How do exclusively breastfed infants receive Vitamin D and Vitamin K supplements?

From the Guidelines

Exclusively breastfed infants should receive both vitamin D and vitamin K supplements to prevent deficiencies and related health issues, with vitamin D given as 400 IU daily and vitamin K as a single intramuscular injection of 0.5-1 mg at birth. The need for these supplements is highlighted due to the inadequate amounts of these nutrients in breast milk alone 1. For vitamin D, the recommended dose is 400 IU daily, which can be administered as oral drops, starting within the first few days of life and continuing until the child consumes adequate vitamin D-fortified foods, usually around 12 months 1.

For vitamin K, a single intramuscular injection of 0.5-1 mg is recommended at birth to prevent vitamin K deficiency bleeding 1. This injection is typically administered in the hospital shortly after delivery. If parents decline the injection, oral vitamin K can be given as an alternative, though it requires multiple doses. The importance of vitamin K supplementation is also emphasized in other contexts, such as for infants with cystic fibrosis, where vitamin K status is often suboptimal 1. However, the primary recommendation for exclusively breastfed infants, based on the most relevant and recent evidence, focuses on the standard supplementation practices 1.

Key points to consider include:

• Vitamin D production requires sun exposure, which infants should avoid, making supplementation necessary 1.
• Newborns have sterile intestines lacking the bacteria needed to produce vitamin K, necessitating supplementation 1.
• Without supplementation, infants risk developing vitamin D deficiency leading to rickets, or vitamin K deficiency bleeding, which can cause serious or fatal hemorrhage 1.
• The recommended supplementation practices are designed to ensure that exclusively breastfed infants receive adequate amounts of these essential nutrients to support their health and development 1.

From the FDA Drug Label

The American Academy of Pediatrics recommends that vitamin K1 be given to the newborn. A single intramuscular dose of Vitamin K1 Injection 0. 5 to 1 mg within one hour of birth is recommended.

• Vitamin K supplements for exclusively breastfed infants are given as a single intramuscular dose of 0.5 to 1 mg within one hour of birth.
• There is no information in the provided drug label about Vitamin D supplements for exclusively breastfed infants. 2

From the Research

Vitamin D Supplementation for Exclusively Breastfed Infants

• Exclusively breastfed infants are at risk of vitamin D insufficiency or deficiency due to the low vitamin D content of breast milk 3, 4.
• The American Academy of Pediatrics recommends vitamin D supplementation for breastfeeding infants, with a recommended dose of 400 IU/day 5, 4.
• Maternal vitamin D supplementation is a safe and effective alternative to achieving vitamin D sufficiency in breastfeeding infants, with some studies suggesting that maternal high-dose vitamin D supplementation (up to 6,400 IU/day) can be used as an alternate strategy to direct infant supplementation 3, 6.
• However, the evidence for the effectiveness of maternal vitamin D supplementation in preventing vitamin D deficiency in breastfed infants is still limited, and further research is needed to refine the dose and gestational timing of maternal vitamin D supplementation 4, 7, 6.

Vitamin K Supplementation for Exclusively Breastfed Infants

• There is no direct evidence in the provided studies regarding Vitamin K supplementation for exclusively breastfed infants.
• Therefore, there are no research papers to assist in answering this question regarding Vitamin K supplementation.

Comparison of Supplementation Methods

• Vitamin D supplementation given to infants may increase 25-OH vitamin D levels and reduce the incidence of vitamin D insufficiency, but the evidence is still limited 4.
• Maternal vitamin D supplementation may also increase infant 25-OH vitamin D levels and reduce the incidence of vitamin D insufficiency and deficiency, but the evidence is still uncertain 4, 7, 6.
• The comparison of infant vitamin D supplementation with maternal vitamin D supplementation is still limited by the small number of eligible trials and variable quality of analytically derived 25-OH vitamin D data 4, 7.