Infant nutrition is all about milk…and vitamin D supplement
You’ve brought your new tiny baby back home.
You’ve survived childbirth (you rock!).
As you find your ways, here is the one recommendation we want you to know about infant nutrition: give baby a vitamin D supplement.
Does my baby need a vitamin D supplement?
Is your baby exclusively breastfed?
Your baby will need to receive 400IU of vitamin D everyday. Although breast milk contains a little bit of vitamin D, it is not enough to ensure adequate vitamin D status for baby. On top of that, the vitamin D concentration in the maternal milk depends on the mother’s own vitamin D status, which might not be optimal all year round. A supplement of 400IU/day vitamin D is recommended.
Is you baby formula fed?
Formula contains about 100IU of vitamin D per 8oz. To get the recommended 400 IU per day, your baby needs to drink 32oz of formula per 24 hours (which would be the equivalent of 8 bottles of 4 oz each for example). If your baby is drinking less than that volume, s/he will need a supplement of vitamin D everyday.
Is your baby mixed fed (breastmilk + formula)?
Mix feeding is likely not going to provide baby enough vitamin D, as breast milk contains very little vitamin D, and your baby probably won’t drink 32oz of formula on top of breast milk. Offer a supplement of 400IU of vitamin D everyday.
For most babies, a 400 IU/day vitamin D supplement is recommended
Sunshine vitamin: can my baby produce vitamin D if exposed to the sun?
Our bodies are able to produce vitamin D when we are exposed to the UBV rays of the sun. But it is not recommended to expose young infants to the sun because their skin is thin and fragile. It is also not recommended to apply sunscreen to infant that young, which would protect against the UVB rays.
We suggest to get your baby enough vitamin D by offering a supplement rather than exposing him/her to the sun without sunscreen.
Vitamin D supplement is a safer strategy than exposing baby to the sun
What is vitamin D?
Vitamin D helps the absorption of calcium, and because calcium is the predominant building block of the skeleton, vitamin D is necessary for strong bones and teeth.
There are 2 types of vitamin D in our food chain : vitamin D2 and vitamin D3. Vitamin D2 is obtained from plant-based sources while vitamin D3 is obtained from animal-based sources. Most of our food sources are vitamin D3, like fatty fish, egg yolk, milk (mandatory fortified in Canada), and other fortified foods.
Both vitamin D2 and vitamin D3 are adequate to raise baby’s blood vitamin D concentration
How much of vitamin D should I give to baby?
Health Canada recommends to give 400 IU of vitamin D per day. This is the amount that is sufficient to maintain bone health and normal calcium metabolism in healthy babies.
Look on the bottle of the supplement you bought to know how much to give to baby. Most vitamin D supplements for infants/babies are in a liquid form that you dispense using a dropper; either it automatically let go of one drop at a time, or you suck up the correct dose of supplement. In both cases, do take the time to read the label of the supplement you bought and to make sure you understand the posology, so baby truly received 400 IU per day.
Vitamin D supplements targeted for older kids and adults typically contain higher dose, up to 1 000 IU/dose. We suggest you buy an infant supplement so that the dose is appropriate for your baby’s needs – it just makes things easier for new parents who are sleep-deprived!
As always, only buy supplements with a Drug Identification Number (DIN) or a Natural Product Number (NPN). This ensure that the supplement is registered and approved by Health Canada.
Baby needs a supplement of 400IU/d of vitamin D. Read the supplement bottle to understand how to give that dose.
I forgot to give my baby a vitamin D supplement!
if you forgot most days, or you didn’t know to supplement your baby, or your birth experience got complicated and you had other things to worry about, it is okay! Just start now. Offer a supplement today to your baby and continue to give it daily.
Because vitamin D is essential in calcium absorption and metabolism, babies with not enough intake of vitamin D can develop various problems that are difficult to reverse: week tooth enamel, fragile bones, slow growth, a delay in closing of the soft spot on the head, etc. So a forgetting here and there to supplement isn’t the end of the world, but it is a recommendation that has a reason to exist. Sure you will hear parents (maybe even your own!) swear that they didn’t give vitamin D to their babies and they all grew up fine, but nutrition science and our understand of the human bodies have evolved since then, so why not benefit from it!
Here are suggestions to help you remember to give the supplement to your baby:
- put the vitamin D supplement bottle near your nursing station
- put the vitamin D supplement bottle near your own medication that you take daily
- put the vitamin D supplement bottle near your coffee machine or anything that you use daily
- put an alarm or a reminder in your online calendar, nothing like a beeping phone to keeps you on top of it!
- buy more than one bottles so you can have them easily available in your favourite nursing spots
The challenging part is to remember to give the supplement to baby everyday!
Can mom take vitamin D instead of baby?
In theory yes, but in practice not really.
First, it would be relevant only for mothers who breastfeed.
One randomized controlled trial in the USA has look at this idea. A team of researcher recruited breastfeeding mothers to study the impact of supplementing the mothers instead of the infants in the first 7 months of life. Mothers were either giving their baby a 400IU/d supplement of vitamin D, or mothers were themselves taking a 6,400IU/d supplement of vitamin D. All mothers were exclusively breastfeeding regardless of the supplementation strategy. It was observed that both methods led to adequate vitamin D status in the infant for the first 7 months, but also cause very high vitamin D concentration in the baby’s blood. Although no toxic effects due to the supplementation were reported, this maternal supplement dose of 6,400IU/d is more than 3 times higher than the maximal daily dose set by Health Canada.
