Vitamin D for Infants: Does My Baby Need Supplements?

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  • July 13, 2015
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Vitamin D for Infants: I heard I’m supposed to give vitamin D to my baby. What is it? Why is it important?

If you’ve made a baby, grown a baby, birthed a baby, or witnessed any of these, you know how amazing the human body is. How our bodies make vitamin D is an amazing process in itself.

Soaking up the sun’s ultraviolet rays is the most effective way for your body to make vitamin D. Your skin absorbs it and sends it to your liver and kidneys where it changes to 25(OH)D. There it becomes activated and transported to the rest of your body’s tissues and organs where it works with other minerals like calcium and phosphorous to help your body work the best it can. It’s well known that vitamin D contributes to bone health, but new research is showing how important it is for the rest of your body, too: your immune system, cardiovascular system, respiratory system, muscles and brain all function better with the right amount of vitamin D.1

Vitamin D deficiency can lead to rickets, which is the softening and weakening of the bones and is most often seen in children ages 6-24 months when their bones go through periods of rapid growth. It’s rare in the U.S. but the deformities can be permanent and it is easily preventable by getting enough of this vitamin synthesized from the sun.2

But aren’t we supposed to avoid the sun?

Right. About that. Sun exposure (specifically UVB rays) is truly the best way to get vitamin D, and the more of your skin that is exposed (ie. your whole back vs. just your hands and face), the quicker you fill up your vitamin D cup. There are many factors that affect how efficiently your body synthesizes these rays into vitamin D:

  • the pigment of your skin (lighter skin absorbs vitamin D faster than darker skin)
  • your weight (research has shown that a higher BMI leads to lower vitamin D levels3, possibly due to the the decreased bioavailability of vitamin D as a result of obesity4
  • the time of day (middle of the day sun exposure produces more vitamin D)
  • the latitude at which you live (the closer you are to the equator, the less time it takes to soak up the rays and create vitamin D)
  • the time of year (anyone who lives in the north knows that the sun is in short supply in the winter!)5

There can be many different combinations of these factors which is why vitamin D status is unique to each person, and why everyone should be tested regularly or take a supplement to ensure an adequate level. 

 

What about sunscreen? 

Great question! Preventing skin cancer while getting enough vitamin D starts with staying aware of your sun exposure. You want a little bit, but not too much. Frequent, moderate sun exposure is healthy for adults, while intense or overexposure can increase the risk of skin cancer. Sunscreen has been shown to prevent some forms of skin cancer, but not all, so covering up with shade or clothing after getting some sun is the most effective and safest way to protect your skin. Babies, on the other hand, have such sensitive skin that always covering up in the sun is the recommendation (and using a safe sunscreen6 if covering up isn’t possible), so getting vitamin D through food and/or supplements is best.7

 

So I SHOULD give my baby a vitamin D supplement since I shouldn’t expose her to the sun?

The American Academy of Pediatrics (AAP) and the U.S. Centers for Disease Control (CDC) recommend all infants are given 400IU of a vitamin D oral supplement every day starting soon after birth.8,9 This is because research has shown that most infants and mothers are deficient or severely deficient in vitamin D. Risk factors for infant vitamin D deficiency include maternal deficiency, winter birth, black race, and a maternal BMI of ≥35.10,11,12

The National Institute for Health and Clinical Excellence (NICE) in the UK suggests that healthy infants born to mothers who have taken 400IU of vitamin D throughout pregnancy and while breastfeeding should have enough vitamin D stored in their bodies to last up to their first six months of life.13 At that point, they suggest supplementing babies with 400IU of vitamin D. However, “if the mother’s vitamin D status in pregnancy is uncertain, or if she falls into one of the risk groups, vitamin D supplements for mother and baby should be started soon after birth.”14

So moms, your vitamin D status in pregnancy is important because it affects how much your infant will be born with. Be sure to get your levels tested so you know if/how much you need to supplement. Currently, recommendations during pregnancy are conflicting, ranging from 600-6,000IU a day15, so talk with your OB or midwife about how much you should take.

 

Is vitamin D in any foods that we eat?

