"Vitamin D Supplements for Babies: When are they Necessary?"

As a new parent, you want to ensure that your baby is healthy and getting all the essential nutrients they need to grow and develop properly. One important nutrient that many parents may not be aware of is vitamin D. While our bodies can produce vitamin D through exposure to sunlight, there are certain circumstances where a vitamin supplement may be necessary for infants.

 In this blog post, we will explore whether or not your baby needs vitamin D supplements and why.

Why  Vitamin D  is Important for Health 

Vitamin D is essential for the development of strong bones and teeth, as it helps the body absorb calcium and phosphorus. It also plays a critical role in the immune system, helping to fight off infections and diseases. While adults can get vitamin D from food sources like fatty fish, eggs, and fortified dairy products, babies rely on breast milk or formula to meet their nutritional needs.

However, breast milk and formula alone may not provide enough vitamin D for infants, especially if they are not exposed to enough sunlight. This is because breast milk contains very little vitamin D, and formula may not have enough to meet the recommended daily intake. In addition, infants younger than six months old should not be exposed to direct sunlight, which limits their ability to produce vitamin D naturally.

Vitamin D is a crucial nutrient for overall health and well-being. It plays an important role in building strong bones, helps the body absorb calcium, and even has been linked to gene regulation and reducing the risk of chronic conditions.

However, not having enough vitamin D can be a major problem, especially in children whose bodies are still growing and developing. Severe vitamin D deprivation can lead to rickets, a condition in which the bones become soft and weak, which can cause physical deformities, developmental delays, and an increased risk for fractures. Low vitamin D in adults can also lead to mood changes, including depression.

Vitamin D is an essential nutrient for our overall health, and there are three ways our bodies can obtain it: from the sun, from food, and from supplements. However, the majority of the vitamin D we use is obtained through exposure to sunlight, as our skin can convert a type of cholesterol into an active form of vitamin D called D3.

While this process may soundstraightforward, there are many variables that can impact vitamin D production, such as skin color, location, season, time of day, and even air quality. Additionally, not all of us get enough sun exposure to produce sufficient amounts of vitamin D.

For those who cannot or should not get sun exposure, such as babies, obtaining vitamin D from food or supplements may be necessary. However, it's important to note that not all foods contain high levels of vitamin D, and supplements should be taken under the guidance of a healthcare professional.

Babies and Vitamin d 

Babies require vitamin D to grow and develop properly, but unlike school-age children, they are unlikely to get enough of it from sunlight alone. This is partly due to medical recommendations that advise against exposing infants younger than 6-months-old to direct sunlight and encourage parents to cover their skin with protective hats and clothing when outdoors.

Since babies cannot produce enough vitamin D on their own, they must obtain it from other sources, such as food or supplements. Although breast milk is an excellent source of nutrition for infants, it often does not contain enough vitamin D to meet their needs. This is because the amount of vitamin D in breast milk depends on the mother's individual vitamin D levels. If a mother has low levels of vitamin D, her breast milk will also have low levels of this nutrient.

Therefore, it is important for parents to ensure that their babies receive adequate amounts of vitamin D through other means, such as vitamin D-fortified infant formula or supplements. These supplements are typically available in drops and are easy to administer.

In conclusion, although babies require vitamin D for proper growth and development, they are unlikely to get enough of it from sunlight alone. Therefore, it is important for parents to make sure their babies receive enough vitamin D from food or supplements to support their health and well-being.

 while sunlight is the primary source of vitamin D, it's important to be mindful of other factors that can impact vitamin D production and to consider alternative methods of obtaining this essential nutrient when necessary.

The recommended daily intake of vitamin D for full-term infants is 400 IU (international units). 

In recent years and for various reasons, low vitamin D and vitamin D deficiency among women has become increasingly common, and so it is widely accepted that breast milk does not contain sufficient vitamin D to meet infants’ needs. Given the situation, the American Academy of Pediatrics has a blanket recommendation stating thatall breastfed infants take a daily vitamin D supplement (400 IU/day) for the first year of life. Infant vitamin D supplements are usually sold as drops, which are sold in any pharmacy and are super easy to administer. 

