What are the recommended dosages and frequencies of minerals and vitamins for pediatric age groups?

Recommended Dosages and Frequencies of Minerals and Vitamins for Pediatric Age Groups

For routine supplementation in healthy children, provide vitamin D 400 IU daily for infants under 12 months and 600 IU daily for children 1-18 years, zinc 5 mg daily for children over 12 months, and vitamin C 25 mg daily for school-age children, with most other micronutrients adequately supplied through breast milk, formula, or a balanced diet. 1, 2

Vitamin D Supplementation by Age

Infants (0-12 months):

• 400 IU daily from all sources for both breastfed and formula-fed infants 2, 3
• Preterm infants on parenteral nutrition require 200-1000 IU daily (or 80-400 IU/kg/day) 2
• Upper safety limit: 1,000 IU/day for 0-6 months; 1,500 IU/day for 7-12 months 2

Children and Adolescents (1-18 years):

• 600 IU daily for routine maintenance 1, 2
• Upper safety limits: 2,500 IU/day (ages 1-3), 3,000 IU/day (ages 4-8), 4,000 IU/day (ages 9-18) 2
• Target serum 25(OH)D level: >50 nmol/L (20 ng/mL) 2

The American Academy of Pediatrics increased these recommendations in 2008 based on growing evidence of vitamin D deficiency and rickets in certain pediatric populations, particularly among exclusively breastfed infants. 3 Children consuming less than 1 liter of vitamin D-fortified milk daily will likely need supplementation. 3

Zinc Supplementation by Age

Parenteral Nutrition (PN) Requirements:

• Preterm infants: 400-500 mcg/kg/day 4
• Term infants to 3 months: 250 mcg/kg/day 4
• Infants 3-12 months: 100 mcg/kg/day 4
• Children >12 months: 50 mcg/kg/day, up to maximum 5 mg/day 4

Oral Supplementation:

• Healthy children (≥5 years): 5 mg daily 1
• Upper safety limit for ages 4-8: 12 mg/day 1

Children with high gastrointestinal fluid losses (ileostomy, severe diarrhea) require significantly higher zinc intake and should have zinc status monitored periodically through serum zinc and alkaline phosphatase levels. 4

Copper Supplementation

Parenteral Nutrition Requirements:

• Preterm infants: 40 mcg/kg/day 4
• Term infants and children: 20 mcg/kg/day, up to maximum 0.5 mg/day 4

Children with high gastrointestinal losses need an additional 10-15 mcg/kg of copper. 4 Monitor plasma copper and ceruloplasmin in patients on long-term PN, especially those with cholestasis or high GI losses, though recent data suggests copper should not be routinely removed from PN in cholestatic patients as this may cause deficiency. 4

Vitamin C Supplementation

• Healthy children (≥5 years): 25 mg daily 1
• Upper safety limit for ages 4-8: 650 mg/day 1

Vitamin C functions in collagen synthesis and as a reversible reducing agent. 1 Whole fruits should be prioritized over juice, with juice intake limited to 4-6 ounces daily for children aged 4-6 years to avoid diarrhea, flatulence, and tooth decay. 1

Vitamin E Supplementation

Age-Specific Dosing:

• Preterm infants: 2.8-3.5 mg/kg/day, not exceeding 11 mg/day total 5
• Term infants and children <11 years: ≤11 mg/day 5
• Children and adolescents 9-18 years: 11-15 mg/day 5
• Upper safety limit: 1000 mg/day (approximately 1500 IU/day) 5

Critical safety consideration: Serum levels >3.5 mg/dL significantly increase risks of sepsis and necrotizing enterocolitis in preterm infants treated for >1 week. 5 Administer with lipid emulsions when possible to prevent absorption losses. 5

Vitamin B12 Supplementation

Pediatric Intake:

• Infants and children: 0.5-3 mcg daily as recommended by the Food and Nutrition Board 6
• Pregnant women: 4 mcg daily 6
• Lactating women: 4 mcg daily 6

Vegetarian diets containing no animal products require regular oral B12 supplementation, as deficiency has been recognized in breastfed infants of vegetarian mothers even when mothers were asymptomatic. 6 Vitamin B12 requirements increase during pregnancy and lactation. 6

Critical Clinical Considerations

Prioritize whole foods over supplements: Individuals should acquire daily vitamin and mineral requirements from natural food sources rather than supplements, with supplementation viewed as therapeutic intervention requiring safety and efficacy demonstration. 1 Megadoses carry potential toxicity risks. 1

Special populations requiring monitoring:

• Children on long-term parenteral nutrition need periodic monitoring of zinc, copper, and vitamin D status 4, 2
• Children with chronic kidney disease may require water-soluble vitamin supplementation if dietary intake doesn't meet 100% of DRI 5
• Children on dialysis (stage 5D) should receive water-soluble vitamin supplements 5

Common pitfall: Avoid administering folic acid in place of vitamin B12 in patients with pernicious anemia, as folic acid may prevent anemia but allows progression of irreversible neurologic damage. 6