Children in India – vitamin D guidelines similar to IoM

Created March 2014

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@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.

PDF is attached at the bottom of this page

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