Calcium Dosing in Children by Body Weight

Parenteral Nutrition Dosing

The ESPGHAN recommends calcium dosing for preterm infants at 0.8-2.0 mmol/kg/day (32-80 mg/kg/day) initially and 1.6-3.5 mmol/kg/day (64-140 mg/kg/day) when growing 1
The ESPGHAN suggests that individual requirements for preterm infants depend heavily on growth velocity, with some infants requiring up to 4.0 mmol/kg/day (160 mg/kg/day) 4
The ESPGHAN recommends calcium dosing for term infants 0-6 months at 0.8-1.5 mmol/kg/day (30-60 mg/kg/day) 5
The ESPGHAN recommends calcium dosing for infants 7-12 months at 0.5 mmol/kg/day (20 mg/kg/day) 3
The ESPGHAN recommends calcium dosing for children 1-18 years at 0.25-0.4 mmol/kg/day (10-16 mg/kg/day) 1

The ESPGHAN emphasizes the importance of periodic monitoring of calcium, phosphorus, vitamin D, and bone mineral status to prevent metabolic bone disease in children on long-term parenteral nutrition 5

The ESPGHAN warns that aluminum contamination should not exceed 5 mg/kg/day to prevent metabolic bone disease 1
The ESPGHAN advises using organic phosphorus compounds or carefully sequencing mixing to prevent calcium-phosphorus precipitation in parenteral solutions 6

The American Academy of Pediatrics recommends IV/IO calcium chloride at 20 mg/kg (0.2 mL/kg of 10% solution) for emergency treatment of hypocalcemia, hyperkalemia, hypermagnesemia, or calcium channel blocker toxicity 8

The ESPGHAN notes that oral calcium recommendations differ significantly from parenteral dosing due to absorption differences, with a standard calcium-phosphorus ratio of approximately 1.3:1 (molar) or 1.7:1 (mass) 1
The ESPGHAN suggests that inverse calcium-phosphorus ratios (0.5) with higher phosphorus may be beneficial for long-term parenteral nutrition to prevent bone disease 10