The data were collected as an online survey through a Google form by phone (Whatsapp) or e-mail. Participants were selected from personal contacts with no geographical restrictions. Participant’s consent was incorporated within the online form. The information was collected in an anonymous format. Practice parameters were collected separately for age groups less than 1 year, 1-5 year, 6-10 year and 10-19 year. Approval of the institutional ethics committee was obtained prior to the conduct of the study.

The survey consisted of 11 close-ended questions to cover professional experience in years, knowledge about any vitamin D supplementation guidelines, practice of vitamin D supplementation across different ages, duration (infrequent if less than 6-12 months/year) and dose of vitamin D supplementation if practiced, practice of measuring serum 25-hydroxy vitamin D (25OH-D) before supplementation, and practice of promoting sunlight exposure. Assuming a prevalence of vitamin D supplementation as 15% among healthy adolescents, a sample size of 196 respondents was needed with an absolute precision of 5% and 95% level of confidence.

A total of 230 (140 from private sector) responses were collected over two weeks. The majority (56%) of respondents had more than ten-year experience and only 10% were pursuing pediatric residency. Most (204, 79%) respondents were aware of the national or international guidelines for vitamin D supplementation. Table I shows the vitamin D supplementation practices of these respondents across different age-groups. Eight (3.5%) reported use of a monthly 60,000 IU dose across different age groups. Overall, 182 (79%) promoted sunlight exposure and 171 (74.3%) did not measure serum 25OH-D levels before supplementation.

Table I Practice of Pediatricians Regarding Vitamin D Supplementation for Different Age-groups (N=230)

The present study highlights that the practice of routine vitamin D supplementation prescription was mostly limited to infancy, with a minority practicing routine vitamin D supplementation beyond infancy in the recommended doses [4]. The recent Comprehensive National Nutrition Survey [5] reported low prevalence (14-24%) of vitamin D deficiency (serum 25OH-D <12ng/mL) in Indian children beyond infancy, raising concerns over need of routine vitamin D supplementation in apparently healthy children in this age. A cohort study on annual vitamin D prescriptions of over two million children from UK showed 26-fold rise in prescribing trend between 2008-2016 with maximum rise in adolescent age group (higher for girls than boys) [6]. There were 24 different dosing regimens used with pharmacological doses (>1000 IU/day) prescribed in 42.8% children with insufficient vitamin D levels, suggestive of poor compliance to national guidelines [6].

The meager supplementation rates in older children in the present study probably were related to absence of felt-need for vitamin D supplementation in this age-group. The limitation of this study was that the information was self-reported, and no physical verification of prescriptions was done. Moreover, the data were collected from only opt-in respondents who could be contacted personally by the study team, which may have introduced selection bias. Information on geographical location of participants and the seasonal preferences was not collected.

To conclude, the present survey highlights the varied vitamin D supplementation practices among pediatricians with majority prescribing supplementation during infancy but not for older children and adolescents.

Ethical clearance: Institutional ethics committee of Maulana Azad Medical College, New Delhi; 73/01/2020/41, dated March 13, 2020.

Contributors: PG, DS: conceived the study and its design; AD, MB: data collection, analysis and drafting the manuscript; PG, DS: critical inputs to drafting of manuscript. All authors approved the final manuscript.

Funding: None; Competing interest: None stated.

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5. Comprehensive National Nutrition Survey, 2016-2018. Ministry of Health and Family Welfare, Government of India. Available from: https://www.popcouncil.org/ uploads/pdfs/2019RH_CNNSreport.pdf. Accessed March 09, 2020.