Does My Baby Need Vitamins?

July 26, 2011. Posted in: Vitamins/ Supplements

By Kelly Bonyata, IBCLC

 

Overview

Vitamin and mineral supplements are not necessary for the average healthy, full-term breastfed baby during the first year. Breastmilk is all that your baby needs for at least the first six months of life. Studies have shown that vitamins, fluoride, iron, water, juice, formula and solid foods are rarely beneficial to healthy breastfed babies during the first six months, and some can even be harmful. There are certain cases where a vitamin supplement may be needed for a breastfed baby during the first year, but these cases are the exception, not the rule (see below for specifics).

The American Academy of Pediatrics states:

No supplements (water, glucose water, formula, and so forth) should be given to breastfeeding newborns unless a medical indication exists… Exclusive breastfeeding is ideal nutrition and sufficient to support optimal growth and development for approximately the first 6 months after birth.

AAP recommendations on specific vitamins are noted below.

Some very premature babies (weighing less than 1500 grams/3.3 pounds) may need extra vitamins and minerals, which can be added to their mother’s milk before being given to the baby.

Following is more specific information on baby’s needs for certain vitamins and minerals.

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Vitamin A

Breastmilk is a natural, excellent source of vitamin A. Promoting breastfeeding is the best way to protect babies from Vitamin A deficiency. Vitamin A deficiency is rare in breastfed babies even in areas of the world where vitamin A deficiency is widespread.

PDF Breastmilk: A Critical Source of Vitamin A for Infants and Young Children (PDF format) from the LINKAGES Project. Also available in English, French, Portuguese and Spanish.

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Vitamin B1 (thiamine)

If mom is getting enough thiamine, then her milk has enough for baby and supplements are not needed. If mom is thiamine-deficient, then adding additional thiamine to mom’s diet should increase the amount of thiamine in her milk (since this vitamin is water-soluble) to the necessary levels. Thiamine deficiency (beriberi) is rare in the United States.

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Vitamin B2 (riboflavin)

Supplements are not recommended for breastfed babies, as riboflavin deficiency is rare in developed countries. The levels of riboflavin in human milk are quite constant and are usually affected only by large maternal supplements (3x the maternal RDA).

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Vitamin B6

If mom gets adequate amounts of vitamin B6, then additional supplements are not necessary for a healthy baby. If mom is not getting enough vitamin B6, then adding additional vitamin B6 to mom’s diet will increase the levels in her milk to the required levels.

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Vitamin B12

See Does my baby need vitamin B12 supplements?

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Vitamin C

Breastfed babies should not be routinely supplemented with vitamin C except in cases of obvious scurvy (vitamin C deficiency). FDA requirements for nursing mothers for this vitamin are 100 mg per day. Supplements of vitamin C for the mother do not alter the amounts in breastmilk, as they remain fairly constant no matter what mother’s intake levels (assuming the mother does not have scurvy).

How much vitamin C in breastmilk? by Debbie Donovan, IBCLC

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Calcium

Breastfed babies do not need additional calcium over that which they get from breastmilk and (during the second 6 months) complementary foods. According to the American Academy of Pediatrics Policy Statement on Calcium Requirements of Infants, Children, and Adolescents:

No available evidence shows that exceeding the amount of calcium retained by the exclusively breastfed term infant during the first 6 months of life or the amount retained by the human milk-fed infant supplemented with solid foods during the second 6 months of life is beneficial to achieving long-term increases in bone mineralization.

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Vitamin D

See Does my baby need vitamin D supplements?

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Vitamin E

No known deficiencies of vitamin E have been described in healthy term infants fed human milk. Vitamin E supplements for mothers and their breastfed babies are not indicated.

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Fluoride

Currently there is no conclusive evidence indicating that fluoride supplements in infancy improve a breastfed baby’s dental health. Dr. Ruth Lawrence (author of “Breastfeeding: A Guide for the Medical Profession”) states:

evidence supports the contention that there is adequate fluoride in human milk, and fluorosis from excessive amounts is a concern.

The American Academy of Pediatrics has released an interim policy statement on fluoride supplementation: “Fluoride Supplementation for Children: Interim Policy Recommendations”. Their stance is this:

Fluoride should not be administered to infants during the first 6 months after birth, whether they are breast- or formula-fed. During the period from 6 months to 3 years of age, breastfed infants (and formula-fed infants) require fluoride supplementation only if the water supply is severely deficient in fluoride (<0.3 ppm). [This particular statement is from the AAP's policy statement on breastfeeding.]

Many city water systems add fluoride to the water. If you use well water or bottled water, it’s unlikely that fluoride has been added to your water, but it may still be there. Fluoride occurs naturally in most water, so you really need to know how much fluoride is in your water before you decide whether to supplement.

How do you find out how much fluoride is in your drinking water?

  • If you use city water, call your local water department to find out.
  • If you use bottled water, call the bottling company.
  • If you use well water, you can ask your local water department about having your water tested for fluoride – fluoride analysis isn’t very expensive (I’ve seen it advertised for $10).

After you know how much fluoride is already in your drinking water, you can look at the AAP recommendations and decide whether fluoride supplementation might be beneficial.

