What is the recommended dose of vitamin E (Vitamin E) for children?

Recommended Vitamin E Dosage for Children

For infants and children below 11 years of age, the recommended dose of vitamin E is ≤11 mg/day, with preterm infants requiring 2.8-3.5 mg/kg/day (not exceeding 11 mg/day total). 1

Age-Specific Dosing Recommendations

Preterm Infants (Parenteral Nutrition)

• 2.8-3.5 mg/kg/day, with a maximum of 11 mg/day 1
• This weight-based approach is critical because fixed daily doses create an inverse relationship between serum levels and birth weight, risking both deficiency and toxicity 2
• Target serum tocopherol levels of 1-3.5 mg/dL to reduce retinopathy risk while avoiding sepsis and necrotizing enterocolitis 1, 2

Term Infants and Children <11 Years

• ≤11 mg/day when receiving parenteral nutrition with LC-PUFA-containing fat emulsions 1
• For oral supplementation via formula: up to 10 mg/100 kcal (15 IU/100 kcal) is considered safe 3

Children and Adolescents (9-18 Years)

• 11-15 mg/day based on Dietary Reference Intakes 1, 4
• Males 9-13 years: 11 mg/day; 14-18 years: 15 mg/day 1
• Females 9-13 years: 11 mg/day; 14-18 years: 15 mg/day 1

Conversion Factors for Clinical Use

Understanding vitamin E units is essential for accurate dosing:

• Natural vitamin E (d-α-tocopherol): 1 IU = 0.67 mg 4
• Synthetic vitamin E (dl-α-tocopherol): 1 IU = 0.45 mg 4
• IV multivitamin preparations: 1 IU = 1 mg = 1 USP unit dl-α-tocopheryl acetate 1, 4

Critical Safety Thresholds

Serum levels >3.5 mg/dL significantly increase risks of sepsis and necrotizing enterocolitis, particularly in preterm infants treated for >1 week. 1, 2

Monitoring Strategy

• Use the vitamin E/total lipid ratio (<0.8 mg/g indicates deficiency) rather than absolute serum levels, especially in children with abnormal lipid profiles 1
• Plasma levels do not reliably reflect tissue concentrations in preterm infants, making clinical assessment challenging 1

Upper Safety Limits

• Enteral intake should not exceed 25 mg/(kg·day) to avoid serum levels >3.5 mg/dL 3
• The tolerable upper limit for supplemental α-tocopherol is 1000 mg/day (approximately 1500 IU/day) 4

Special Clinical Considerations

Children with Chronic Kidney Disease

• Water-soluble vitamin supplementation is suggested for CKD stages 2-5 if dietary intake doesn't meet 100% of DRI 1
• Children on dialysis (stage 5D) should receive water-soluble vitamin supplements 1
• Combination of dietary and supplemental intake routinely meets or exceeds RDA in dialysis patients 1

Administration with Parenteral Nutrition

• Administer vitamin E with lipid emulsions whenever possible to prevent absorption onto tubing materials and reduce losses 1
• Vitamin E is minimally affected by light exposure, so special protection of infusion devices is unnecessary 1

Malabsorption Disorders

• Tocofersolan (water-soluble vitamin E) demonstrates increased bioavailability compared to tocopherol or tocopheryl acetate in children with fat malabsorption 5
• VED is more common in children with fat malabsorption syndromes and may lead to peripheral neuropathy and increased erythrocyte hemolysis 6

Common Pitfalls to Avoid

1. Fixed daily dosing in preterm infants: Always use weight-based dosing (mg/kg/day) rather than fixed doses to prevent both deficiency in larger infants and toxicity in smaller ones 2

2. Ignoring lipid status: Abnormal lipid levels affect vitamin E status; always interpret serum vitamin E in context of total lipids 1

3. Prolonged high-dose supplementation: Vitamin E levels >3.5 mg/dL increase infection risk, particularly when treatment exceeds one week 1, 2

4. Inadequate fat co-administration: Vitamin E absorption requires dietary fat; ensure adequate fat intake with oral supplementation 6