A new clinical practice guideline recommends empirical vitamin D supplementation for all children and adolescents.

Vitamin D is important for skeletal growth and bone health in children and adolescents; however, low vitamin D levels in children are prevalent worldwide. The Endocrine Society has updated its 2011 practice guideline on vitamin D supplementation; we have covered the recommendations for adults separately (NEJM JW Gen Med Sep 1 2024). This summary covers the portion of the guideline relevant to children and adolescents.

The Endocrine Society now recommends that all children and adolescents (age range, 1 to 18 years) receive empirical vitamin D supplementation for the following reasons:

1. to prevent nutritional rickets (600 IU daily)
2. to potentially lower risk for respiratory tract infections (300 to 2000 IU daily, based on the clinical trials reviewed by the guideline committee).

Empirical vitamin D can include dietary intake of fortified foods or vitamin D drops or pills. Although these recommendations are based on low-certainty evidence, the authors believe that benefits of supplementation on paediatric skeletal health outweigh the negligible risks.

Comment: When it comes to vitamin D, this guideline will not change the way most paediatricians in the USA practice. Like many of my colleagues, I already inquire routinely about vitamin D intake during well-child visits, and I proactively recommend dietary sources of vitamin D. For my at-risk patients – children with dietary restrictions, limited exposure to sunlight or certain medical comorbidities – I test for serum vitamin D levels and supplement accordingly.

James A. Feinstein, MD, MPH, Associate Professor of Pediatrics, Children’s Hospital Colorado and University of Colorado School of Medicine,
Aurora, USA.

Demay MB, et al. Vitamin D for the prevention of disease: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 2024; 109: 1907-1947.