vitamin D deficiency in a child

Last edited 09/2019

Consult expert advice (1)

• children with vitamin D levels indicative of deficiency or insufficiency should be referred to a specialist, particularly if there are serious concerns about bone growth and development (e.g. suspicion of Rickets) or if there is evidence of atypical physiology or simply if the primary care physician decides the best interests of the child are best served by a referral.

Provision of lifestyle advice, dietary information and occasionally, prescription or purchase of low dose maintenance Vitamin D therapy can be performed in primary care (1).

• National Guidance suggests that all children aged 6 months to 5 years should take a daily supplement containing vitamin D in the form of vitamin drops, to help them meet the requirement set for this age group of 280-340 units (7- 8.5 micrograms) per day.(2,3)
• Infants who are fed infant formula will not need vitamin D supplements unless they are receiving less than 500ml of infant formula a day, as these formulas are fortified with vitamin D. Breastfed infants may need supplements containing vitamin D from one month of age if their mother may be deficient in vitamin D and has not taken vitamin D supplements throughout pregnancy.(2,3)

Preventing Vitamin D deficiency related bone disease in Children - National Guidance

• the Royal College of Paediatrics and Child Health (RCPCH) guidelines recommend the following regimens for preventing vitamin D deficiency related bone disease in children.
  • New born to 1 month: 300 - 400 units daily
  • 1 month to 18 years old: 400 - 1000 units daily

Treating Vitamin D deficiency related bone disease in Children - National Guidance

• The Royal College of Paediatrics and Child Health (RCPCH) guidelines recommend the following regimens for treating vitamin D deficiency related bone disease in children.
  • Up to 6 months old: 1000-3000 units/daily for 4-8 weeks
  • 6 months to 12 years old: 6000 units/daily for 4-8 weeks
  • 12 years to 18 years old: 10,000 units daily for 4-8 weeks

What levels of vitamin D are considered a deficiency in children?

The Royal College of Paediatrics and Child Health (3) suggest that vitamin D deficiency in the paediatric population is defined as:

• < 25 nmol/l = vitamin D deficiency
• 25 to 50 nmol/l = insufficiency
• 50-75 nmol/l = sufficient levels of vitamin D (although sufficient levels are not well defined)

Reference:

• Coventry and Warwickshire Area Prescribing Committee.Vitamin D Prescribing for Children - supplementary (Accessed 22/9/2019)
• Vitamin D - advice on supplements for at risk groups.Ref: CEM/CMO/2012/04. Gateway ref: 17193. Welsh Government, Department of Health, Social Services and Public Safety. The Scottish Government and Department of Health.
• Royal College of Paediatrics and Child Health, Vitamin D in Childhood. October 2013. Available at http://www.rcpch.ac.uk/system/files/protected/page/vitdguidancedraftspreads%20FINAL%20for%20website.pdf