Breastfeeding has long been known to be the perfect food for infants. However, despite all the advantages of breast milk, most mothers’ milk is lacking in one crucial nutrient: vitamin D. For this reason, most infants who are exclusively breastfed should be supplemented with vitamin D.
What Does Vitamin D Do?
The most important function of vitamin D is to help build strong bones. At its most severe, deficiency of vitamin D can lead to rickets, but even milder forms of vitamin D insufficiency can result in osteopenia, osteoporosis, and bone fractures. In addition, vitamin D deficiency has been linked to a host of illnesses, including preeclampsia, autoimmune diseases, type 2 diabetes, cancer, infectious diseases, cardiovascular disease, and neurological diseases.1
But the breast milk from most women does not have enough vitamin D for infants. According to the Centers for Disease Control, human breast milk typically contains 25 IU (international units) of vitamin D per liter or less, which is not enough to provide adequate vitamin D levels in infants.2
How Much Does My Baby Need? And How Do I Give it to Her?
In 2008, the American Academy of Pediatrics officially recommended that all children and adolescents have a daily intake of 400 IU of vitamin D. For breastfed babies, that means they should be supplemented with that amount every day.3
Vitamin D comes in easily accessible over-the-counter drops, either by itself or in combination with other vitamins. These drops can be squeezed into the baby’s mouth just before feeding or mixed with a small amount of breast milk in a bottle or syringe.
Multiple studies since then have shown that breast milk is deficient in vitamin D in most mothers,4,5 and that supplementation of infants restores their vitamin D levels.6,7 Still others have shown that a daily dose of 400 IU is adequate, with higher doses not providing much benefit.8,9 This is one occasion when more is not necessarily better.
And infants with darker skin pigmentation and those who live in areas that don’t get much sun are higher risk of vitamin D deficiency. 2
Can I Take More Vitamin D?
Despite the demonstrated need for vitamin D supplementation and national programs designed to encourage this practice, mothers around the world are sometimes hesitant to give something “extra” to their brand new babies. Studies show that mothers of newborns have not been 100% compliant with the vitamin D supplementation recommendations.10,11
Many mothers prefer to supplement themselves rather than their babies. Because of this, more recent research has focused on ways to increase the vitamin D levels of mothers who are breastfeeding. These studies were not published at the time of the previous blog about vitamin D on The Pulse.
One study found that oral doses of 100,000 IU of vitamin D given once a month to breastfeeding mothers for the first four months post-partum raised the vitamin D levels of their babies. But the authors note that further work needs to be done to determine the best dose and frequency of this supplementation.12
Another study found that 60,000 IU given orally to mothers once a day for 10 days in the first two weeks after birth significantly raised the vitamin D levels in their infants.13
These studies suggest that oral supplementation of mothers may be sufficient to prevent vitamin D deficiency in breast fed infants. However, these high doses should be studied more before they become a recommended policy.
Another source of vitamin D is sunlight, and some studies have tried to quantify the amount of sunlight needed for babies to acquire sufficient vitamin D. However, most locales in the US are not sunny enough the entire year to make this a practical solution. And given what we know about the link between skin cancer and sun exposure, this is not a safe practice at this time.
So, if you breastfeed your infant, congratulations: you are giving her the best start possible. However, if she is exclusively or mostly breastfed, she needs some extra vitamin D. The safest and easiest way to give vitamin D to her is to supplement her with some drops. But you want, discuss with your health care provider the possibility of supplementing yourself instead.
1 Holick MF. The vitamin D deficiency pandemic: Approaches for diagnosis, treatment and prevention. Rev Endocr Metab Disord. 2017 Jun;18 (2):153-65.
2 Vitamin D Supplementation. 2015. (Accessed February 27, 2018, at https://www.cdc.gov/breastfeeding/recommendations/vitamin_d.htm.)
3 Wagner CL, Greer FR, American Academy of Pediatrics Section on Breastfeeding, American Academy of Pediatrics Committee on Nutrition. Prevention of rickets and vitamin D deficiency in infants, children, and adolescents. Pediatrics. 2008 Nov;122 (5):1142-52.
4 vieth Streym S, Hojskov CS, Moller UK, et al. Vitamin D content in human breast milk: a 9-mo follow-up study. Am J Clin Nutr. 2016 Jan;103 (1):107-14.
5 Merewood A, Mehta SD, Grossman X, et al. Vitamin D status among 4-month-old infants in New England: a prospective cohort study. J Hum Lact. 2012 May;28 (2):159-66.
6 Hazell TJ, Gallo S, Vanstone CA, Agellon S, Rodd C, Weiler HA. Vitamin D supplementation trial in infancy: body composition effects at 3 years of age in a prospective follow-up study from Montreal. Pediatr Obes. 2017 Feb;12 (1):38-47.
7 Darmawikarta D, Chen Y, Lebovic G, Birken CS, Parkin PC, Maguire JL. Total Duration of Breastfeeding, Vitamin D Supplementation, and Serum Levels of 25-Hydroxyvitamin D. Am J Public Health. 2016 Apr;106 (4):714-9.
8 Ziegler EE, Nelson SE, Jeter JM. Vitamin D supplementation of breastfed infants: a randomized dose-response trial. Pediatr Res. 2014 Aug;76 (2):177-83.
9 Gallo S, Hazell T, Vanstone CA, et al. Vitamin D supplementation in breastfed infants from Montreal, Canada: 25-hydroxyvitamin D and bone health effects from a follow-up study at 3 years of age. Osteoporos Int. 2016 Aug;27 (8):2459-66.
10 Uday S, Kongjonaj A, Aguiar M, Tulchinsky T, Hogler W. Variations in infant and childhood vitamin D supplementation programmes across Europe and factors influencing adherence. Endocr Connect. 2017 Nov;6 (8):667-75.
11 Umaretiya PJ, Oberhelman SS, Cozine EW, Maxson JA, Quigg SM, Thacher TD. Maternal Preferences for Vitamin D Supplementation in Breastfed Infants. Ann Fam Med. 2017 Jan;15 (1):68-70.
12 Wheeler BJ, Taylor BJ, Herbison P, et al. High-Dose Monthly Maternal Cholecalciferol Supplementation during Breastfeeding Affects Maternal and Infant Vitamin D Status at 5 Months Postpartum: A Randomized Controlled Trial. J Nutr. 2016 Oct;146 (10):1999-2006.
13 Naik P, Faridi MMA, Batra P, Madhu SV. Oral Supplementation of Parturient Mothers with Vitamin D and Its Effect on 25OHD Status of Exclusively Breastfed Infants at 6 Months of Age: A Double-Blind Randomized Placebo Controlled Trial. Breastfeed Med. 2017 Dec;12 (10):621-8.