Guidelines for Vitamin D Supplementation for Babies

I received a question from a mother in my private Facebook group last week about how to get her baby to take her Vitamin D drops. In talking with her, listening to other moms offer suggestions, and doing some research on my own, I realize that there is a lot of confusion surrounding the need for Vitamin D as well as how to administer them. So I decided to write about this for everyone in hopes of making this all a little more clear.

But, I think I may have just left you with more questions to answer. I will let you decide. 

What is the Purpose of Vitamin D in the body

Vitamin D is responsible for helping the body absorb calcium and phosphorus for bone growth. If children are deficient in these, they can develop fragile bones and a disease called rickets. You may have seen this as severely bowed legs and other problems.

Adults need Vitamin D for strong bones and can develop weak and fragile bones as well. Vitamin D also plays a role regulating cell growth, neuromuscular and immune function, and reduction of inflammation.

Some of the diseases associated with Vitamin D (but not proven) are immune disorders and autoimmune disorders, cancers, depression, and heart disease.

How can you get enough Vitamin D?

There are 3 ways to get Vitamin D:

#1 From Sunlight:

Vit D is naturally produced by your skin when it is exposed to sunlight. It is based on how close to the sun you live and how much sunlight you actually are exposed to as well as how much sun your skin allows in.

For example, fair skinned people absorb more sun in a shorter period of time and so make Vitamin D more quickly.  Darker skinned people produce more melanin that blocks the sun and so they produce less Vitamin D.

Also, the larger body surface area is exposed, the more vitamin D is produced.

If you live closer to the equator, you will be exposed to more sunlight year round and produce more Vitamin D. If you live in the northern states, you may not see as much sunlight, or in Alaska, where it is dark for the majority of the day for months on end,  you make very little Vitamin D.

Sunscreen and UV glass block Vitamin D production from your skin.

So to put that into perspective - a dark skinned person in Boston who works in an office building in the winter is going to get very little Vitamin D from sunlight.

But a light skinned person who doesn’t use sunscreen who lives in Miami and walks their dog every day will make more Vitamin D.

You can receive enough natural Vitamin D if you expose your face, arms and back for  ½ the time it takes to receive a sunburn daily in the sun without sunscreen.

That varies based on where you live and your skin type.

But getting Vitamin D from the sun is not recommended by the American Academy of Dermatology due to this putting you at risk for skin cancer.

#2. Diet Sources

It is better to get your Vitamin D from foods. But there are very few sources of naturally occurring Vitamin D in the foods we eat.

The major food sources of Vitamin D are salmon, canned tuna and other types of fatty fish. There are small amounts in egg yolks.  Some foods are fortified with Vitamin D.  Milk was fortified in the 1930’s to prevent rickets and nearly eliminated this condition. But, now is on the upswing again. Some other fortified foods include orange juice, cereals, breads, and some yogurts.

So look to your breakfast for your best bet for your daily supplementation and see how much you are getting in your diet. Then, add in your  fish.

#3 Supplements

That leaves supplements which are quickly becoming an adult’s biggest source of VItamin  D.

Most vitamins are water soluble vitamins (such as Vitamin C). If you take too much of a water soluble vitamin, you will just excrete the rest in your urine (pee it out). Water soluble vitamins don’t build up in your body.

But a few vitamins, Vitamin D being one of them, are fat soluble vitamins. This means that if you take too much, they will build up in your body’s fat. This could be harmful to you.

Who needs supplementation?

If you can’t convert the Vitamin D from sunlight or food or you just aren’t getting enough you may be deficient.

Some people are more at risk for being Vitamin D deficient. Understanding about Vitamin D helps to understand this these risks when looking at this list :

• Dark skinned people
• People who live in areas of decreased sunlight
• Older people
• People who do not get enough milk - lactose intolerant, milk allergic or just don’t drink it
• People with inflammatory bowel disease - because it is a fat soluble vitamin, it depends on the gut for absorption, with these diseases that absorption is decreased
• People who are overweight or obese (BMI > 30)  - Vitamin D is fat soluble and so it is absorbed in the fat and can get trapped there. Higher amounts of Vitamin D are needed for these folks.
• People who had gastric bypass surgery - because the small intestine is bypassed in this surgery  and this is where the vitamin is absorbed
• Breast fed infants  - Vitamin D is in low to nonexistent levels in mother’s milk

But we are beginning to see that a lot of people are more deficient than once realized.  It is nearly impossible for some people to get enough Vitamin D from diet. We do not get enough from sunlight now due to sunscreen and remaining indoors.  