Interestingly, some doctors go another route and suggest dailymaternalvitamin D supplementation (6400 IU/day) to increase the vitamin D content in breast milk — an intriguing solution that has the benefit of helping both mom and baby — but be sure to speak with your pediatrician about what’s best for you and your baby! 

All this^^ applies to breastfed babies, of course — since the Food and Drug Administration requires that infant formula is fortified with vitamin D, formula-fed babies do not typically need any additional vitamin D supplement

To summarize:

Breastfed babies should take a vitamin D supplement of 400 IU daily; and 

Formula-fed babies do not need a separate supplement since formula contains all the daily recommended vitamin D intake. 

Vitamin D, also known as the "sunshine vitamin," is a vital nutrient that our bodies need for healthy bones and overall well-being. Although it can be synthesized by our skin when exposed to sunlight, many people don't get enough vitamin D through this natural process alone. That's why it's important to know the food sources of vitamin D that you can incorporate into your diet.

Here are some of the best food sources of vitamin D:

Fatty fish: Fatty fish such as salmon, tuna, mackerel, and sardines are excellent sources of vitamin D. Just 3.5 ounces of cooked salmon contains around 600-1000 IU of vitamin D, which is more than the recommended daily intake for most adults.

Egg yolks: Egg yolks are another good source of vitamin D, with one large egg containing around 20 IU of vitamin D. However, it's important to note that most of the vitamin D in an egg is found in the yolk, so if you only eat egg whites, you won't be getting much vitamin D.

Mushrooms: Certain types of mushrooms are unique in that they contain vitamin D2, a form of vitamin D that is less potent than the D3 form found in fatty fish and other animal products. However, mushrooms that have been exposed to UV light, either through natural sunlight or artificial UV light, can contain much higher levels of vitamin D2. Just one cup of sliced portobello mushrooms that have been exposed to UV light can contain up to 400 IU of vitamin D2.

Fortified foods: Many foods, such as milk, orange juice, and breakfast cereals, are fortified with vitamin D. This means that vitamin D has been added to these foods during processing. The amount of vitamin D added to these foods can vary, but it can be a good way to increase your vitamin D intake if you're not getting enough through other sources.

Cod liver oil: Cod liver oil is a popular supplement that is rich in vitamin D, as well as omega-3 fatty acids. Just one tablespoon of cod liver oil can contain up to 1360 IU of vitamin D.

Incorporating these vitamin D-rich foods into your diet can help ensure that you're getting enough of this important nutrient. However, if you're still concerned about your vitamin D levels, you may want to consider getting your levels tested and discussing supplementation with your healthcare provider.

When Should You Consider Vitamin D Supplements for Your Baby?

The American Academy of Pediatrics (AAP) recommends that all infants, including those who are exclusively breastfed, receive a daily vitamin D supplement of 400 IU (international units) starting from the first few days of life. This recommendation is based on the fact that breast milk alone may not provide enough vitamin D for infants, and formula may not have enough to meet the recommended daily intake.

If your baby is not getting enough vitamin D from breast milk or formula, they may be at risk of developing rickets, a rare but serious condition that causes soft, weak bones. Signs of rickets include delayed motor development, muscle weakness, and skeletal deformities. In addition, vitamin D deficiency has been linked to an increased risk of respiratory infections, asthma, and allergies in children.

It's important to note that if you live in an area with limited sunlight exposure, have darker skin, or have a family history ofvitamin D deficiency, your baby may be at a higher risk of not getting enough vitamin D. In these cases, it's especially important to discuss vitamin D supplements with your pediatrician.

What Kind of Vitamin D Supplements Are Available for Babies?

There are several forms of vitamin D supplements available for infants, including drops, chewable tablets, and liquid supplements. Most supplements contain vitamin D3, which is the same form that our bodies produce when exposed to sunlight. It's important to choose a supplement that is specifically designed for infants and provides the recommended daily dose of 400 IU.

