Q: “Recently at a doctor’s visit, our paediatrician suggested giving our breastfed baby vitamin D drops. If breastmilk is the perfect food for newborns, why would it lack vitamin D?”
A: Vitamin D is a group of compounds that our bodies need for not only bone health, but for immune function as well. While vitamin D deficiency is most often associated with rickets, emerging research is starting to link deficiency of this vitamin with a host of ailments, including arthritis, diabetes, heart disease, and even cancer.
Although you can get some vitamin D in foods (especially those that are fortified, like milk), your body is meant to mainly synthesise its own vitamin D from sunlight (UVB) exposure. Fifteen to twenty minutes of noon-time sun exposure several times per week is enough. Because of the fear of skin cancer (and our regular use of sunscreen) as well as our more indoor 21st century lifestyles, our sun exposure has become more limited, making many adults vitamin D deficient.
Other Risk Factors For Low Vitamin D Levels
Other factors can affect our vitamin D production include:
- Living at a high latitude, where there are fewer hours of sunlight and the sun is not as strong as it is at lower latitudes (the father from the equator, the less UVB available);
- Living in areas of greater air pollution (which blocks some of the necessary ultraviolet rays);
- Living in a culture where much of the skin is covered (which is especially true for women); and,
- Skin pigmentation (the darker the skin, the longer you need to be in the sun).
These risk factors are true for children and babies too. Other risk factors for babies include being breastfed, prematurity, and being born in the winter or early spring. Given the fact that sunscreen isn’t recommended for babies younger than 6 months, the advice is to keep them out of the sun altogether. Which means that a baby’s main source of vitamin D is altogether absent. And while it may seem like your doctor is picking on you because you’re breastfeeding, ALL babies need vitamin D.
Artificially fed babies are getting it through their formula, which is fortified with more than enough in hopes that baby will absorb enough for good health. Your breastfeeding in and of itself isn’t the problem — it’s the modern lack of sunlight exposure that makes breastfeeding problematic. In more traditional cultures, where mothers spend many hours each day outdoors, babies get plenty of vitamin D in their breastmilk diets.
Another risk factor for babies is a mother’s vitamin D status. During pregnancy, a fetus lays down stores of vitamin D taken from his or her mother’s body, which it then uses during the first few months of life. But the infant’s vitamin D status is dependent on his mother’s — if she is deficient, baby will be too.
Researchers believe that mothers should be tested early in pregnancy to establish their baseline vitamin D status, and if it’s not within the range of normal, the pregnant mother should be supplemented. The amount of supplement would depend on her vitamin D levels. It is possible to get too much vitamin D, and toxic levels can cause damage to the unborn baby. So working closely with your healthcare provider is essential.
How Much Vitamin D Do I Need?
A wide variety of opinions exist for the best way to optimise the vitamin D status of breastfed babies.
- In the United States, the American Academy of Pediatrics recommends 400 IU per day of vitamin D for all breastfed babies from birth.
- In Australia, the recommendation is the same, but some Australian sources advise infants have their vitamin D levels tested to make a determination as to whether or not the baby needs a supplement.
- In Canada and the UK, it’s recommended that a mother be supplemented so her baby can get more vitamin D through breastmilk.
Research shows that supplementing breastfeeding mothers works. One study found that if a breastfeeding mother took a supplement of 2000-4000 IU of vitamin D daily, her baby’s vitamin D status improved. Other researchers found that a 2000 IU vitamin D supplement for mum was as effective at maintaining baby’s vitamin D status as giving the baby 400 IU per day directly. In opposition to this, Wagner’s research team has found that 6400 IU per day are needed to maintain baby’s status through breastmilk.
If you decide to take a vitamin D supplement yourself instead of giving one to your baby, be sure to take it every day. Vitamin D isn’t stored for long — the body needs regular exposure. And be sure you are taking enough — 400 IU for mum is probably not going to raise the amount in breastmilk enough to be protective for baby.
Will Exposing My Baby To Some Sunlight Help?
Because no one is sure how much UV exposure is appropriate for infants (or at what point damage begins), you need to weigh up the risks of sun exposure with the possible benefits. If you plan to have your baby out in the sun, limit exposure to early morning or late afternoon or evening and avoid exposure when the sun is the strongest. The length of time needed in the sun, however, is variable and not accurately quantifiable.
Will Giving My Baby Vitamin D Impact On Breastfeeding?
Don’t worry that giving your baby a vitamin D supplement is somehow going to sabotage breastfeeding. This isn’t a subversive plot by an anti-breastfeeding regime. Vitamin D deficiency is the consequence of modern lifestyles, and the best way to combat the adverse health effects is by supplementing the compound for baby. Exclusive breastfeeding can be maintained along with vitamin D drops.
If you’re living in Australia, just a few minutes exposure all year round in Queensland and the Northern Territory is enough to keep little ones healthy without burning. Other states will require around 2-3 hours per week in the winter months, and just a few minutes during summer. If you’re interested in a more in-depth exploration, the book New Insights into Vitamin D During Pregnancy, Lactation and Early Infancy is a great resource. A fact sheet produced by the National Institutes of Health in the US is another great resource — especially if you’re interested in food sources of vitamin D as well as recommendations for different life stages.
- Centers for Disease Control and Prevention. (2009). Vitamin D supplementation.
- Creighton University. Vitamin D and the nursing mother. ScienceDaily, 6 June 2014.
- Kulie, T., Groff, A., Redmer, J., Hounshell, J., & Schrager, S. (2009). Vitamin D: an evidence-based review. J Am Board Fam Med, 22(6), 698-706.
- Merewood, A. (2013). Does my breastfed baby need extra vitamin D? J Hum Lact 29(1), 100-1.
- Munns, C., Zacharin, M. R., Rodda, C. P., Batch, J. A., Morley, R., Cranswick, N. E. & Cowell, C. T. (2006). Prevention and treatment of infant and childhood vitamin D deficiency in Australia and New Zealand: a consensus statement. Med J Australia, 185(5), 268.
- Wagner, C. L. (2011). Vitamin D: Recommendations during Pregnancy, Lactation and Early Infancy. Clinical Lactation, 2(1), 27-32.