Some foods like breakfast cereals, orange juice, and soy and dairy products are fortified with vitamin D. Fatty fish like tuna, mackerel, and salmon may be the best real-food bang for your buck, though, with at least 500-800IUs per serving. Mushrooms and egg yolks also provide around 300-800IU.16

 

Speaking of food. I’m breastfeeding my baby. Isn’t breast milk supposed to be the perfect food? Why am I supposed to give my baby a vitamin D supplement?

Since we know that vitamin D is best absorbed through the skin and that it is best for babies to avoid sun exposure, the next best way for babies to get vitamin D is through their digestive system. Breast milk is the perfect food in the sense that it is exactly what your baby’s body is expecting. It is made specifically for your baby and is full of antibodies, hormones, enzymes, growth factors, stem cells, nutrients and so much more. It doesn’t, however, always have as much vitamin D as babies may need, especially since moms are most likely to be deficient themselves. If you don’t have enough vitamin D for yourself, you won’t have enough vitamin D to meet your baby’s needs through your breast milk either.

 

Ok, that makes sense. But can my baby get enough vitamin D through my breastmilk if I take vitamin D supplements myself?

More research is needed to determine how much vitamin D moms need to take (or synthesize from the sun) in order to ensure high enough levels in her milk to meet her baby’s requirements. There is also conflicting information about how much is safe for mom to take before reaching toxic levels. The Journal of Human Lactation published a systematic review in 2013 showing that moms can take in enough vitamin D to transfer an amount in her breast milk that would be adequate for her infant. They also found no change in vitamin D toxicity markers and that “doses up to 10 times the current recommended daily intake of vitamin D were needed to produce sufficient transfer from mother to breastfed infant.” The call is out for further research in order to learn the necessary and appropriate dose and gestational timing of maternal vitamin D supplementation.17

 

I feed my baby formula. Does that have vitamin D in it?

Infant formula is fortified with vitamin D, but babies need to be consuming at least one liter (about 34 ounces) each day before they get the recommended 400IUs a day. The AAP and CDC recommend vitamin D supplements for these babies until they’re consuming that much formula (or cow’s milk after 1yr). Some babies take at least a week before they start consuming that much milk, while others never quite get to that point, rarely drinking more than 24-30 ounces a day.18,19

 

Where can I find vitamin D supplements for my baby?

Ask your baby’s doctor for his or her recommendation. Vitamin D is often found in infant multivitamins though there are anecdotal reports that babies sometimes gag, choke, or spit up these versions. You can, however, find vitamin D only supplements that include the full daily dose in just one drop. This can be dropped onto mom’s nipple before latching baby on, or can be added to baby’s food or drink once they are drinking from a bottle or eating solids.

Hopefully this has clarified some of the confusion around what exactly vitamin D is, why we all need it, and why even breastfed babies benefit from a vitamin D supplement, too! Now get out there and safely soak up some sun!


Kara Kaikini is the Course Developer and Educator at Doula Spot as well as an International Board Certified Lactation Consultant (IBCLC). Besides being a mom, Kara’s main gig is the Parent Education Program Coordinator at Maine Medical Center’s Family Birth Center where she immerses herself in everything pregnancy, birth, postpartum, babies, and breastfeeding. Having spent time as a postpartum doula Kara loves providing education and support to new parents and babies as they embark on this new adventure of parenthood. She spends her “free time” on the beautiful coast of Maine on her dad’s boat or at her family’s home, and daydreaming about future family adventures. Kara lives in Freeport, Maine with her husband and her young sons Bode and Eli.


  1. “What is Vitamin D,” Vitamin D Council, accessed June 25, 2015, http://www.vitamindcouncil.org/about-vitamin-d/what-is-vitamin-d/# 

  2. “Rickets,” National Institutes of Health, U.S. National Library of Medicine, Medline Plus, last updated August 30, 2014, http://www.nlm.nih.gov/medlineplus/ency/article/000344.htm 

  3. Vimaleswaran KS, et al. Causal Relationship between Obesity and Vitamin D Status: Bi-Directional Mendelian Randomization Analysis of Multiple Cohorts. PLoS Med 10 (2013):e1001383. Accessed June 25, 2015, doi:10.1371/http://ajcn.nutrition.org/content/72/3/690.full 

