What are the other Names for this Condition? (Also known as/Synonyms)

• Calcium Deficiency in Children
• Hypocalcemia in Children
• Low Calcium Levels in Children

What is Pediatric Hypocalcemia? (Definition/Background Information)

• Pediatric Hypocalcemia is a condition that is characterized by low calcium levels in blood that occurs in newborns, infants, toddlers and older children. Children of both male and female genders are affected and no predominance of either gender is noted
• Pediatric Hypocalcemia can be classified into the following types:
  • Neonatal hypocalcemia: Occurs soon after birth, and can either be early-onset neonatal hypocalcemia or late-onset neonatal hypocalcemia
  • Infantile hypocalcemia: Occurs in children under the age of 12 months
  • Hypocalcemia in toddlers: Occurring in children aged between 1-4 years
  • Hypocalcemia in older children: Occurring in children over the age of 4 years
• Most cases of Hypocalcemia in Children are reported in neonates. The condition is observed within the first few days after birth. It is generally caused by low birth weight, premature birth, oxygen deprivation during birth, maternal gestational diabetes, or maternal parathyroidism
• In infants, toddlers, and older children, any serous illness, vitamin D deficiency, and acquired hypoparathyroidism may be some causes of Pediatric Hypocalcemia.
• Since calcium is essential for the development of bones, teeth, and hair, the symptoms in affected children may include bone abnormalities, lesions in skin, twitches, numbness and impaired function of muscles
• Treatment methods involve intravenous or oral calcium supplementation, as well as addressing the underlying condition that resulted in Pediatric Hypocalcemia
• The prognosis of the condition depends on the severity of the underlying (pre-existing) condition, the severity of the symptoms, and the child’s response to treatment. Neonatal Hypocalcemia is usually transient and typically resolves with treatment

Who gets Pediatric Hypocalcemia? (Age and Sex Distribution)

• Pediatric Hypocalcemia of the neonatal type is the most common type that occurs in babies born prematurely or to diabetic mothers
  • About 33% or premature babies develop hypocalcemia within 48 hours of birth
  • Neonatal Hypocalcemia occurs in approximately 10-20% of babies born to diabetic mothers
• In older children, Pediatric Hypocalcemia generally occurs as a consequence of a chronic illness
• Pediatric Hypocalcemia can affect children of both male and female genders, any race or ethnicity

What are the Risk Factors for Pediatric Hypocalcemia? (Predisposing Factors)

The risk factors for Pediatric Hypocalcemia may include:

In newborn children:

• Premature birth
• Low birthweight babies
• Mothers with gestational diabetes, or diabetes during pregnancy
• Mothers with hyperparathyroidism during pregnancy
• Maternal hypovitaminosis D (low vitamin D levels) during pregnancy
• Being deprived of oxygen for a prolonged period during the birthing process (neonatal asphyxia)
• Congenital abnormalities of the parathyroid gland, such as due to DiGeorge syndrome, which is characterized by poor development of body tissues and organs
• Being fed milk with a high phosphate content, such as baby formula soymilk

In older children:

• Vitamin D deficiency
• Hyperphosphatemia or elevated phosphate levels in blood
• Hypoparathyroidism or low levels of parathyroid hormone
• DiGeorge syndrome

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Pediatric Hypocalcemia? (Etiology)

Pediatric Hypocalcemia is the depletion of blood calcium in children. It may be caused by several different factors that include:

In neonates/newborns:

• Premature birth and low birth weight, which may be associated with 
  • Improperly functioning parathyroid glands, which regulate calcium levels in the body
  • Increased calcitonin hormone, which regulates calcium metabolism and inhibits calcium leaching from bones
  • Increased loss of calcium in urine
• Diabetes or hyperparathyroidism in the mother during gestation, which may lead to increased suppression of parathyroid gland functioning in the newborn
• Maternal vitamin D deficiency, which can lead to alterations of parathyroid hormone (PTH) levels 
• Infections that cause frequent diarrhea and loss of calcium
• Stress caused by illness immediately after birth and the use of certain medications may also lead to loss of calcium from blood
• Low oxygen levels during the birthing process, known as neonatal asphyxia, can lead to elevated levels of serum calcitonin, which inhibits calcium leaching from bones and consequential low calcium levels in blood
• Increased phosphate intake via baby formula milk can increase serum phosphate levels, which in turn can lead to a decrease in serum calcium concentration
• Congenital abnormalities in organ and tissue formation from conditions such as DiGeorge syndrome

In infants, toddlers, and older children:

• Vitamin D deficiency that may result from:
  • An inadequate intake of vitamin D
  • Disorders of vitamin D metabolism
  • Liver disorders that can increase vitamin D breakdown
• Hyperphosphatemia, or increase in the levels of phosphate in blood, which can result in precipitation of calcium and phosphate. This may be caused by factors such as:
  • Drinking milk with excess phosphorus and low calcium (such as certain soy-based formula milk for infants or cow’s milk)
  • Kidney failure
  • Chemotherapy
• Hypoparathyroidism: Parathyroid hormone (PTH) is secreted by the parathyroid glands. Normal PTH levels and activity are crucial for maintaining proper blood calcium levels. Hypoparathyroidism is a decrease in the levels of PTH, which may result from:
  • Autoimmune disorders that cause inflammation of the parathyroid glands and suppress PTH synthesis (such as parathyroiditis)
  • DiGeorge syndrome, characterized by malformation of several body tissues and organs, including parathyroid glands
  • Pseudoparathyroidism, in which the levels of PTH are normal, but the PTH receptor is dysfunctional
• Certain disorders, such as Wilson’s disease, which can lead to a decrease in PTH levelsIntestinal-related conditions that may arise from infections, inflammation, surgery or medications, can cause malabsorption syndrome. This condition can lead to decreased absorption of nutrients including vitamin D in the body
• Acute pancreatitis (inflammation of pancreas) can cause calcium to be precipitated in the abdomen, causing reduced calcium levels in blood
• Blood transfusions, where the blood may contain chelating agents (such as ethylenediaminetetraacetic acid/EDTA and citrate) can precipitate calcium and cause its blood levels to drop

What are the Signs and Symptoms of Pediatric Hypocalcemia?

