Vitamin D deficiency in childhood-a review of current guidelines on diagnosis and management.
Indian Pediatr. 2013 Jul;50(7):669-75.
Balasubramanian S1, Dhanalakshmi K, Amperayani S.
1 Kanchi Kamakoti CHILDS Trust Hospital, The CHILDS Trust Medical Research Foundation, 12-A, Nageswara Road, Nungambakkam, Chennai 600 034, Tamil Nadu, India. sbsped at gmail.com
Vitamin D deficiency has emerged as a significant public health problem throughout the world. Even in the Indian context,it has been reported to be present in majority of children in spite of wide availability of sunlight. Recent guidelines have defined vitamin D status as severe deficiency, deficiency, sufficiency and risk for toxicity as 25(OH)D levels <5, <15, >20 and >50ng/mL, respectively.The manifestations of deficiency may vary from hypocalcemic seizures, tetany in infancy and adolescence to florid rickets in toddlers. Treatment is necessary for all individuals with deficiency whether symptomatic or not and consists of vitamin D supplementation as Stoss therapy or daily or weekly oral regimens with equal efficacy and safety, combined with calcium supplements. Routine supplementation starting from newborn period is being increasingly endorsed by various international organizations. Prevention by sensible sunlight exposure, food fortification and routine supplementation are the currently available options for tackling this nutritional deficiency.
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Whom to screen for vitamin D deficiency
- i. Dark skinned infants who live at higher altitude and infants born to vitamin D deficient mothers.
- ii. In the presence of nonspecific symptoms like poor growth, gross motor developmental delay and unusual irritability.
- iii. Children with suspected rickets, those with osteoporosis.
- iv. Chronic kidney disease
- v. Hepatic failure
- vi. Mal absorption syndromes.
Cystic fibrosis
Inflammatory bowel disease
Crohn’s disease - vii.Hyper parathyroidism
- viii.Medications
Anticonvulsants
Glucocorticoids
AIDS medications
Antifungals (ketoconazole) - ix. Obese children and adults (BMI > 30kg/m2)
- x. Granuloma forming disorders
1. Sarcoidosis
2. Tuberculosis
3. Histoplasmosis
See also VitaminDWiki
- Infant-Child category listing
- Fewer pre-infants were vitamin D deficient when they got 800 IU – RCT Feb 2014
- Third study found that Infants needed 1600 IU of vitamin D – JAMA RCT May 2013
- Why India's vitamin D deficiency is grim - 40 pages Feb 2014
- Rickets in 30 percent of infants in India who had low vitamin D – March 2011
- Search VitaminDWiki for INDIA 730 items as of March 2014
- Search VitaminDWiki for those items with INDIA in the title 18 items as of Feb 2014