  4. Wortsman, J, et al. Decreased Bioavailability of Vitamin D in Obesity. The American Journal of Clinical Nutrition 72 (2000): 690-693. http://ajcn.nutrition.org/content/72/3/690.full 

  5. “What is Vitamin D,” Vitamin D Council, accessed June 25, 2015, http://www.vitamindcouncil.org/about-vitamin-d/what-is-vitamin-d/# 

  6. “EWG Guide to Sunscreens”, Environmental Working Group, accessed June 25, 2015, http://www.ewg.org/2015sunscreen/ 

  7. “How Do I Get the Vitamin D My Body Needs,” Vitamin D Council, accessed June 25, 2015, http://www.vitamindcouncil.org/about-vitamin-d/how-do-i-get-the-vitamin-d-my-body-needs/# 

  8. “Vitamin D Supplementation,” Centers for Disease Control and Prevention, Division of Nutrition, Physical Activity and Obesity, last updated June 15, 2015, http://www.cdc.gov/breastfeeding/recommendations/vitamin_d.htm 

  9. “Vitamin D Supplementation for Infants,” American Academy of Pediatrics, accessed June 25, 2015, https://www.aap.org/en-us/about-the-aap/aap-press-room/pages/Vitamin-D-Supplementation-for-Infants.aspx 

  10. Merewood, A. et al. Widespread Vitamin D Deficiency in Urban Massachusetts Newborns and Their Mothers. Pediatrics (2010): 2009-2158. Accessed June 25, 2015. doi: 10.1542/peds.2009-2158 http://pediatrics.aappublications.org/content/early/2010/03/22/peds.2009-2158.abstract 

  11. Forrest, KY & Stuhldreher, WL. Prevalence and Correlates of Vitamin D Deficiency in US Adults. Nutrition Research 1 (2011): 48-54. Accessed June 25, 2015. doi: 10.1016/j.nutres.2010.12.001 http://www.ncbi.nlm.nih.gov/pubmed/21310306 

  12. Perrine, CG et al. Adherence to Vitamin D Recommendations Among US Infants. Pediatrics 125 (2010):627-632. doi: 10.1542/peds.2009-2571.  http://pediatrics.aappublications.org/content/125/4/627.full 

  13. “Vitamin D: Increasing Supplement Use Among At-Risk Groups,” National Institutes for Health and Care Excellence (NICE), accessed June 25, 2015, http://www.nice.org.uk/guidance/ph56 

  14. “Statement on Vitamin D Supplementation for Breastfed Babies”, UNICEF UK, The Baby Friendly Initiative, Accessed June 25, 2015, http://www.unicef.org.uk/BabyFriendly/News-and-Research/News/UNICEF-UK-Baby-Friendly-Initiative-Statement-on-vitamin-D-supplementation-for-breastfed-babies/ 

  15. “Vitamin D During Pregnancy and Breastfeeding,” Vitamin D Council, accessed June 25, 2015, http://www.vitamindcouncil.org/further-topics/vitamin-d-during-pregnancy-and-breastfeeding/# 

  16. “Nutrients List,” United States Department of Agriculture, Agricultural Research Service,  National Nutrient Database for Standard Reference Release 27, accessed June 25, 2015, http://ndb.nal.usda.gov/ndb/nutrients/report/nutrientsfrm? 

  17. Thiele, DK, Senti, JL, & Anderson, CM. Maternal Vitamin D Supplementation to Meet the Needs of the Breastfed Infant: A Systematic Review. Journal of Human Lactation 29 (2013): 163-170, Accessed June 25, 2015, doi:10.1177/0890334413477916. http://jhl.sagepub.com/content/29/2/163.abstract 

  18. “Vitamin D Supplementation,” Centers for Disease Control and Prevention, Division of Nutrition, Physical Activity and Obesity, last updated June 15, 2015, http://www.cdc.gov/breastfeeding/recommendations/vitamin_d.htm 

  19. “Vitamin D Supplementation for Infants,” American Academy of Pediatrics, accessed June 25, 2015, https://www.aap.org/en-us/about-the-aap/aap-press-room/pages/Vitamin-D-Supplementation-for-Infants.aspx 

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