What are the recommended screening guidelines for vitamin D deficiency in children at risk of rickets?

Recommended Screening Guidelines for Vitamin D Deficiency in Children at Risk of Developing Rickets

Routine screening or monitoring of serum 25-hydroxyvitamin D (25[OH]D) levels is not recommended for children, even those at risk of developing rickets, unless they have clinical symptoms of deficiency or are considered to be at very high risk (e.g., very low sunlight exposure or clinical conditions such as osteomalacia) ¹,².

Vitamin D supplementation should be widely promoted and made accessible for at-risk children to prevent deficiency and rickets, rather than relying on routine blood testing ¹,².

For children aged 0–1 year (including breastfed infants), a daily vitamin D supplement of 340–400 IU (8.5–10 micrograms) is recommended, and for children aged 1–4 years, 400 IU (10 micrograms) daily is advised ¹.

Children who consume more than 500 mL of infant formula daily do not require additional vitamin D supplementation as formula is fortified ¹.

If there is clinical suspicion of rickets or hypocalcaemia, or if symptoms are present, serum 25(OH)D and bone profile testing should be performed, and specialist advice sought ¹.

Assessment of dietary calcium intake is also important, as low calcium intake independently increases rickets risk; calcium intake should be optimized alongside vitamin D supplementation ¹.