Treatment of Pediatric Vitamin A Deficiency
For children with confirmed vitamin A deficiency, administer oral vitamin A 10,000-25,000 IU daily for 1-2 weeks in older children and adolescents, while infants and young children require age-specific dosing based on severity of deficiency and clinical presentation. 1
Age-Specific Treatment Protocols
Infants and Young Children (0-5 years)
For severe acute malnutrition with clinical signs of vitamin A deficiency (xerophthalmia, Bitot's spots, night blindness):
- Give high-dose vitamin A on day 1 of admission, day 2, and day 14 2
- Follow with daily low-dose vitamin A supplementation 2
- This regimen is critical as active corneal xerophthalmia is a medical emergency requiring immediate high-dose treatment 3
For measles, severe diarrhea/shigellosis, or any clinical signs of deficiency:
- High-dose vitamin A treatment is specifically recommended 2, 3
- These conditions warrant aggressive supplementation even in the absence of documented deficiency 4
For uncomplicated vitamin A deficiency without severe malnutrition:
- Low-dose daily supplementation is preferred over high-dose regimens 2
- Evidence shows improved outcomes with low-dose compared to high-dose supplementation in children without severe acute malnutrition, measles, or severe diarrhea 2
Older Children and Adolescents
- Administer 10,000-25,000 IU oral vitamin A daily for 1-2 weeks for clinical improvement 1
- This dosing is based on adult protocols and is appropriate for older pediatric patients 1
Special Population: Premature Infants on Parenteral Nutrition
Premature infants require 700-1500 IU/kg/day (227-455 µg/kg/day) of vitamin A, which must be administered with lipid emulsion, not water-based solutions. 5, 6
- More than 60% of vitamin A is lost when given with water-soluble solutions; lipid emulsion administration is essential to minimize losses 6
- This dosing reduces risk of bronchopulmonary dysplasia and oxygen requirement 6
- Serum levels <200 µg/L (0.7 µmol/L) indicate deficiency; <100 µg/L indicates severe deficiency with depleted liver stores 6, 7
Critical Monitoring During Treatment
Monitor for toxicity, as the therapeutic window between deficiency and toxicity is narrow: 5, 6
Acute toxicity signs (>150,000 µg):
Chronic toxicity signs (~30,000 µg/day):
- Bone abnormalities, dermatitis, alopecia, ataxia, muscle pain, hepatocellular necrosis 5, 6
- Toxicity can be established by measuring retinyl-ester levels 5
Vomiting within 48 hours of supplementation:
- This is a known side effect occurring in approximately twice as many children receiving vitamin A versus placebo 8
- Does not necessarily indicate toxicity but warrants clinical assessment 8
Populations Requiring Aggressive Treatment
High-risk conditions associated with vitamin A deficiency requiring treatment consideration: 5, 7
- Sepsis, HIV infection, burns, mechanical ventilation 5
- Steroid use, hepatobiliary dysfunction, renal failure 5
- Chronic liver disease, malabsorptive procedures, steatorrhea 7
- Protein-energy malnutrition, zinc deficiency, cystic fibrosis 5
Evidence-Based Outcomes
Vitamin A supplementation in deficient populations reduces: 8
- All-cause mortality by 12% 8
- Diarrhea-related mortality by 12% 8
- Incidence of diarrhea by 15% 8
- Incidence of measles by 50% 8
- Bitot's spots by 58% 8
- Night blindness by 68% 8
Critical Pitfalls to Avoid
Do not use high-dose supplementation routinely in well-nourished children:
- Adverse outcomes related to respiratory infection, diarrhea, and growth have been associated with high-dose supplementation in adequately nourished children 2
- Reserve high-dose regimens for documented deficiency, severe malnutrition, measles, severe diarrhea, or clinical signs of deficiency 2
Do not delay treatment when clinical signs are present:
- Night blindness is the earliest characteristic symptom; xerophthalmia can progress to permanent blindness if untreated 1, 7
- Active corneal xerophthalmia is always a medical emergency 3
Account for inflammation when interpreting laboratory values: