Synopsis
Prescribe age-appropriate vitamin D and A, C and D supplements, recognise when formula already supplies enough, prevent duplicate dosing, distinguish routine prevention from treatment of deficiency, and adapt plans for prematurity, restricted diets and malabsorption.
- First-line prevention for a breastfed infant is a daily vitamin D supplement containing 8.5–10 micrograms from birth, even when the breastfeeding parent takes vitamin D.
- A formula-fed infant does not need additional vitamin D while taking at least 500 mL formula daily, because infant formula is fortified; start drops when intake falls below this threshold.
- Children aged 6 months to 5 years should receive daily vitamins A, C and D unless they consume at least 500 mL infant formula daily; children aged 1–4 years need 10 micrograms vitamin D daily.
Key red flags
Seizures, apnoea, stridor, tetany, carpopedal spasm or arrhythmia requires emergency assessment for hypocalcaemia and other metabolic causes.
Investigation priorities
Determine whether routine prevention is correct and detect omitted or duplicate dosing.
Management branches
An infant receives breast milk, including mixed feeding with less than 500 mL formula daily.
- Choose an age-appropriate preparation supplying 8.5–10 micrograms vitamin D daily.
- Demonstrate the exact measured dose and check no other product duplicates it.
Key medicines
Vitamin D preventive supplementBreastfed infants from birth: 8.5–10 micrograms (340–400 units) orally once daily. Formula-fed infants: give when formula intake is below 500 mL daily. Age 1–4 years: 10 micrograms (400 units) daily.