MANAGEMENT GUIDELINES FOR PAEDIATRIC ENDOCRINOLOGY
Vitamin D deficiency
Clinical suspicion
of vitamin D deficiency in a child < 16 years of age
Investigations
U&E, Creatinine, LFT’s, Calcium, Phosphate, 25(OH)Vit D, PTH, Wrist X-ray
Is vitamin D less than 30 nmol/L?
No
See below and also
consider alternative
diagnosis
Yes
1.
2.
3.
4.
5.
6.
7.
Are any of the following present?
Clinical rickets
Abnormal X-ray
Creatinine above upper limit reference range
LFTs abnormal
Calcium outside normal reference range for age
Growth failure
Atypical features
Yes
Refer to Paediatric
Endocrinology.
No
Treatment (NB: very small children may need lower doses than recommended for age)
3000units/ml colecalciferol solution daily for 2 months then recheck vitamin D levels
- Age 1-12 months: 3000 units/day
- Age 12 months - 12 years: 6000 units/day
- Age 12-18 years: 9000 units/day
Patient’s family have similar risk of vitamin D deficiency
Investigate siblings and mother, and treat if required
Option 1
Prevention of further deficiency or if Vit D insufficient (30-70 nmol/L)
Abidec/Dalivit Oral daily, ongoing until completion of growth
Age ≥ 6 weeks: 400 units = 0.6ml = 14 drops
Option 2
Calcichew D3 Forte, 1 tablet daily (400 units), orally, may be preferred by older children
Option 3
Annual single oral dose 150,000 units Ergocalciferol (50ml of solution (3000 units/ml))
$
In the event of non-availability of oral vitamin D: best option in absence of rickets is Abidec/Dalivit daily but as
this doesn’t replenish vitamin D stores, it will need to be continued until completion of growth.
Allgrove J, BSPED website
$ Oliveri B et al, Eur J Clin Nutr 1996;50:807-810
Oxford Paediatric Endocrine Team, May 2013
Review date, May 2016