Vitamin D3 Supplementation Guidelines for Children

Recommended Daily Dosages

• Preterm infants on parenteral nutrition should receive 200-1000 IU/day (or 80-400 IU/kg/day) of vitamin D3 1
• Term infants up to 12 months on parenteral nutrition should receive 400 IU/day (or 40-150 IU/kg/day) of vitamin D3 1
• Older children on parenteral nutrition should receive 400-600 IU/day of vitamin D3 1

Vitamin D Status Classification and Treatment

• The American Academy of Pediatrics recommends a target level of ≥30 ng/mL (75 nmol/L) to prevent secondary hyperparathyroidism 4
• Severe vitamin D deficiency (<5 ng/mL) requires higher replacement doses 2, 3
• Mild vitamin D deficiency (5-15 ng/mL) requires therapeutic supplementation 2, 3

Supplementation Strategies for Deficiency/Insufficiency

• For vitamin D deficiency, higher doses are required for repletion 2, 3
• For maintenance after repletion, 200-1000 IU/day of vitamin D3 is recommended 2, 3

Special Populations

• Children with CKD should be monitored annually for 25(OH)D levels and supplemented with vitamin D3 to correct deficiency 2, 5
• Children with CKD should have calcium and phosphorus levels monitored one month after initiating or changing vitamin D dose 5
• Children with nephrotic syndrome may require higher doses due to urinary losses of vitamin D-binding protein and should have close monitoring of ionized calcium, 25-OH-D3, and PTH levels 6

Monitoring Recommendations

• Annual monitoring of 25(OH)D levels is recommended for children with CKD 5
• Annual monitoring of 25(OH)D levels is recommended for children on long-term parenteral nutrition 1
• Monitoring of calcium and phosphorus levels is recommended one month after initiating or changing vitamin D dose in children with CKD 5