Zinc in Pediatrics
Key Points
- Essential trace element crucial for growth, immunity, and neurodevelopment
- WHO recommends zinc supplementation for treatment of diarrhea
- Critical for wound healing and protein synthesis
- Deficiency common in developing countries and specific conditions
Physiological Role
- Enzyme cofactor for over 300 metalloenzymes
- DNA synthesis and cell division
- Immune system development and function
- Protein and collagen synthesis
- Growth and development
- Taste and smell perception
Clinical Uses
Primary Indications
- Acute Diarrhea
- Reduces duration and severity
- Decreases risk of subsequent episodes
- Recommended by WHO/UNICEF
- Growth Failure
- Supplementation in zinc-deficient children
- Prevention in high-risk populations
- Skin Conditions
- Acrodermatitis enteropathica
- Diaper rash
- Wound healing
Secondary Indications
- Upper respiratory infections
- May reduce duration and severity
- Preventive role in recurrent infections
- Wilson's Disease (with copper chelation)
- Prevention of growth retardation in at-risk populations
- Support during catch-up growth
Available Preparations
Oral Supplements
- Zinc Sulfate
- Available strengths: 10mg, 20mg, 50mg
- Most commonly used form
- Good bioavailability
- Zinc Gluconate
- Available strengths: 5mg, 10mg, 15mg
- Better tolerated than sulfate
- Common in OTC preparations
- Zinc Acetate
- Available strengths: 10mg, 25mg, 50mg
- Used in Wilson's disease
- Good absorption profile
Topical Preparations
- Zinc Oxide
- Concentrations: 10-40%
- Used in diaper rash creams
- Barrier protection properties
- Zinc Pyrithione
- Concentrations: 0.25-2%
- Used in seborrheic dermatitis
- Antifungal properties
Dosing Guidelines
Acute Diarrhea Treatment
- Age < 6 months: 10mg daily for 10-14 days
- Age ≥ 6 months: 20mg daily for 10-14 days
Prevention and Supplementation
- Infants (0-6 months): 2mg/day
- Infants (7-12 months): 3mg/day
- Children (1-3 years): 3-5mg/day
- Children (4-8 years): 5-8mg/day
- Children (9-13 years): 8-11mg/day
Therapeutic Doses for Specific Conditions
- Wilson's Disease: 25-50mg elemental zinc 3 times daily
- Acrodermatitis Enteropathica: 1-3mg/kg/day
- Severe Malnutrition: 2-3mg/kg/day
Special Populations
Premature Infants
- Higher requirements (400-800 μg/kg/day)
- Monitor serum levels closely
- Adjust based on growth and clinical response
Malabsorption Syndromes
- Celiac disease
- Inflammatory bowel disease
- Cystic fibrosis
- May require higher doses
At-Risk Groups
- Vegetarians/vegans
- Children with sickle cell disease
- Chronic liver disease
- Burns and trauma patients
Monitoring & Precautions
Side Effects
- Common:
- Nausea
- Vomiting
- Metallic taste
- Epigastric pain
- Less Common:
- Copper deficiency
- Iron interaction
- Neutropenia
Monitoring Parameters
- Clinical response
- Growth parameters
- Serum zinc levels (if indicated)
- Complete blood count
- Copper levels in long-term therapy
Drug Interactions
- Iron supplements (separate by 2 hours)
- Tetracyclines
- Quinolone antibiotics
- Penicillamine
Further Reading
