Vitamin D requirement for BreastFeed infants

Concerns:

• Vitamin D requirements cannot ordinarily be met by human milk alone which provides <25 IU/L to 78 IU/Lwhich provides <25 IU/L to 78 IU/L
• breast milk alone does not provide infants with an adequate intake of vitamin D
• The vitamin D content of human milk is related to the mother's vitamin D status, so mothers who supplement with high doses of vitamin D may have correspondingly high levels of this nutrient in their milk
• Most breastfed infants are able to synthesize additional vitamin D through routine sunlight exposure
• While the sun is a potential source of vitamin D, the AAP advises keeping infants out of direct sunlight and having them wear protective clothing and sunscreen

High Risk Groups:

• Babies of mothers with darker skin types, particularly when living in high latitude areas such as the UK where the winter sun provides little or no access to vitamin D;
• Babies and mothers who wear concealing clothing, preventing skin exposure to sunlight;
• Babies and mothers who spend a lot of time indoors or use sun creams critically reducing exposure to sunlight;
• Babies of obese mothers (BMI >30).
• Rickets is also more prevalent among immigrants from Asia, Africa, and the Middle East, possibly because of genetic differences in vitamin D metabolism and behavioral differences that lead to less sun exposure

Need for Vitamin D Supplementation

• It is essential that vitamin D deficiency is prevented and / or corrected during pregnancy in order to prevent babies being born with depleted stores. A baby born deficient in vitamin D will not restore their levels from breastmilk alone.
• Healthy breastfed babies born to mothers (who have been taking 400mcg Vit D daily) should receive a vitamin D supplement from six months of age (as part of a multivitamin supplement)
• if the mother’s vitamin D status in pregnancy is uncertain, or if she falls into one of the risk groups, vitamin D supplements for mother and baby should be started soon after birth
• AAP recommends that exclusively and partially breastfed infants be supplemented with 400 IU of vitamin D per day [23], the RDA for this nutrient during infancy

Available Products

Adequate amounts of vitamin D can be achieved by currently available multivitamin products (Appeton, syrup multivitamins etc) containing 400 IU of vitamin D per mL

Prescription preparations of vitamin D have very high vitamin D concentration and are not for routine home use.

If an infant is weaned to vitamin-D fortified infant formula (consuming at least 1000 mL per day) or a child one year of age or older is weaned to vitamin-D fortified milk, then further supplementation is not necessary

References:

1. www.uptodate.com
2. http://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/
3. http://www.cdc.gov/breastfeeding/recommendations/vitamin_d.htm
4. http://www.unicef.org.uk/BabyFriendly/News-and-Research/News/UNICEF-UK-Baby-Friendly-Initiative-Statement-on-vitamin-D-supplementation-for-breastfed-babies/