 5-15 ng/mL
- Insufficiency: 16-30 ng/mL
- Target level: ≥30 ng/mL 1
Treatment Regimens Based on Vitamin D Status
Treatment should be tailored according to the severity of vitamin D deficiency:
| Serum 25(OH)D Level | Classification | Recommended Supplementation | Duration |
|---|---|---|---|
| <5 ng/mL | Severe deficiency | 8,000 IU/day or 50,000 IU weekly | 4 weeks, then 4,000 IU/day for 2 months |
| 5-15 ng/mL | Mild deficiency | 4,000 IU/day or 50,000 IU every other week | 12 weeks |
| 16-30 ng/mL | Insufficiency | 2,000 IU/day or 50,000 IU every 4 weeks | 12 weeks |
Age-Specific Recommendations for Maintenance
After treating insufficiency, maintenance dosing should follow these guidelines:
- Preterm infants on PN: 200-1000 IU/day (or 80-400 IU/kg/day) 2
- Term infants up to 12 months: 400 IU/day (or 40-150 IU/kg/day) 2, 3
- Children and adolescents (1-18 years): 400-600 IU/day 2
Monitoring and Follow-up
- Measure serum 25(OH)D levels after 3-6 months of treatment to ensure adequate dosing 1
- For patients on long-term parenteral nutrition, monitor periodically for vitamin D deficiency 2
- In patients with persistent 25(OH)D levels <50 nmol/L, additional supplementation should be provided 2
Special Considerations
- Oral supplementation should be considered in patients on partial parenteral nutrition and during weaning from parenteral nutrition 2
- Higher doses may be required for patients with obesity, liver disease, or malabsorption syndromes (up to 7000 IU/day) 1
- Daily dosing is preferred over single large annual doses, which have been associated with increased risk of fractures and falls 1
Safety Considerations
- According to ESPGHAN guidelines, vitamin D intake up to 10,000 IU daily or serum 25(OH)D concentrations up to 240 nmol/L appears safe 2
- Tolerable upper intake levels by age:
- 0-6 months: 1000 IU/day
- 7-12 months: 1500 IU/day
- 1-3 years: 2500 IU/day
- 4-8 years: 3000 IU/day
- 9-18 years: 4000 IU/day 2
Common Pitfalls to Avoid
- Using single large annual doses instead of regular supplementation 1
- Failing to account for individual factors like obesity or skin pigmentation 1
- Starting bisphosphonate therapy before correcting vitamin D deficiency 1
- Neglecting to monitor serum levels after initiating treatment 1
Remember that vitamin D insufficiency treatment aims to normalize levels to relieve symptoms and decrease the risk of adverse health outcomes including bone mineralization defects and potential chronic disease risks 4, 3.