How much Supplement Do You Need?

This is dependant on whether you are supplementing your diet with Vitamin D ( just boosting your supply) or whether your body is deficient in Vitamin D (lower than normal levels) and you are replacing what you body is missing.This makes a big difference.

A supplement adds to what your body already has.

A replacement dose replaces what your body is missing.

Replacement dosing, because your body is lacking in that vitamin, usually requires higher doses. In this case, your Vitamin D levels would need to be checked and a medical provider would need to prescribe that replacement dose.

Levels would need to be checked periodically, both to make sure that the level comes up to normal and to make sure that you are not exceeding the maximum recommended amount.

The Recommended Daily Allowance of Vitamin D per Age according to the Institute of Medicine

Infants up to age one - 400 iu/day

Children over 1 year old -  600 iu/day  

Adults up to age 71 - 600 iu/day

Older Adults over age 71 - 800 iu per day

(Did you notice that the dose for anyone over age one was the same until age 71?)

There are some people who may need higher doses, as we talked about earlier - those are people who are at risk for being deficient.

In obese patients, patients with malabsorption syndromes, and patients on medications affecting vitamin D metabolism, a higher dose of Vitamin D is suggested.

If you think that your diet may be deficient in Vitamin D, it is ok to take a supplement. You can find Vitamin D over the counter at many Vitamin Shops and pharmacies.

Just supplementing with the recommended daily allowance is suggested. Remember that Vitamin D is fat soluble, so you don’t want to take mega doses of Vitamin D without consulting a physician.  

It isn’t recommended to test everyone for Vitamin D deficiency, only those suspected of being at risk. But a test is very easy to obtain if you suspect you may be in a risk category.

If you have a medical condition, take medications or are obese, you will want to discuss supplementing with your healthcare provider first.

You may think that it is just a vitamin, but there could either need a higher dose or it could be recommended not to take the vitamin based on your condition.  

Now, what does Vitamin D have to do with Babies?

Again, the recommendations according to the AAP and Institute of Medicine are:  

All infants under one year old should receive 400 iu/day of Vitamin D starting at birth to prevent rickets and weak bones.

But babies don’t have the ability to produce their own Vitamin D from sunlight as it is not recommended to take them into sun.

They do not eat solid foods until at least 6 months, so they don’t have a source of food for Vitamin D.

We know that mother’s milk has low levels of Vitamin D because it does not readily cross over from mom’s into the milk supply. So, it is recommended that babies receive supplementation.

How do babies get their Vitamin D?

If an infant under one is receiving formula as their only source of nutrition, their formula has all the Vitamin D needed and they don’t require any supplementation.

If a baby is exclusively breast fed, there are low levels of available Vitamin D in mother’s milk and they will require supplementation with 400 iu/day of Vitamin D every day until they are weaned to fortified milk.

If a baby is breastfed and receiving supplemental formula, the baby will require 400 iu/day of Vitamin D every day until he is taking 32 oz of formula/day or is weaned to fortified milk.

Children over 1 year old should receive 600 iu/day of Vitamin D which they can receive by drinking fortified cow’s milk in their diet.

If you do not think that your child isn’t drinking enough cow’s milk. Discuss with your healthcare provider about the need for supplementation in the form of a multivitamin which has Vitamin D in it.

 
Supplement the Baby

Vitamin D supplementation for babies comes as liquid drops that can be given directly to babies. This has been the recommended form of supplementation.

It has to be given daily as Vitamin D has a short life span when given in recommended dosages.

But, we know that there have been problems with this, because many babies are not receiving adequate levels of Vitamin D.

This may be for many reasons.

• Mother’s say that babies spit out the Vitamin D liquid drops,
• Some mothers forget to give the drops
• Some say they weren’t told to give Vitamin D
• Others say that they think the baby gets everything they need in the breast milk
• Still others didn’t understand why babies needed the vitamins

Here are ways to help make sure your baby gets his Vitamin D:

Baby spits it out

Solutions:

Make sure that you are not squirting the drops directly on the tongue

Baby has a tongue thrust reflex until around 4 months that makes them spit out anything on their tongue

Squirt tiny bits of the vitamin in between the cheek and gum (not touching the tongue.)

