Vitamin D and the breastfed baby: Do I need to supplement the baby?

Vitamin and mineral supplements are usually not needed for the average healthy, full-term breastfed baby during the first year old life. One of the major exceptions to that is Vitamin D. Vitamin D is essential to babies in order to maintain healthy bone growth and development.  Recent research also tells us that vitamin D is key in the maintenance of our immune systems to help prevent and fight infections and inflammation. The American Academy of Pediatrics recommends that all babies receive routine vitamin D supplementation (400 IU per day) due to decreased sunlight exposure and an increase in rickets, which impacts leg growth and development. Practically everyone is at risk for vitamin D deficiency with, ironically, only formula-fed babies out of the danger zone because infant formula already contains 400 IU of vitamin D per quart of properly prepared formula.

If you are exclusively breastfeeding, your pediatrician should have educated you to supplement your baby with vitamin D, typically given as drops. But they may not have told you about how to supplement. There are two ways to supplement: to the baby or to you are the parent.

The primary source of vitamin D for babies, other than sunlight, is the stores that were laid down in baby’s body prior to birth. Because our vitamin D status during pregnancy directly affects baby’s vitamin D stores at birth and through the first 2-3 months of life, make sure to get enough vitamin D while pregnant! Human breastmilk is considered a very poor source of vitamin D, usually containing less than 50 IU per quart. This is why the AAP recommends all breastfed infants receive 400 IU per day vitamin D by supplement drops. This IS NOT A DEFECT IN BREAST MILK but a defect in the recommended amount of vitamin D the lactating parent should be taking. 

The best way to get vitamin D, the way that our bodies were designed to get the vast majority of our vitamin D, is from the sun. Depending upon where you live and how dark your skin is, going outside regularly may be all that is required for you or your baby to generate adequate amounts of vitamin D to need no further supplementation.  However, most health care professionals won’t tell you to get vitamin D from the sun because the risks of sun burn and skin cancer! One of the other problems with getting your vitamin D with sun exposure is simply that it’s hard to determine how much time outside is needed since it depends on so many factors (your unique skin tone, the latitude on the earth of where you live, the time of year, how much skin is exposed, amount of air pollution, etc.) There is a range of how much skin exposure to how long you need to be outside int the sun for your body to make adequate levels for your unique self. I cannot tell you through this video how much skin exposure or a length of time to be in the sun because of all of these factors, you would need to research these individual factors. 

So how else can you get vitamin D? Research shows that maternal vitamin D supplementation of 4000-6400 IU/d or a single monthly dosage of 150,000 IU) can adequately supply your breastmilk where no additional supplementation to your baby would be needed.  As long as you are not vitamin D deficient, your breastmilk will also have adequate amounts of vitamin D levels. For more information on the research behind this, check out  [Hollis et al 2015] and Hollis & Wagner 2004. In summary, yes, someone needs supplemented for vitamin D. In reality, vitamin D is just as essential for you as it is for the baby. If you have any concerns with vitamin D deficiency, both you AND the baby need to be supplemented. You can supplement the baby by drops, usually done on the nipple before latching or if you are giving breast milk bottles, you can add that to one of the bottles. You could also put the drop on a pacifier and have baby suck it that way. For you, taking 4000-6400 IU per day is adequate for most to prevent deficiencies and sun exposure is an option when done safely knowing your unique situation.