At what age should vitamin D supplementation be initiated in a breast-fed infant?

From the Guidelines

Vitamin D supplementation should begin at hospital discharge for all exclusively or partially breastfed infants, with a recommended dose of 400 IU per day. This recommendation is based on the American Academy of Pediatrics guidelines, as stated in the study published in Pediatrics in 2005 1. The guidelines suggest that all infants consuming less than 28 ounces of commercial infant formula per day should receive an oral supplement of vitamin D 400 IU per day, beginning at hospital discharge and throughout breastfeeding.

Key points to consider:

• Breast milk alone typically contains insufficient vitamin D to meet an infant's needs, even if the mother has adequate vitamin D levels herself 1.
• Vitamin D is crucial for calcium absorption and bone development in rapidly growing infants, and deficiency can lead to rickets, a condition causing soft, weak bones.
• While sunlight exposure can produce vitamin D in the skin, direct sun exposure is not recommended for infants due to skin cancer risks, making supplementation the safest approach to ensure adequate vitamin D levels in breastfed babies.
• An alternative strategy to vitamin D supplementation of the infant is to supplement the mother who is breastfeeding with 6400 IU of vitamin D, as mentioned in the study published in Pediatrics in 2005 1. However, the most direct and effective approach is to supplement the infant directly.

The recommended dose of 400 IU per day is sufficient to maintain adequate serum vitamin D concentrations in breastfed infants, and this supplementation should continue until the infant is consuming at least 1 liter per day of vitamin D-fortified formula or milk, typically around 12 months of age.

From the Research

Vitamin D Supplementation for Breastfed Infants

• The American Academy of Pediatrics recommends that breastfed infants be supplemented with 400 IU/day of vitamin D, starting in the first few days of life 2, 3.
• A study published in 2017 found that exclusively breastfed infants who received a daily vitamin D supplement of 4.0 µg (160 IU) from 1 month of age achieved sufficient vitamin D levels by 5 months of age 4.
• Another study published in 2014 found that breastfed infants who received a daily vitamin D supplement of 400 IU from 1 month of age had higher plasma 25(OH)D levels than those who received lower doses 3.
• The optimal time to start vitamin D supplementation for breastfed infants is not well established, but most guidelines recommend starting supplementation at birth or within the first few days of life 2, 3, 5.

Alternatives to Daily Supplementation

• Some studies have examined alternative approaches to daily vitamin D supplementation, such as maternal postpartum supplementation or infant intermittent supplementation 5.
• However, the evidence for these alternative approaches is limited, and more research is needed to determine their efficacy and safety 5.

Forms of Vitamin D

• Cholecalciferol is the most commonly used form of vitamin D for supplementation, and it is considered the most effective and stable form 6.
• Ergocalciferol is a synthetic form of vitamin D that is less potent and less stable than cholecalciferol, and it is not recommended for supplementation 6.