Your Baby And Vitamin D

This page is designed to answer questions about your baby and vitamin D, a subject which often causes confusion for parents.

PLEASE NOTE: The information given here is meant as a guide only and does not replace professional medical advice. You should always discuss your baby's nutritional needs (including possible vitamin supplementation) with your doctor.

How does my baby's body use vitamin D?

Vitamin D helps your baby's body absorb calcium, which is needed for the healthy development of strong bones and teeth. A deficiency of vitamin D can result in rickets, which affects the way bones develop and grow. The bones of a child with rickets are unable to sufficiently support his body weight, resulting in bowed legs.

How can I ensure my baby is getting enough vitamin D?

The answer to this question can vary greatly from one culture/country to another, which is why you might come across lots of conflicting advice on the subject.

SOURCES OF VITAMIN D

The most important source of vitamin D is not food... it's sunlight! In fact, vitamin D isn't actually a vitamin at all, but is a steroid hormone that the body produces using UVB rays from the sun. Vitamin D deficiences in babies can arise if babies receive inadequate exposure to sunlight.

Other risk factors for vitamin D deficiency in babies include

darker pigmented skin
premature birth
vitamin D deficiency in a breastfeeding mother
lead exposure
offering babies low-calcium foods in place of breast milk

SAFELY EXPOSING YOUR BABY TO THE SUN

We are all used to protecting our babies from the sun - in fact, AAP guidelines say that babies under 6 months of age should not be exposed to the sun at all and that older babies should be fully protected with sunscreen... but then we discover that they NEED sunlight in order to make vitamin D! So how do we safely meet these needs?

Well, babies don't actually need a lot of sun to make vitamin D - in fact, casual sun exposure is enough. As this helpful article in Mothering Magazine advises...

"To make enough vitamin D, a baby in a diaper needs a total of only 30 minutes of sunlight a week-less than five minutes a day. Fully clothed and without a hat, a baby would need two hours of sunlight a week, or about 20 minutes a day. Medium to darker skin tones need a little more time in the sun."

And to allay parents' fears about exposing their babies to the sun WITHOUT sunscreen, Becky Saenz, MD, IBCLC, Associate Professor of Family Medicine at the University of Mississippi Medical Center, points out...

"There is a vast difference between recommending that it's okay for baby to sit in the grocery buggy while mom puts the groceries into the car in the early morning or late afternoon, and recommending nude sunbathing at noon."

Clearly, the best approach is to use common sense - avoid taking your baby out unprotected during the hottest part of the day. Instead, make sure he gets a little sunshine before 10am or after 3pm.

LIMITED SUN EXPOSURE AND VITAMIN D DEFICIENCY

Sometimes, babies do not get enough sunlight to make sufficient vitamin D. This could be due to

darker skin pigmentation - darker skins take longer to produce vitamin D
pollution or cloudy conditions limiting the amount of UVB rays getting through
living in areas that receive little sunlight for part of the year
cultural practises that mean that little time is spent outdoors or that the body is constantly covered with clothing.

In these cases, vitamin D supplements may be recommended by a medical professional.

Official recommendations for vitamin D supplementation for babies

It is very difficult for any one medical authority to issue all-encompassing guidelines for infant vitamin D requirements, because of the many variables listed above. So recommendations vary from country to country.

In the US, the American Academy of Pediatrics conservatively (and controversially) recommend that ALL breastfed babies be given vitamin D supplements. This is because, they say, breast milk does not contain enough vitamin D. (Formula milk is fortified with vitamin D, so this recommendation does not apply to formula-fed infants).
The La Leche League, however, is emphatically opposed to the routine vitamin D supplementation of breastfed infants. This article, published on the La Leche League website, reiterates that - with adequate sun exposure - vitamin D supplements are not routinely required for full-term, healthy breastfed babies (provided that Mom is not vitamin D deficient herself). Some experts feel that the AAP's cautious approach is more of a "better safe than sorry" type policy.
Routine vitamin D supplementation is also recommended by the Ministry of Social Welfare in Sweden and the Canadian Pediatric Society.
In the UK, vitamin D supplements are given only to at-risk babies. This policy is also applied by the National Health and Medical Research Council in Australia.
The Ministry of Health in New Zealand offers vitamin D supplements only when a vitamin D deficiency is proven.

Do any baby foods contain vitamin D?

Many parents wonder if they can avoid the "sunlight" issue by including more vitamin D in their babies' diets.

But only a few foods (listed below) contain vitamin D and even they do not contain huge amounts, so it is difficult to meet your baby's needs with diet alone. Another approach is for a breastfeeding mother to increase her OWN vitamin D intake - the amount of vitamin D contained in her breast milk relates directly to the vitamin D levels in her body. Again, though, a mother would need to eat at least 3 servings of oily fish a week to meet her OWN vitamin D requirements. So exposure to sunlight is still a key factor in maintaining the necessary vitamin D levels.

FOODS THAT CONTAIN VITAMIN D INCLUDE

fortified milk, cereals and certain brands of orange juice (not recommended for babies under 1 year of age)
egg yolk
cheese
oily fish (like salmon, tuna and mackerel - although king mackerel should be avoided) and fish oils
mushrooms. These contain a little vitamin D - but recent research has shown that brief exposure to UVB rays can dramatically boost their vitamin D levels. This could mean that mushrooms may soon become a better dietary source of vitamin D than the dreaded cod liver oil!

Vitamin D and YOUR baby

There is no doubt that this is a very controversial subject with widely varying guidelines. Your child's vitamin D levels can be ascertained with a simple blood test, which some parents may find preferable to automatic supplementation.

The choice - of course - is yours to make, with the guidance of your child's doctor.

For more information about vitamin D and your baby, you may find the following external links helpful.

Dietary Supplements Fact Sheet: Vitamin D

Facts About Vitamin D From The Vitamin D Council