Treatment of vitamin D deficiency in children

ABSTRACT

Introduction

Vitamin D deficiency affects from 10% to 50% in various pediatric population groups and causes life-threatening hypocalcemia in infants, crippling rickets in infants and children, and increased risk of subsequent adult metabolic and neurologic problems.

Areas covered

An English language literature search of PubMed was performed since 1940 as were the authors’ personal literature collections. References identified in the reviewed literature are considered.

Diagnosis

The diagnosis of vitamin D deficiency is based on serum 25-hydroxyvitamin D levels. Clinical features of rickets include bone deformities and elevated alkaline phosphatase. Most children and adolescents who are biochemically vitamin D deficient do not have specific symptoms or signs of deficiency.

Prevention

Prevention of vitamin D deficiency is via exposure to sunshine, food and beverage fortification, and dietary supplementation.

Treatment

Effective treatment of vitamin D deficiency is via oral or injectable administration of vitamin D. Dosing and duration of vitamin D therapy have been described for healthy children and for children with underlying medical conditions, but recommendations vary.

Expert opinion

Further investigation is needed to determine long-term non-skeletal effects of childhood vitamin D deficiency, benefits of supplementation in asymptomatic individuals with biochemical vitamin D deficiency, and appropriate screening for vitamin D deficiency in asymptomatic children and adolescents.

KEYWORDS:

• Calcium
• dietary supplementation
• food fortification
• hypovitaminosis D
• micronutrient
• rickets
• sunshine
• vitamin D

Article highlights

• Vitamin D deficiency is common (> 10% prevalence) in many pediatric population groups in North America and around the world.

• Vitamin D deficiency can be life-threatening and crippling.

• Vitamin D status is best determined by measurement of the serum 25-hydroxyvitamin D level.

• Consequences of vitamin D deficiency can often be seen on physical exam (bone deformities), radiography evaluation (altered growth plates of long bones), and biochemical testing (low phosphorous and/or calcium levels, elevated alkaline phosphatase level, elevated parathyroid hormone level).

• Prevention of vitamin D deficiency is via exposure to sunshine, food and beverage fortification, and supplementation.

• Treatment of vitamin D deficiency is with oral or injectable vitamin D, and doses vary depend on adiposity and underlying medical conditions.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.