What are the guidelines for Vitamin A supplementation in children?

Guidelines for Vitamin A Supplementation in Children

Children in areas at risk of vitamin A deficiency should receive vitamin A supplementation according to standardized dosing schedules to prevent morbidity and mortality. 1, 2

Recommended Dosing Schedule for Preventive Supplementation

• Children 12 months to 5 years of age: 200,000 IU every 3-6 months 1
• Infants less than 12 months of age: Total of 400,000 IU in the first year of life, administered as:
  • 100,000 IU every 3 months (if 3-month dosing is feasible) 1
  • 200,000 IU every 6 months (if 6-month dosing is more practical) 1
  • 200,000 IU as a single dose (if subsequent dosing is unlikely) 1
• Breastfeeding mothers: 200,000 IU within 2 months of giving birth (to ensure adequate vitamin A in breast milk) 1, 3

Treatment Dosing for Vitamin A Deficiency

• Children with clinical vitamin A deficiency (xerophthalmia): Full treatment schedule of 200,000 IU on day 1,200,000 IU on day 2, and 200,000 IU 1-4 weeks later (half doses for children under 12 months) 1
• Children with severe malnutrition: Same treatment schedule as for clinical deficiency 1

Special Populations

Children with Cystic Fibrosis

• Supplementation approach: Aim to achieve normal serum retinol concentrations for healthy, same-age individuals 1
• Monitoring: Check serum levels annually and 3-6 months after dosage changes 1
• Dosing options:
  • Retinol (preformed): Start with low doses and adjust based on serum levels 1
  • Beta-carotene (provitamin A): 1 mg/kg/day (maximum 50 mg/day) for 12 weeks, followed by maintenance dose (maximum 10 mg/day) 1

Children Receiving Parenteral Nutrition

• Preterm infants: 700-1500 IU/kg/day (227-455 μg/kg/day) 1
• Infants up to 12 months: 150-300 μg/kg/day or 2300 IU/day 1
• Children and adolescents 1-18 years: 150 μg/day 1

Monitoring and Assessment

• Document all vitamin A doses on the child's growth record chart 1
• Serum retinol levels below 200 μg/L (0.7 μmol/L) indicate deficiency in premature infants 1
• Serum retinol levels below 100 μg/L (0.35 μmol/L) indicate severe deficiency 1
• Normal range for children older than 6 months: 300-800 μg/L (1.05-2.8 μmol/L) 1

Clinical Benefits of Vitamin A Supplementation

• Reduces all-cause mortality by 12-24% in children 6 months to 5 years in at-risk populations 2
• Reduces diarrhea-specific mortality by 12% 2
• Reduces incidence of diarrhea by 15% 2
• Reduces incidence of measles by 50% 2

Important Considerations and Precautions

• Vitamin A supplementation is one of the most cost-effective interventions in international public health 4
• Vitamin A deficiency is common in children with pancreatic insufficiency (10-35%) 1
• Do not assess serum vitamin A levels during acute infections, as retinol concentrations fall in response to inflammation 1
• Water-miscible and water-soluble forms of vitamin A carry higher risk of hypervitaminosis than oil-based supplements 1, 5
• Vomiting within 48 hours of supplementation may occur (increased risk by 97%) 2

Pregnancy Considerations

• Keep vitamin A intake below 10,000 IU/day in pregnant women to avoid potential teratogenic effects 5
• Assess vitamin A intake and blood levels before conception or early in pregnancy 1, 5
• Both hypervitaminosis A and hypovitaminosis A can cause harm to mother and fetus 1, 5

Vitamin C Supplementation (When Indicated)

• For children with malnutrition: 15-25 mg/kg/day 6
• For premature infants and infants up to 12 months on parenteral nutrition: 15-25 mg/kg/day 6
• For older children: 80 mg/day 6
• Vitamin C helps with iron absorption, essential for preventing anemia in malnourished children 6