When giving your baby a vitamin D supplement, it's important to follow the recommended dosage and avoid giving them too much. Overdosing on vitamin D can be harmful and lead to a condition called hypervitaminosis D, which can cause nausea, vomiting, and kidney damage.

Experts recommend that infants receive 400 IU/day of vitamin D, while toddlers between the ages of 12-24 months should aim for 600 IU/day. While it's possible to obtain vitamin D from sunlight and certain foods, it's not always easy to ensure that your child is getting enough, especially during the fall and winter months.Concerns about sunscreen limiting vitamin D production are common, but in reality, most of us don't use sunscreen as frequently as we should and typically have some unprotected sun exposure throughout the day. Spending just 15-30 minutes in the sun with hands and face exposed during the summer months can provide your child with all the vitamin D they need. In fact, a child wearing a bathing suit can generate 10,000 to 20,000 IU of vitamin D after just 15-30 minutes of sun exposure on a sunny day.

I was fascinated to learn that children can produce more vitamin D with less sun exposure compared to adults — partly because they have a greater surface-area-to-volume ratio and partly because their bodies are just, well, better at making vitamin D — another thing to chalk up to aging, hah! (And BTW, you can’t “OD” on vitamin D synthesized from the sun — good to know!) 

Based on the wide variability in sun exposure,many pediatricians favor offering a vitamin D supplement during the fall and winter, when children usually spend less time outdoors and there are fewer hours of daylight. 

*Note that if your toddler takes a multivitamin, it may contain vitamin D — be sure to check before offering a separate supplement. While vitamin D toxicity is uncommon, you still want to make sure you are in communication with your pediatrician before offering supplementation that exceeds the daily recommended doses. Nutritional research on vitamins and minerals across the spectrum — not just vitamin D — all indicates that when it comes to supplementation,more is not better. That is, going above and beyond the recommended daily amounts does not yield additive benefits or advantages, and in fact is more likely to be harmful than anything else. 

Again, “too much” vitamin D is a rarity for the most part, but here are the upper intake levels (i.e., the levels not to be exceeded) for the pediatric crowd: 

Babies: 1000-1500 IU/day 

Children 1-8 years old: 2500-3000 IU/day

Children 9+ years old: 4000 IU/day 

At the end of the day — if you’re concerned or don’t know if your child is getting adequate vitamin D, you can speak to your pediatrician about your child’s risk-level and ask about vitamin D screening and/or supplementation. 

For now, since it’s summer, get outside and soak up those rays! 😎

References:

Abram SA. Vitamin D in Preterm and Full-Term Infants. Ann Nutr Metab 2020.

Tam ML et al., Vitamin D supplementation for term breastfed infants to prevent vitamin D deficiency and improve bone health. Cochrane review 2020

O’Callaghan KM et al. Vitamin D in Breastfed Infants: Systematic Review of Alternatives to Daily Supplementation. Adv Nutr 2020

Polzonetti V et al. Dietary Intake of Vitamin D from Dairy Products Reduces the Risk of Osteoporosis. Nutrients 2020

Rueter K et al. In “High-Risk” Infants with Sufficient Vitamin D Status at Birth, Infant Vitamin D Supplementation Had No Effect on Allergy Outcomes: A Randomized Controlled Trial. Nutrients 2020

Rosendahl J et al. High-Dose Vitamin D Supplementation Does Not Prevent Allergic Sensitization of Infants.

J Pediatr 2019

Saggese G et al. Vitamin D in pediatric age: consensus of the Italian Pediatric Society and the Italian Society of Preventive and Social Pediatrics, jointly with the Italian Federation of Pediatricians. . Italian Journal of Pediatrics 2018

Verkaik‑Kloosterman J et al. Vitamin D intake of Dutch infants from the combination of (fortified) foods, infant formula, and dietary supplements. Eur J Nutr 2017

Wagner CL & Hollis BW. Early-Life Effects of Vitamin D: A Focus on Pregnancy and Lactation. Ann Nutr Metab 2020 

https://www.chop.edu/news/health-tip/vitamin-d-supplements-what-parents-should-know