The signs and symptoms of Pediatric Hypocalcemia may vary in type and severity among the affected children. Some children may be asymptomatic, whereas others may have clinically significant symptoms.

The signs and symptoms of Pediatric Hypocalcemia in newborns may include:

• Twitching
• Vomiting
• Shakiness and jerky movements
• Bloated belly
• Poor feeding
• Difficulty breathing; rapid breathing
• Rapid resting heart rate (tachycardia)
• Lethargy (lack of energy)

The signs and symptoms of Pediatric Hypocalcemia in infants, toddlers, and older children may include:

• Weakness
• Muscle twitching
• Muscle cramps particularly during physical exertion
• Temporary inability to speak (laryngospasm)
• Tingling or “pin prick” sensations (parasthesia)
• Numbness
• Twitching of facial muscles, when the area over the facial nerve is tapped (Chvostek’s sign)
• Bone abnormalities
• Fragile bones leading to fractures
• Developmental delays
• Breathing difficulty; rapid breathing
• Rapid heartbeat
• Seizures

How is Pediatric Hypocalcemia Diagnosed?

The diagnosis of Pediatric Hypocalcemia is made on the basis of the following tests and exams:

• A thorough physical examination and an assessment of the presenting signs and symptoms
• Evaluation of the medical history of the mother and family (for inherited disorders)
• Blood test to assess the total and ionized calcium levels. The total calcium test helps measure both the free and bound forms of calcium in blood. The ionized fraction is the free calcium and is considered the active form. A child is considered hypocalcemic, if serum calcium concentration is any of the following:
  • Less than 8 mg/dL of total serum calcium in a full-term baby, with ionized calcium levels below 4.4 mg/dL
  • Less than 7 mg/dL of total serum calcium in a prematurely born baby, with ionized calcium between 0.8-0.9mg/dL
  • 8.5 mg/dL of total serum calcium in older children, or below 4.3 mg/dL of ionized calcium
• Additional tests to ascertain causative conditions for hypocalcemia may be necessary for an accurate diagnosis

The normal values, called the reference range, may vary from lab to lab. Hence, most lab reports come with a reference range, which is used in that particular center. A physician interprets the results based on the reference values provided.

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Pediatric Hypocalcemia?

The following are some potential complications of Pediatric Hypocalcemia, if the condition is not diagnosed or treated in a timely manner:

• Inadequate weight gain due to poor feeding in newborns
• Delay in achieving developmental milestones
• Increased risk for fractures
• Seizures, which can cause aspiration pneumonia
• Injuries due to seizures
• Dysfunction of cardiac muscles can lead to sudden cardiac arrest, which can be life-threatening

How is Pediatric Hypocalcemia Treated?

The treatment options for Pediatric Hypocalcemia depend on the severity of symptoms, the child’s overall health status, and his/her tolerance for certain medications and therapies. The treatment measures may include:

• Intravenous (IV) calcium gluconate for early-onset neonatal hypocalcemia
• Oral calcium supplements for newborns with late-onset neonatal hypocalcemia and for older children
• Medication for infections, if needed
• Medication for stopping diarrhea, if necessary
• In case of a fracture, resetting the broken bone in a cast to let it heal
• Additional treatments as deemed necessary by the healthcare provider, to address any underlying condition causing Pediatric Hypocalcemia

How can Pediatric Hypocalcemia be Prevented?

If Pediatric Hypocalcemia occurs as a consequence of congenital disorders, such as DiGeorge syndrome, there are no methods or guidelines available for its prevention. In other cases, the following may be considered:

• Proper control of blood sugar during pregnancy may help avoid development of Pediatric Hypocalcemia in a newborn child
• Regular medical screening at periodic intervals with tests and physical examinations are strongly recommended for pregnant women with gestational diabetes or hyperparathyroidism

What is the Prognosis of Pediatric Hypocalcemia? (Outcomes/Resolutions)

• The prognosis of Pediatric Hypocalcemia is typically good; since, in most cases, the condition is transient in nature. An appropriate treatment leads to restoration of normal blood calcium levels
• Nevertheless, the prognosis also depends on the severity of the underlying causative condition, if any
• If life-threatening complications, such as cardiac arrest, is noted, then the prognosis may be guarded

Additional Relevant Useful Information for Pediatric Hypocalcemia:

Calcium is an important mineral for several cellular functions, which ultimately impact the whole body. Calcium is involved in the following processes in the body:

• Cell-cell communication
• Muscle contraction
• Conduction of nerve signals
• Activation of enzyme cascades
• Blood clotting, since calcium is also known as coagulation factor IV, and is necessary for the functioning of many enzymes involved in the clotting cascade
• Exocrine secretions, such as bile and pancreatic juice