What is the recommended vitamin D supplementation for a 10-year-old child with low vitamin D levels?

Vitamin D Supplementation for a 10-Year-Old Child with Low Vitamin D Levels

For a 10-year-old child with low vitamin D levels, supplementation should be based on the severity of deficiency: 2,000 IU daily for 12 weeks or 50,000 IU every other week for 12 weeks for mild to moderate deficiency, followed by maintenance therapy of 600 IU daily. 1

Treatment Based on Severity of Vitamin D Deficiency

The appropriate supplementation regimen depends on the specific level of vitamin D deficiency:

• Severe vitamin D deficiency (<5 ng/mL):

  • 8,000 IU/day orally for 4 weeks OR 50,000 IU weekly for 4 weeks
  • Then 4,000 IU/day OR 50,000 IU twice monthly for 2 months 2, 3

• Mild vitamin D deficiency (5-15 ng/mL):

  • 4,000 IU/day orally for 12 weeks OR 50,000 IU every other week for 12 weeks 2, 1

• Vitamin D insufficiency (16-30 ng/mL):

  • 2,000 IU daily OR 50,000 IU every 4 weeks 2

Maintenance Phase After Repletion

• Once vitamin D levels normalize (>30 ng/mL), maintain with 600 IU daily for children aged 1-18 years 3, 1
• The American Academy of Pediatrics recommends a target level of ≥30 ng/mL to prevent secondary hyperparathyroidism 3

Monitoring Recommendations

• Recheck 25(OH)D levels after the 12-week treatment period to confirm normalization 1
• Once normalized, monitor levels every 6-12 months, especially during winter months when sun exposure is limited 1
• Evaluate serum calcium, phosphorus, and alkaline phosphatase to assess for metabolic bone disease 1

Important Clinical Considerations

• Cholecalciferol (vitamin D3) appears to have higher bioefficacy than ergocalciferol (vitamin D2), although long-term comparative trials are lacking 2
• Ensure adequate dietary calcium intake during treatment, as vitamin D improves calcium absorption 1
• The tolerable upper intake level for children 9-18 years should not exceed 4,000 IU/day 1

Potential Pitfalls

• Avoid using active vitamin D analogs (calcitriol, alfacalcidol, doxercalciferol, paracalcitol) to treat nutritional vitamin D deficiency 2, 1
• Monitor for hypercalcemia, which would indicate excessive dosing, although vitamin D toxicity is rare at recommended doses 2, 1
• Ensure adherence to the treatment regimen, as inconsistent supplementation may lead to treatment failure 1

Additional Considerations

• Limited sun exposure is a common cause of vitamin D deficiency in children 2, 4
• Dietary sources of vitamin D include cod liver oil, fish, liver, egg yolk, and fortified milk 2, 5
• Children who consume less than 1 L of vitamin D-fortified milk per day will likely need supplementation to reach adequate vitamin D levels 4