What is the recommended supplementation of Vitamin D for a breastfed infant?

From the Guidelines

Breastfed infants should receive a vitamin D supplement of 400 IU per day starting within the first few days of life and continuing until they are consuming adequate vitamin D from other dietary sources. The supplement is typically given as vitamin D3 (cholecalciferol) in liquid form, administered orally using the dropper provided with the medication. Parents should give the supplement directly into the infant's mouth, either on its own or mixed with a small amount of expressed breast milk. This supplementation is necessary because breast milk alone typically contains insufficient vitamin D (about 25 IU per liter), and infants have limited sun exposure, which is needed for the body to produce vitamin D naturally. Vitamin D is crucial for calcium absorption and bone development in infants, and deficiency can lead to rickets, a condition causing soft, weak bones.

Key Points

• The American Academy of Pediatrics recommends vitamin D supplementation with 400 IU/day for all infants and children 1.
• Breast milk alone typically contains insufficient vitamin D, making supplementation necessary for breastfed infants 1.
• Vitamin D is essential for calcium absorption and bone development in infants, and deficiency can lead to rickets 1.
• The supplement should be continued until the infant is consuming at least 1 liter per day of vitamin D-fortified formula or, in older infants, is obtaining sufficient vitamin D through solid foods and safe sun exposure.

Administration

• The supplement is typically given as vitamin D3 (cholecalciferol) in liquid form, administered orally using the dropper provided with the medication.
• Parents should give the supplement directly into the infant's mouth, either on its own or mixed with a small amount of expressed breast milk.

Recommendation

Based on the evidence from 1 and 1, vitamin D supplementation is essential for breastfed infants to prevent deficiency and promote healthy bone development.

From the Research

Vitamin D Supplementation for Breastfed Infants

• The American Academy of Pediatrics (AAP) recommends 400 IU of vitamin D supplementation for all infants, including breastfed infants, to prevent vitamin D deficiency 2.
• Research has shown that vitamin D supplementation of breastfed infants can increase 25-OH vitamin D levels and reduce the incidence of vitamin D insufficiency 3, 4.
• Maternal vitamin D supplementation can also increase infant 25-OH vitamin D levels and reduce the incidence of vitamin D insufficiency and deficiency 3, 5.
• The effectiveness of maternal vitamin D supplementation in preventing vitamin D deficiency in breastfed infants depends on the dose and duration of supplementation, with higher doses (up to 10 times the current recommended daily intake) needed to produce sufficient transfer from mother to breastfed infant 5.

Dose-Response Trials

• A randomized dose-response trial found that breastfed infants receiving 400 IU, 600 IU, or 800 IU of vitamin D per day had higher plasma 25(OH)D levels than those receiving 200 IU per day 4.
• The trial also found that the higher doses of vitamin D were more efficacious in maintaining vitamin D sufficiency in breastfed infants, but did not affect illness incidence or growth 4.

Alternative Supplementation Strategies

• A systematic review found that maternal postpartum supplementation and infant intermittent supplementation may be plausible substitutes for routine daily infant vitamin D supplementation, but the evidence is too weak to support a policy update 6.
• The review highlighted the need for dose-ranging, adequately powered trials to establish the efficacy, safety, and feasibility of alternative strategies to prevent vitamin D deficiency in breastfeeding infants 6.