What is the recommended dose of zinc syrup (zinc) in pediatric patients?

Zinc Syrup Dosing in Pediatric Patients

For routine supplementation in healthy children, zinc syrup dosing is age-stratified: 250 μg/kg/day for term infants 0-3 months, 100 μg/kg/day for infants 3-12 months, and 50 μg/kg/day for children >12 months (maximum 5 mg/day). 1

Age-Based Dosing Algorithm

Preterm Infants

• 400-500 μg/kg/day is required to match in-utero accretion rates during rapid growth 1
• Standard trace element preparations typically don't supply adequate amounts for preterm infants, requiring additional supplementation 1

Term Infants (0-3 months)

• 250 μg/kg/day for routine supplementation 1
• This dose accounts for the higher zinc requirements during early infancy 2

Infants (3-12 months)

• 100 μg/kg/day is the recommended dose 1, 2
• This reflects decreasing per-kilogram requirements as growth velocity slows 2

Children (>12 months)

• 50 μg/kg/day, up to a maximum of 5 mg/day for routine supplementation 1, 2
• The maximum cap prevents excessive intake in larger children 2

Special Clinical Scenarios Requiring Higher Doses

Acute Diarrhea Treatment

• Children 6 months to 5 years: 20 mg daily for 10-14 days reduces diarrhea duration by approximately 10-27 hours 3, 4
• Infants <6 months with diarrhea: 10 mg daily for 10-14 days 4
• Recent evidence suggests lower doses (5-10 mg) may be equally effective with less vomiting than the standard 20 mg dose 5

Documented Zinc Deficiency

• Therapeutic dosing: 0.5-1 mg/kg/day of elemental zinc for 3-4 months 3, 2
• This higher dose is necessary to replete body stores in deficient children 2

High Gastrointestinal Losses

• Children with diarrhea, stoma losses, or severe skin disease require significantly higher supplementation 1
• Monitor serum zinc and alkaline phosphatase levels more frequently in these patients 1, 2

Important Clinical Considerations

Administration Guidance

• Zinc should ideally be given between meals rather than with food for optimal absorption 2
• Avoid co-administration with foods high in phytates, which reduce zinc absorption 2
• Most commonly formulated as zinc sulfate syrup 6

Monitoring Requirements

• Serum zinc levels and alkaline phosphatase should be monitored periodically in children on long-term supplementation 1, 2
• Children with high gastrointestinal fluid output require more frequent monitoring 1

Common Pitfall: Co-supplementation with Iron

• Co-supplementation of zinc with iron decreases the beneficial effect of zinc 7
• When both are needed, consider separating administration times to minimize interaction 7

Adverse Effects

• Vomiting is the most common side effect, occurring more frequently with higher doses 5, 8
• Vomiting within 30 minutes of administration occurred in 19.3% with 20 mg doses versus 13.7% with 5 mg doses 5
• No serious adverse events have been reported at recommended doses 8

Critical Caveat for Infants <6 Months

• Zinc supplementation is NOT routine for healthy infants younger than 6 months except for specific indications (parenteral nutrition, documented deficiency, or diarrhea treatment) 3
• Subgroup analyses show no benefit from zinc supplementation in children under 6 months with acute diarrhea 8

Clinical Impact

Zinc deficiency in children leads to stunted growth, increased infection risk, and characteristic skin rash 1, 2. Preventive zinc supplementation likely reduces all-cause diarrhea incidence and leads to slight increases in linear growth 7. The benefits of preventive supplementation outweigh harms in regions where zinc deficiency risk is relatively high 7.