More information (both pro & con):

Fluoride Supplements from AskDrSears.com

What is Fluoride and Why You Won’t Want to Use It by Carol S. Kopf, BS, MA, from DrJayGordon.com

Debunking Fluoride: Cavity Fighter or Toxic Intruder? by Carol S. Kopf, BS, MA, from Mothering Issue 107, July/August 2001

Teething and Dental Hygiene from the American Academy of Pediatrics

Journal search on Fluoride and Human Milk

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Folic acid (folate)

Folic acid deficiency has not been reported in breastfed, full-term infants, and supplements are not recommended.

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Iron

Here’s my information page on Is Iron Supplementation Necessary?

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Vitamin K

Baby’s vitamin K stores at birth are very low. Vitamin K is needed for proper blood clotting, and a deficiency of this vitamin causes a syndrome called Vitamin K deficiency bleeding (VKDB). Increasing mom’s vitamin K intake increases the amount of vitamin K in her milk. The review article “Do breastfed infants need supplemental vitamins?” (Greer 2001) recommends:

Other than the intramuscular injection of 1 mg of vitamin K at birth, there are no further recommendations for vitamin K supplements to breastfed infants with well-nourished mothers. If parents refuse the intramuscular injection, then 2 mg of the parenteral solution should be given orally. Because this is variably absorbed and there is no well-absorbed liquid product available in the United States for infants, it seems best to repeat the oral dose at 7 and 28 days after birth, as is done in northern Europe when oral vitamin K is used in newborns.

Additional information:

 

Vitamin K at Birth: To Inject or Not by Linda Folden Palmer, DC

PDF Vitamin K1 Prophylaxis from the British Columbia Reproductive Care Program

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Niacin

Niacin deficiency in breastfed infants in developed countries is extremely rare, and no supplementation is recommended.

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Zinc

Healthy full-term breastfed babies do not need additional zinc past what they get from breastmilk and (after 6-8 months) from complementary foods. Good sources of zinc include meat (especially red meat) and yogurt. Signs of a mild zinc deficiency include: lessened appetite, lowered immune function, limited activity, growth faltering. Low birth weight, small for gestational age and premature infants are at risk for zinc deficiency.

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If you’re worried that your baby will need vitamins because your diet is not ideal

Studies have shown that when a mother is deficient in a certain nutrient, improving the mother’s nutrition and/or supplementing her diet (multivitamins, etc.) may be as effective or more effective than giving her baby vitamin supplements.

More information @ kellymom

Additional information

FAQ on Vitamin and Fluoride Supplements for the Breastfed Baby from La Leche League.

The Science of Feeding Your Children by Jay Gordon, MD

Supplementation for Breastfed and Bottle-Fed Infants from the American Academy of Pediatrics

Nutrient Information from the the American Society for Nutritional Sciences includes current information on food sources, diet recommendations, deficiencies, toxicity, clinical uses, recent research and references for further information for many micro- and macronutrients.

Nutrition Fact Sheets from Feinberg School of Medicine at Northwestern University

USDA Food Composition Data

Nutrition Analysis Tool (NAT) from the Food Science and Human Nutrition Department at the University of Illinois

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References

American Academy of Pediatrics, Committee on Nutrition. Fluoride supplementation for children: interim policy recommendations. Pediatrics. 1995;95(5):777

American Academy of Pediatrics, Work Group on Breastfeeding. Breastfeeding and the Use of Human Milk. Pediatrics. 1997;100(6):1035

Baker SS, Cochran WJ, Flores CA, Georgieff MK, Jacobson MS, Jaksic T, Krebs NF. American Academy of Pediatrics. Committee on Nutrition. Calcium Requirements of Infants, Children, and Adolescents. Pediatrics 1999 Nov;104(5 Pt 1):1152-7.

Milner JD, Stein DM, McCarter R, Moon RY. Early Infant Multivitamin Supplementation Is Associated With Increased Risk for Food Allergy and Asthma. Pediatrics. 2004 Jul;114(1):27-32.

Greer, FR. Do breastfed infants need supplemental vitamins? Pediatr Clin North Am (United States), Apr 2001, 48(2) p 415-23

In conclusion, in healthy, breastfed infants of well-nourished mothers, there is little risk for vitamin deficiencies and the need for vitamin supplementation is rare. The exceptions to this are a need for vitamin K in the immediate newborn period and vitamin D in breastfed infants with dark skin or inadequate sunlight exposure.

Krebs NF, Westcott J. Zinc and breastfed infants: if and when is there a risk of deficiency? Adv Exp Med Biol. 2002; 503: 69-75.

Krebs NF. Dietary zinc and iron sources, physical growth and cognitive development of breastfed infants. J Nutr 2000 Feb;130(2S Suppl):358S-360S.

Mohrbacher, N. and Stock, J. BREASTFEEDING ANSWER BOOK. Schaumburg, Illinois, USA; LLLI 1997.

Hamosh M, Dewey, Garza C, et al: Nutrition During Lactation. Institute of Medicine, Washington, DC; National Academy Press 1991, pp. 133-140.

Butte NF, Lopez-Alarcon MG, Garza C. PDF Nutrient adequacy of exclusive breastfeeding for the term infant during the first six months of life. Geneva, Switzerland; World Health Organization 2002, pp. 26-30.

Dietary Reference Intakes (DRI) and Recommended Dietary Allowances (RDA) from the US Department of Agriculture’s Food and Nutrition Information Center