Try squirting tiny amounts on the breast when the baby is nursing and have the baby suck it off

You may want to try a different brand of Vitamin  D

(i.e. D Drops is a brand that is tasteless and comes as only one drop instead of a dropper full)

Parent Forgets to Give Vitamin

 Solutions

Set a reminder alarm on your phone and another caregiver’s phone too (but don’t double dose baby)

Create a routine - link them to something you do every day like diaper changing   

Put the drops where you will see them ( like the changing table if you do not have other children in the home)

Write a big note

Write on calendar and cross off each day

Put a date on the bottle of when they were filled and when they should be empty-  check to see if you are giving them in a reasonable length of time

Supplement the Mother's Milk

Recently, it was suggested that the level of Vitamin D in breast milk could be increased so that babies could receive the Vitamin D from their mother’s milk supply instead of the baby taking the supplement.

A group of researchers from the University of South Carolina did a study that was published in the journal Pediatrics (which is the professional publication of the American Academy of Pediatrics) in 2015, that compared three doses of Vitamin D (400iu/day, 2400iu/day,  and 6400iu/day) given to breastfeeding mothers in attempts to increase the levels in her breastmilk.  

Only the highest dose - 6400 iu -  gave the infants adequate levels of Vitamin D to meet their recommended daily allowances.

The researchers were able to say in their study that if mothers took  6400iu of Vitamin D daily, they transferred adequate levels of Vitamin D to their baby and they did not have to give the baby oral Vitamin D.

The mothers also did not find any adverse reactions to this dose of Vitamin D.

However, this was only a 6 month study, with 338 mothers beginning the study and 148 completing the study.

What does this mean for moms and babies?

Although, this study was reported in the journal Pediatrics, the American Academy of Pediatrics still recommends, as of May, 2017, that babies receive the supplementation and has not officially changed their policy or recommendations.

There are health care providers who are advising mothers to make these changes.

Is this a safe dose?

If the recommended daily allowance of Vitamin D is 600iu/day, is 6400iu/day a safe dose?

There are several organizations that look at Vitamin D and determine recommended daily allowances, safe dosages etc. Among those are The institute of Medicine, The Endocrinology Society, The National Institutes of Health. All three of these organizations report that, for supplementation purposes, the maximum upper limit of safe doses of supplementation are 4000 iu/day.

The Endocrinology Society  does suggest that higher doses may be needed for many conditions. They report that breastfeeding mothers may need to take 4000- 6000 iu to increase the level of Vitamin D in breast milk.

The also report that replacement doses for Vitamin D deficiency may be needed even up to 10,000 units in some conditions and that dose is safe. (remember the differences between replacement and supplemental doses)

However, The Endocrinology Society continually reports that doses higher than 4000iu should not be used for supplementation without medical supervision. Read about that here. 

I would definitely discuss these findings with your healthcare provider before ever making this change on your own. I would weigh out the pros and cons carefully.

How do you decide which option to consider for Vitamin D supplementation ?

Here are some things to consider when trying to decide whether you will take the increased supplementation or the baby will take Vitamin D. 

1. Are you having a difficult time remembering to give the baby the vitamin drops?
2. Are you able to get the baby to take the drops?
3. Who is more likely to receive the vitamins daily? Would you be more likely to give the baby the vitamins or take your own vitamins?
4. Do you remember to take your own vitamins daily?
   • If you forget to take your vitamins - baby would not receive any vitamin D that day

If you think that you will not remember to give the baby the Vitamin D drops or you are having a difficult time getting the baby to take the drops, despite the suggestions above, then you may want to discuss with your medical provider taking an increased dose of Vitamin D for yourself and providing the Vitamin D to the baby in your breastmilk.

If you think that it is a better option for you, then I recommend that you discuss this option with your baby’s health care provider.

My personal recommendation would be to make every attempt to supplement the baby appropriately as recommended by the guidelines of the AAP until further studies are done that back up the findings of the previous study. 

Vitamin D is  necessary to help the body absorb calcium and phosphorus to build strong bones. Many people are at risk for Vitamin D deficiency these days and are needing supplementation.

Breastfed babies need to receive supplementation until they are no longer breastfeeding. We know that some of those babies are not receiving enough vitamin D.

The information in this article was designed to give you information about how to make sure your family gets enough Vitamin D.  I wanted to make sure that you know why your baby needs Vitamin D and how to get that Vitamin D into your baby daily in the safest way possible.

Talk to your health care provider if you feel that your baby or child  is not getting the Vitamin D that he needs or If you want to explore some of the other options.

If you have some thoughts or ideas about this topic, come on over to the Facebook Group and discuss your thoughts and ideas with other moms.