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Vitamin D for children: use medicines and not food supplements to prevent the risk of overdose

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News of 27/01/2021

Cases of vitamin D overdose have recently been reported in young children following the use of food supplements fortified with this vitamin. These cases present as hypercalcaemia (excessive calcium in the blood), which can have serious consequences on the kidneys such as lithiasis or nephrocalcinosis (calcium deposition in the kidneys).

In response to this, ANSES, the French Health Products Safety Agency (ANSM), paediatric scientific societies[1], the National College of Midwives and French poison control centres are alerting healthcare professionals and parents to the risk of overdose associated with giving vitamin D supplements to children, especially infants.

To prevent this risk, they are asking healthcare professionals and parents to:

  • opt for medicines rather than food supplements;
  • check the doses administered (verify the amount of vitamin D per drop);
  • avoid combining different products containing vitamin D.

Read the opinion drawn up in consultation with the paediatric scientific societies, the National College of Midwives, French poison control centres and ANSES.

 

Risks associated with Vitamin D and food supplements

The use of vitamin D supplements in children is not without risk, for the following reasons:

  • the vitamin D concentration per drop can be very high (up to 10,000 IU) and there is sometimes no recommended dose according to age,
  • possible dosage errors when switching from a medicine to a food supplement, or when changing to a different food supplement,
  • the large number of products on the market with different concentrations/doses, sometimes under the same brand (products with different names leading to a risk of confusion, or even dose accumulation, if products containing vitamin D are combined),
  • the presence in the food supplement of other vitamins (e.g. vitamin K, for which there is no recommendation for daily administration to children) or calcium in high doses (aggravated risk of kidney damage such as lithiasis/nephrocalcinosis).

 

What should be done

For healthcare professionals

Vitamin D supplementation is recommended in France from the first few days of a baby’s life in order to prevent rickets; this supplementation should be continued throughout the bone growth and mineralisation phase, i.e. until the age of 18.

However, there is a real risk of overdose fostered by high concentrations (500 to 10,000 IU of vitamin D in one drop), if the food supplement label is misread or if different food supplements are combined.

We therefore recommend that prescribers always opt for the use of a medicine rather than a food supplement, regarding both the expected benefit and the risk, especially for young children. Prescribers are also advised to choose the pharmaceutical product they consider to be best following a discussion with the parents.

The national recommendations on vitamin D doses for children are currently being updated[2]. These will be brought in line with European recommendations, i.e. 400 IU per day for healthy children from 0 to 18 years of age without risk factors, and 800 IU per day for children from 0 to 18 years of age with risk factors.

In addition, ANSES will soon be publishing an update of its dietary guidelines, including those for vitamin D, in order to improve the intakes provided by food.

For parents

Vitamin D is essential for bone growth in children. To ensure this growth, vitamin D is prescribed in France from the first few days of a baby’s life to prevent rickets, which is a disease of growth and ossification.

However, giving your child too much vitamin D can be just as harmful as not giving enough.

It is therefore necessary to:

  • carefully control the doses given to your child and avoid combining different products containing vitamin D, in order to prevent overdoses that could impair kidney function;
  • opt for the use of a medicine containing vitamin D rather than a food supplement fortified with this vitamin, especially for young children;

Children should not be given a product daily whose origin and composition are not guaranteed and which could lead to irreversible poisoning through excessive vitamin D intake. In any event, food supplements should not be purchased on the Internet, as they may not comply with the regulations.

Report any adverse effects on the vigilance portal:

www.signalement-sante.gouv.fr or to a Poison Control Centre (CAP),

or to a Regional Pharmacovigilance Centre (CRPV) if it concerns a medicinal product,

or to ANSES’s national nutrivigilance scheme if it concerns a food supplement.


[1] SFP: French Society of Paediatrics, SFN: French Society of Neonatology, SFMP: French Society of Perinatal Medicine, FFRSP: French Federation of Perinatal Health Networks,  SFEDP: French Society of Paediatric Endocrinology and Diabetology, SNP: Society of Paediateric Nephrology, AFPA: French Association of Ambulatory Paediatrics, the OSCAR network and the Reference Centre for Rare Calcium and Phosphorus Diseases.

[2] Multi-disciplinary working group coordinated by the Reference Centre for rare calcium and phosphorus diseases, and validated by the scientific societies and groups of professionals working in child health (SFP, SFEDP, SNP, SOFREMIP, AFPA, SFN in particular) using the DELPHI method

               

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