What is the recommended daily dosage of vitamin C (ascorbic acid) for pediatric patients of different ages?

Vitamin C Dosage for Pediatric Patients

For infants up to 12 months of age receiving parenteral nutrition, administer 15-25 mg/kg/day of vitamin C, and for children over 12 months, administer 80 mg/day parenterally or 25 mg/day orally for healthy children over 5 years. 1, 2

Parenteral Nutrition Dosing (Strong Recommendation)

The ESPGHAN/ESPEN/ESPR/CSPEN guidelines provide the most authoritative dosing for pediatric patients on parenteral nutrition:

• Preterm and term infants (up to 12 months): 15-25 mg/kg/day 1
• Children over 12 months: 80 mg/day 1
• Vitamins should be administered daily when possible 1
• Add water-soluble vitamins to lipid emulsions or lipid-containing mixtures to increase stability 1

Oral Supplementation for Healthy Children

For children not requiring parenteral nutrition:

• Healthy children over 5 years: 25 mg daily 3
• Upper safety limit (ages 4-8): 650 mg/day 3
• Prioritize whole fruits over juice, limiting juice to 4-6 ounces daily for children aged 4-6 years 3

Treatment of Scurvy (FDA-Approved Dosing)

When treating documented scurvy with intravenous ascorbic acid (ASCOR):

• Infants 5 months to <12 months: 50 mg once daily IV 4
• Children 1 year to <11 years: 100 mg once daily IV 4
• Children ≥11 years and adults: 200 mg once daily IV 4
• Maximum treatment duration: 1 week 4
• Must be diluted prior to administration as a slow IV infusion 4

Special Clinical Situations

Children with malnutrition require higher doses:

• Standard dosing: 15-25 mg/kg/day for infants, 80 mg/day for older children 2
• Severe malnutrition or symptomatic deficiency may require higher therapeutic doses 2
• Continue supplementation until nutritional status improves and dietary intake is sufficient 2
• Children with inflammatory diseases require higher doses to maintain normal serum concentrations 2

Children with chronic kidney disease:

• Limit to 100 mg/day for CKD stages 1-4 (not on dialysis) to prevent oxalate accumulation 5
• Monitor electrolytes closely in patients receiving kidney replacement therapy 5

Critical Administration Considerations

Storage and stability requirements for parenteral vitamin C:

• Store at 2-8°C for up to 72 hours stability 5
• At room temperature (25°C), vitamin C becomes unstable after 48 hours 5
• Minimize light exposure as vitamin C is photosensitive 5, 4
• Administer with IV lipid emulsions to reduce peroxidation and vitamin loss 5

Absolute contraindications to screen for before administration:

• Hemochromatosis or iron overload conditions 5
• G6PD deficiency 5
• History of oxalate kidney stones 5
• Severe renal dysfunction without dialysis support 5

Important Clinical Pitfalls

Never exceed 10 times the dietary reference intake without proven severe deficiency 5

• High doses (>2 g/day) can cause gastrointestinal disturbances 2
• Monitor for edema if using doses >1 g daily 5
• Low birth weight infants have less adaptive capacity to high or low doses and may require specific vitamin preparations 5

For pregnant and lactating women, do not exceed the U.S. Recommended Dietary Allowance (RDA) 4

• This precaution applies to ensure safety in special populations where excessive vitamin C may pose risks 4

Dietary Sources for Prevention

Natural food sources should be prioritized over supplements:

• Fresh fruits: oranges, kiwis, strawberries 2
• Vegetables: bell peppers, broccoli, tomatoes 2
• Five servings of fruits and vegetables daily provide sufficient vitamin C for healthy children 3