Vitamin D recommendations

Does my baby need vitamin D?

Breastfed babies are at risk of low levels of vitamin D, especially those with darker skin, those who live in more northern or southern regions, and those whose mothers have low levels of vitamin D. Low levels in babies can increase the risk of poor bone growth, infection, type 2 diabetes, and autoimmune diseases. The most common recommendation is that babies receive at least 400 IU a day. Please check with your health-care providers for specific recommendations.

A) Describing vitamin D

Most of the vitamin D in our bodies is made from a type of cholesterol. Ultraviolet light, which is found in sunshine, is needed to start the process. That’s why vitamin D is called “the sunshine vitamin.”

Breastfed babies are at risk of low levels of vitamin D. This risk is increased in babies who:

  • Have darker skin.
  • Live in the further northern or southern areas of the planet.
  • Have limited exposure to sunlight.
  • Have mothers who have low levels of vitamin D (Bellows 2017).

Women in warmer, sunnier climates can also have low levels of vitamin D in their breast milk (Bellows 2017; Stoutjesdijk 2017).

B) Effects of low levels of vitamin D on babies

Low levels in babies can increase the risk of (Uday 2018):

  • Small, soft, and deformed bones (rickets)
  • Pain
  • Delayed motor skills
  • Bones breaking (fractures)
  • Low calcium levels, which can cause seizures
  • Weakness of the heart muscle and difficulty breathing

C) Taking vitamin D

Please check with your health-care providers for more specific recommendations for your individual situation.

1) Recommendations under one year of age

In general, experts recommend that babies under one year of age receive at least 400 IU of vitamin D per day (Munns 2016).

Recommendations may vary because of local and individual factors. For example, the Canadian Paediatric Society recommends that babies who live in northern communities (north of the 55th latitude) or who have other risk factors, such as dark skin, should receive 800 IU a day between October and April, when there is less sunlight (CPS 2012).  

Infant formula is designed to give babies roughly 400 IU per day.

2) Giving vitamin D to babies under one year of age

Vitamin D is given to babies by mouth as a liquid and started soon after birth. Taking a vitamin D supplement is effective and safe (Gallo 2016; Terashite 2017).

Most organizations continue to recommend giving daily vitamin D supplements directly to babies. There is some evidence that changing the dosing schedules of babies or giving periodic, large amounts of vitamin D to breastfeeding mothers may result in babies with adequate levels of vitamin D (Schossow 2018; Trivedi 2020; Wagner 2020).

3) After one year of age

After one year of age, solid foods contribute to a child’s vitamin D intake. All children and adults should receive at least 600 IU in this way (Munns 2016).

Good dietary sources of vitamin D include:

  • Foods fortified with vitamin D such as some dairy products and soy milk
  • Cheese made from vitamin D-fortified milk
  • Fatty fish such as mackerel
  • Egg yolks
  • Beef liver

If your child’s diet does not provide enough vitamin D, you should continue giving supplements. This can be especially important for breastfeeding toddlers who do not drink whole cow’s milk that is fortified with vitamin D.

Some organizations recommend that all breastfeeding children receive vitamin D until weaned (Li 2019).

D) Recommendations for mothers

Some countries recommend that all breastfeeding mothers take vitamin D supplements to prevent low levels in both mothers and babies (Aghajafari 2018).

Vitamin D is available as a single preparation but is often taken along with other vitamins and minerals (multivitamin tablet). 

References

Aghajafari F, Field CJ, Weinberg AR, et al. Both Mother and Infant Require a Vitamin D Supplement to Ensure That Infants' Vitamin D Status Meets Current Guidelines. Nutrients. 2018 Mar 29;10(4). pii: E429 
 
Bellows AL, Smith ER, Muhihi A, et al. Micronutrient Deficiencies among Breastfeeding Infants in Tanzania. Nutrients. 2017 Nov 17;9(11). pii: E1258 
 
Canadian Paediatric Society (CPS). Caring for Kids [Internet]. Toronto: Canadian Paediatric Society; [date unknown]. Vitamin D; 2012 Nov [cited 2017 Aug 29] 

Gallo S, Hazell T, Vanstone CA, et al. Vitamin D supplementation in breastfed infants from Montréal, Canada: 25-hydroxyvitamin D and bone health effects from a follow-up study at 3 years of age. Osteoporos Int. 2016 Aug;27(8):2459-6 
 
Li P, Rourke L, Leduc D, et al. Rourke Baby Record 2017: Clinical update for preventive care of children up to 5 years of age. Can Fam Physician. 2019 Mar;65(3):183-191
 
Munns CF, Shaw N, Kiely M, et al. Global Consensus Recommendations on Prevention and Management of Nutritional Rickets. J Clin Endocrinol Metab. 2016 Feb;101(2):394-415
 
Schossow K, Clark AM, Harris MA. Maternal supplementation of vitamin D during lactation to support infant vitamin D needs: a systemic review. O J Ped 2018;8(3)
 
Stoutjesdijk E, Schaafsma A, Nhien NV, et al. Milk vitamin D in relation to the 'adequate intake' for 0-6-month-old infants: a study in lactating women with different cultural backgrounds, living at different latitudes. Br J Nutr. 2017 Nov;118(10):804-812 
 
Terashita S, Nakamura T, Igarashi N. Longitudinal study on the effectiveness of vitamin D supplements in exclusively breast-fed infants. Clin Pediatr Endocrinol. 2017;26(4):215-222

Trivedi M, Faridi MMA, Aggarwal A, et al. Oral Vitamin D Supplementation to Mothers During Lactation-Effect of 25(OH)D Concentration on Exclusively Breastfed Infants at 6 Months of Age: A Randomized Double-Blind Placebo-Controlled Trial. Breastfeed Med. 2020 Apr;15(4):237-245

Uday S, Fratzl-Zelman N, Roschger P, et al. Cardiac, bone and growth plate manifestations in hypocalcemic infants: revealing the hidden body of the vitamin D deficiency iceberg. BMC Pediatr. 2018 Jun 26;18(1):183

Wagner CL, Hollis BW. Early-Life Effects of Vitamin D: A Focus on Pregnancy and Lactation. Ann Nutr Metab. 2020;76 Suppl 2:16-28