Does My Baby Need Vitamins?

July 26, 2011. Posted in: Vitamins/ Supplements

By Kelly Bonyata, IBCLC

 

Overview

Vitamin and mineral supplements are not generally necessary for the average healthy, full-term breastfed baby during the first year. Studies have shown that most vitamins, fluoride, iron, water, juice, formula and solid foods are not 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 (see below for specifics).

The American Academy of Pediatrics does recommend that all babies receive a vitamin K injection soon after birth to reduce the risk of hemorrhagic disease of the newborn, and routine vitamin D supplementation due to decreased sunlight exposure and an increase in rickets.

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 breastfeeding mothers for this vitamin are 120 mg per day (over 18 years) and 115 mg per day (under 18 years). If you smoke, add 35 mg per day to these amounts. Supplements of vitamin C for a mother do not significantly alter the amounts in breastmilk, as they remain fairly constant no matter what mother’s intake levels (assuming the mother is not vitamin-C deficient).  For a mother deficient in vitamin C, supplements will increase milk levels.

 

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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

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.

The babies who do need these supplements need them due to a lack of sufficient sunlight. Factors that put your breastfed baby at risk for vitamin D deficiency (rickets) are:

  • Baby has very little exposure to sunlight. For example: if you live in a far northern latitude, if you live in an urban area where tall buildings and pollution block sunlight, if baby is always completely covered and kept out of the sun, if baby is always inside during the day, or if you always apply high-SPF sunscreen.
  • Both mother and baby have darker skin and thus require more sun exposure to generate an adequate amount of vitamin D. Again, this is a “not enough sunlight” issue – the darker your skin pigmentation, the greater the amount of sun exposure needed. There is not much information available on how much more sunlight is needed if you have medium or darker toned skin.
  • Mother is deficient in vitamin D – there is increasing evidence in the last few years indicating that vitamin D deficiency is becoming more common in western countries. The amount of vitamin D in breastmilk depends upon mom’s vitamin D status. If baby gets enough sunlight, mom’s deficiency is unlikely to be a problem for baby. However, if baby is not producing enough vitamin D from sunlight exposure, then breastmilk will need to meet a larger percentage of baby’s vitamin D needs. If mom has minimal exposure to sunlight (see above examples)and is not consuming enough foods or supplements containing vitamin D, then she may be vitamin D deficient.

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 sun exposure. Depending upon where you live, going outside regularly is often all that is required for you or your baby to generate adequate amounts of vitamin D. (Keep in mind that there is a concern of sunburn and increased risk of skin cancer with too much sun exposure, however.)

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 mom’s vitamin D status during pregnancy directly affects baby’s vitamin D stores at birth and particularly during the first 2-3 months, it is very helpful for pregnant women to make sure they are getting enough vitamin D.

Adding a vitamin D supplement to mom’s diet and/or exposure to ultraviolet light will increase the amount of vitamin D in her breastmilk. As long as mom is not vitamin D deficient, her breastmilk will have the right amount of vitamin D. However, babies were “designed” to get only part of their vitamin D from breastmilk and the remainder from sun exposure – what if baby does not get a minimum amount of sun? A 2004 study [Hollis & Wagner 2004] determined that supplementing the mother with 2000-4000 IU vitamin D per day safely increased mother’s and baby’s vitamin D status: the 2000 IU/d dose resulted in a limited improvement, and “A maternal intake of 4000 IU/d could achieve substantial progress toward improving both maternal and neonatal nutritional vitamin D status.” A Finnish study [Ala-Houhala 1986] showed that supplementing the mother with 50 µg (2000 IU) vitamin D per day was as effective for maintaining baby’s vitamin D levels as supplementing the baby with 10 µg (400 IU) per day.

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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 evidence indicating that fluoride supplements in infancy improve a breastfed baby’s dental health. Dr. Ruth Lawrence (in Breastfeeding: A Guide for the Medical Profession, 7th ed., p.932) states:

The supplementation of fluoride in the diet of a healthy breastfed infant is no longer recommended by the AAP. 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 recommends that fluoride supplements only be given after 6 months, and only to children at high risk for developing cavities and whose primary water source is deficient in fluoride.

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.

After you know how much fluoride is already in your drinking water and determine whether your child is at high risk for developing cavities, you can decide whether fluoride supplementation might be beneficial.

More information:

Fluoride Supplements from AskDrSears.com

Fluoride Dietary Supplementation from the American Academy of Pediatrics

Rozier RG, Adair S, Graham F, et al. Evidence-based clinical recommendations on the prescription of dietary fluoride supplements for caries prevention: a report of the American Dental Association Council on Scientific Affairs. J Am Dent Assoc. 2010;141(12):1480-9.

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 American Academy of Pediatrics recommends:

Intramuscular vitamin K1 (phytonadione) at a dose of 0.5 to 1.0 mg should routinely be administered to all infants on the first day to reduce the risk of hemorrhagic disease of the newborn. A delay of administration until after the first feeding at the breast but not later than 6 hours of age is recommended. A single oral dose of vitamin K should not be used, because the oral dose is variably absorbed and does not provide adequate concentrations or stores for the breastfed infant.

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