Not only, the results need to be taken carefully, but the same challenges apply: mom would need to remember to take her vitamin D supplement, and not minimize the importance of adopting a healthy plate.
It seems safer to supplement babies with moderate doses of vitamin D supplement than to supplement mothers with massive doses
Vitamin D supplements options for vegetarian and vegan families
Vitamin D supplement are usually made of vitamin D3, and that type of vitamin D is extracted from lanolin which comes from sheep wool. It is not vegetarian nor vegan.
Alternatively, vitamin D2 is always vegetarian and vegan because it is derived from plants. Current research suggests that vitamin D2 is slightly less potent than the vitamin D3 to raise anyone’s vitamin D blood concentration. That being said, it still works but you might require a bit more vitamin D2 to get the same benefits as with vitamin D3.
For vegetarian and vegan parents who are concerned and would prefer to give a vitamin D3 supplement, there are now some options on the market. Supplements companies keep innovating to offer parents products that meet their needs and respect their values. A novel way of manufacturing vegan vitamin D3 is to extract it from lichen! Lichen is and algae (source of vitamin D3) living with a mushroom (source of vitamin D2), and can be cultivated in large amount.
Companies like Nordic Naturals (0.5ml=1000 IU vitamin D3) and Vitashine (1 spray = 200IU vitamin D3) offer vegan vitamin D3 supplements extracted from lichen. If you choose to offer one of these supplements, make sure to adapt the posology so your baby receives 400 IU everyday.
Otherwise, vegetarians and vegan parents can offer a supplement of vitamin D2. The company Pure-le Natural offers vegan vitamin D2 supplement for infants (400 IU/drop). The company Ddrops offers a vegan vitamin D2 supplement, but 1 drop = 1000 IU, which is too much for infants. If parents choose that supplement, we suggest to offer baby one drop every 3 days.
Companies are constantly innovating to offer products that align with their customers needs and values, including vegetarian and vegan parents.
A vitamin D supplement until when?
You can continue supplementing your baby until s/he is eating a significant amount of solids foods, including enough sources of vitamin D. This is likely to happen around 2 years of age, when your baby has adopted a balanced “adult” diet, with 3 meals a days and snacks.
Food sources of vitamin D include fatty fish like salmon and tuna (fresh or in a can!), eggs with the yolk, cow milk (or plant-based milk but do check the label to make sure it is fortified in vitamin D), or dairy products made with fortified milk. In addition to eating a variety of solid foods 3 times a day, if your baby is drinking mostly cow’s milk (or formula, or a fortified plant-based milk) you can stop the vitamin D supplement, but if you are still offering only breastmilk, continue with the supplement of vitamin D.
Offer a vitamin D supplement until baby eats a balanced diet, likely around 2 years of age.
Is more the merrier?
Don’t worry if you gave too much with the dropper or if 2 (or 3) drops fell, it’s not a big deal!
Obviously, we encourage you to follow the posology and aim for 400IU/d, but nothing bad will happen overnight! Repeated high doses of supplement can however cause problems.
It is good to know that the upper limit (the maximum amount of vitamin D baby can receive before seeing toxic effects) is set at 1,000 IU/d (for babies 0-6months old), 1,500IU/d (for babies 7-12months old), and 2,500IU/d (for babies 1-3years old). Due to it’s role in ensuring calcium is absorb properly, eating too much vitamin D (from food and/or supplements) can create a buildup of calcium in baby’s body and that can be very dangerous.
Although there are more interest than ever in the field of vitamin D as it seems a promising vitamin to manage or prevent different health conditions, there are to date no convincing evidence of a benefit for babies to received more than 400 IU/d, and certainly not massive dose of supplements.
There are no convincing evidence to date that giving more than 400IU/d of vitamin D to baby provide benefits without risks.
Tripkovic L et al. Comparison of vitamin D2 and vitamin D3 supplementation in raising serum 25-hydroxyvitamin D status: a systematic review and meta-analysis. The American journal of clinical nutrition. 2012 May 2;95(6):1357-64.
Jäpelt RB. Jakobsen J. Vitamin D in plants: a review of occurrence, analysis, and biosynthesis. Frontiers in Plant Science 2013
Gallo S et al. Effect of different dosages of oral vitamin D supplementation on vitamin D status in healthy, breastfed infants: randomized trial. Jama. 2013 May 1;309(17):1785-92.
Kovacs CS. Bone development and mineral homeostasis in the fetus and neonate: roles of the calciotropic and phosphotropic hormones. Physiological Reviews. 2014 Oct;94(4):1143-218.
Kovacs CS. Maternal mineral and bone metabolism during pregnancy, lactation, and post-weaning recovery. Physiological reviews. 2016 Feb 17;96(2):449-547.
Hollis BW et al. Maternal Versus Infant Vitamin D Supplementation During Lactation : A Randomized Controlled Trial. Pediatrics 2015;136:4.
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