Is 1.25mg of folic acid (folate) per day too much for a 6-month-old infant?

Folic Acid Dosing for a 6-Month-Old Infant

The prescribed dose of 1.25 mg folic acid daily for your 6-month-old is higher than standard maintenance dosing but falls within the safe therapeutic range and is appropriate if being used to treat a specific condition such as folate deficiency or as adjunctive therapy for certain infections. 1

Standard Dosing Guidelines

The FDA-approved folic acid labeling provides clear guidance for pediatric dosing:

• Maintenance dosing for infants: 0.1 mg (100 mcg) daily is the standard maintenance dose 1
• Therapeutic dosing for treatment: Up to 1 mg daily is the usual therapeutic dose in children regardless of age when treating deficiency or specific conditions 1
• Your baby's dose: 1.25 mg daily exceeds typical maintenance but is within the therapeutic range used for treatment 1

Safety Profile

Folic acid has an excellent safety profile in infants and children, with daily doses greater than 1 mg considered safe, though most excess is excreted unchanged in urine. 1, 2

Key safety considerations:

• Oral folic acid is generally regarded as non-toxic for normal humans 2
• Daily supplements of 5-15 mg have been studied without significant adverse effects in healthy subjects 2
• The primary concern with high-dose folic acid is potential masking of vitamin B12 deficiency, which is rare in infants unless they have specific risk factors 1, 3

Clinical Context Matters

The appropriateness of this dose depends entirely on why it was prescribed:

• If treating documented folate deficiency or malabsorption: 1.25 mg daily is reasonable and within standard therapeutic dosing 1
• If used as adjunctive therapy (such as with pyrimethamine for toxoplasmosis, where folinic acid 10 mg three times weekly is standard): the dose may be intentionally higher 4
• If prescribed for routine supplementation only: this dose is higher than necessary, as 0.1 mg daily would suffice 1

Important Caveats

You should clarify with your prescribing physician the specific indication for this dose. The key questions to ask:

• Is your baby being treated for a specific condition requiring therapeutic folate dosing?
• Is this being used alongside other medications that interfere with folate metabolism?
• Has folate deficiency been documented?

If your baby is on anticonvulsant therapy, has chronic infection, or hemolytic anemia, higher maintenance doses may be intentionally prescribed. 1

Monitoring Recommendations

• Close supervision is recommended when using therapeutic doses, with adjustment if clinical response is inadequate 1
• Vitamin B12 status should be considered, especially if there are dietary restrictions (strict vegetarian diet) or malabsorption concerns 3
• Once clinical improvement occurs, the dose should typically be reduced to maintenance levels (0.1 mg daily for infants) 1

The dose is not dangerous but appears higher than routine supplementation—contact your prescribing physician to confirm the indication and whether this therapeutic dose should continue long-term or be reduced to maintenance levels once the treatment goal is achieved.