From the Guidelines
Breastfed infants still need vitamin D supplements, even if the mother is taking vitamin D, as the American Academy of Pediatrics recommends 400 IU of vitamin D daily for all breastfed infants, starting within the first few days of life. This recommendation is based on the fact that breast milk typically contains low levels of vitamin D, which is insufficient to meet an infant's needs, regardless of the mother's supplementation status 1. While maternal supplementation with very high doses (4000-6400 IU daily) might transfer enough vitamin D through breast milk, standard maternal supplements (400-2000 IU) don't provide adequate amounts to the infant 1. Some key points to consider include:
- Vitamin D is crucial for calcium absorption and bone development in rapidly growing infants, and deficiency can lead to rickets.
- Infant vitamin D drops are readily available over-the-counter and are typically given once daily.
- This supplementation should continue until the infant is consuming at least 1 liter of vitamin D-fortified formula or milk per day, which usually occurs after weaning. It's also worth noting that 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 1. However, the standard recommendation remains to supplement the infant directly with 400 IU of vitamin D daily.
From the Research
Vitamin D Supplementation for Breastfed Infants
- Breastfed infants are at risk of vitamin D deficiency due to the low vitamin D content of breast milk and restricted sunlight exposure 2.
- The recommended intake of vitamin D for lactating mothers to optimize their overall vitamin D status and, consequently, of their breast milk is 200-2,000 IU/day, indicating a lack of consensus 2.
- Direct infant supplementation is the currently available option to support vitamin D status in breastfed infants, with a recommended dose of 200-1,200 IU/day 2.
- Most international guidelines recommend that exclusively or partially breastfed infants be supplemented with 400 IU/day of vitamin D during their first year of life 2.
Effectiveness of Maternal Vitamin D Supplementation
- Maternal high-dose vitamin D supplementation (up to 6,400 IU/day) can be used as an alternate strategy to direct infant supplementation, but concern persists about the safety of maternal high-dose vitamin D supplementation 2.
- Vitamin D supplementation given to lactating mothers may increase infant 25-OH vitamin D levels, reduce the incidences of vitamin D insufficiency and deficiency, and decrease the risk of biochemical rickets 3.
- Maternal vitamin D supplementation reduces vitamin D insufficiency and deficiency in breastfed infants, but there is insufficient evidence to determine its effect on bone health 3.
Comparison of Infant and Maternal Vitamin D Supplementation
- Vitamin D supplementation given to infants compared to lactating mothers may increase infant 25-OH vitamin D levels and reduce the incidence of vitamin D insufficiency and deficiency, but the evidence is very uncertain 3.
- Infant vitamin D supplementation led to greater increases in infant 25-OH vitamin D levels, reductions in vitamin D insufficiency and deficiency compared to supplementation of lactating mothers in populations at higher risk of vitamin D deficiency 3.
Clinical Practice and Recommendations
- Family Medicine clinicians are knowledgeable regarding current recommendations for vitamin D supplementation in breastfeeding infants and are open to recommending maternal supplementation or offering parents a choice of maternal or infant vitamin supplementation 4.
- Daily oral vitamin D supplementation (400 IU) is recommended for breastfeeding infants, but alternative approaches such as maternal postpartum or infant intermittent vitamin D supplementation are being explored 5.
- More research is needed to establish the efficacy, safety, and feasibility of alternative strategies to prevent vitamin D deficiency in breastfeeding infants 5.