How should I manage a child diagnosed with rickets due to vitamin D deficiency, including supplementation dosages?

Management of a child diagnosed with rickets due to vitamin D deficiency involves:

• Referral: Arrange referral to a paediatrician for children with clinical features of rickets before starting treatment ¹.
• Vitamin D supplementation: Initiate high-dose vitamin D treatment for 8–12 weeks to rapidly correct deficiency, typically using cholecalciferol (vitamin D3) as per Royal Osteoporosis Society (ROS) guidelines ¹.
• Dosage: Although exact dosing should be guided by specialist advice, high-dose regimens often involve daily doses of 2000 IU to 6000 IU vitamin D3 for 8–12 weeks, followed by maintenance doses ¹. The British National Formulary for Children supports reducing to maintenance doses after 8–12 weeks to avoid hypercalcaemia ¹.
• Maintenance therapy: After loading, maintain vitamin D supplementation at 400–600 IU daily to sustain adequate levels and prevent recurrence ¹.
• Calcium intake: Assess dietary calcium intake and advise increasing calcium-rich foods; if inadequate, consider calcium supplementation as many children with vitamin D deficiency are also calcium deficient ¹. Recommended daily calcium intake to prevent rickets is 200 mg (birth to 6 months), 260 mg (6–12 months), and >500 mg (over 12 months) ¹.
• Monitoring and follow-up: Arrange follow-up to reassess serum 25(OH)D and bone profile levels and monitor symptoms ¹. Routine monitoring is not required if the child is asymptomatic and compliant with therapy ¹.
• Lifestyle advice: Advise on safe sunlight exposure and dietary sources of vitamin D to maintain adequate levels ¹.