new expert consensus on supplements for children

France – What are the practical recommendations for vitamin D (VitD) supplementation and calcium intake in the pediatric and adolescent population? Experts from the French Pediatric Society and other learned societies* have just drafted a consensus [1].

*Representatives of the French Society of Pediatrics, French Society of Neonatology, Pediatric Endocrinology, Pediatric Rheumatology, Pediatric Nephrology, Gastroenterology, Hepatology and Pediatric Nutrition, as well as the French Association of Pediatrics in Primary Care, representatives of general practitioners and biochemists.

What dose?

The main purpose of vitamin calcium supplements (vitD/Ca) remains the prevention of rickets. Three A-level recommendations (high level of evidence) were also adopted by expert consensus. They recommend:

  • achieve 25(OH)D levels >20 ng/mL (>50 nmol/L) in the general pediatric population; levels >30 ng/mL are sometimes necessary to limit mineralization defects and seasonal variability, but do not exceed 80 ng/mL to avoid long-term renal toxicity associated with supplementation;

  • supplement healthy children from 0 to 18 years of age with at least 400 IU of vitD per day. This dose is sufficient to compensate for the physiological decrease in 25(OH)D concentration during winter and allows to maintain these levels in the target range for a long time. Supplementation is recommended during puberty because the mineralization peak is delayed compared to the growth peak;

  • supplement children from 0 to 2 years with vitD2 or D3.

Over-the-counter vitD preparations are not recommended as there have been reports of unsupervised overdose poisoning, often with large doses of these preparations.

What is the administration rate?

In terms of type and rate of administration, experts recommend daily supplementation for children ages 2 to 18 (using D2 or D3) (Grade C). However, if the requirements are not met, it can be replaced by periodic supplementation of 50,000 IU of vitamin D3 every quarter or in two doses of 80,000-100,000 IU in the autumn-winter period (grade D).

Weekly rather than daily supplementation has also been evaluated in some populations. In any case, the reasoning must be explained and discussed with the parents.

What about calcium in food?

For children between 1 and 18 years of age, consuming at least three to four servings of dairy products daily meets the calcium requirement (class B). Failing this, a supplement of 500-1000 mg/day is recommended to supplement insufficient food intake, especially for those following a vegan diet (Grade C). Regular physical activity should meet these recommendations.

After experiencing pain or a broken bone, the doctor should assess the child’s calcium intake (Grade B).

The text also lays down the behavior to be observed with regard to premature babies.

This article was originally published on the websiteMember of Medscape Network.

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