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Vitamin D Supplementation When Breastfeeding

Find out why the American Academy of Pediatrics recommends supplementing your baby with vitamin D when breastfeeding.

Published March 3, 2023

by Casey Williams

Registered Nurse and IBCLC

After doing your research and seeing all the amazing benefits breast milk offers your baby, you decide you will exclusively breastfeed. Way to go, mama! But now your doctor recommends you give your baby supplemental vitamin D when breastfeeding. You’re thinking, “Why? I thought breast milk was all my baby needed.”

Don’t worry; breast milk is still the recommended and optimal source of nutrition for your baby. However, the American Academy of Pediatrics (AAP) recommends breastfeeding babies receive supplemental vitamin D because while breast milk is packed full of amazing nutrients, it lacks vitamin D, making supplementation crucial to prevent infant deficiency.

Importance of Vitamin D

Vitamin D is a critical nutrient for your and your baby’s health. It helps your body properly absorb calcium and helps regulate the body’s balance of how much calcium and phosphorus your bones store.1,2 To put it simply, vitamin D is essential for bone health. Without vitamin D, your body cannot absorb and use the calcium you get from your diet. Vitamin D is important to your child’s immune system and offers lifelong health benefits.3

Unfortunately, studies show that many Americans are vitamin D deficient. About 42% of Americans, with an estimated 15% of those children ages 1-11.2

Vitamin D levels are measured through a blood test that looks at a form of vitamin D called 25-hydroxy vitamin D.  According to the National Institute of Health (NIH), levels of 50+ nmol/L meet the required vitamin D needs to support bone and overall health. Blood levels below 30 nmol/L are cause for concern, and when bones are at risk for weakening. In contrast, vitamin D levels of 125+ nmol/L are considered too high and can cause health problems. Extremely high vitamin D levels (375nmol/L) can cause vomiting, confusion, dehydration, kidney failure, and heart problems. It is important to note that high levels are almost always a result of an increase in dietary supplemental vitamin D.1

Why is My Breastfed Baby at Risk?

Breastfed babies run a higher risk of developing vitamin D deficiency. They have two main factors stacked against them from the start. First, the amount of vitamin D in breast milk directly reflects the mother’s intake. Without purposeful supplementation, it is uncommon for a mother to meet the baby’s vitamin D needs. The NIH reports breast milk usually only provides less than 0.6 to 2.0 mcg/L of vitamin D.4

Second, our body needs sunlight to make vitamin D.1 The AAP advises limiting babies’ sunlight exposure to avoid sunburns. They do not get light exposure like older children and adults to help increase vitamin D levels through sunlight.5 Even with some sun exposure, it is too difficult to measure if the amount they receive is adequate.6

Even for older children and adults, it is not common to be exposed to enough direct sunlight to meet vitamin D recommended levels. Many factors limit our bodies from obtaining optimal amounts of vitamin D from sun exposure. Some of these include the prevalence of using sunscreen, which blocks sun rays, living in areas where clouds or air quality limit the amount of sun exposure, and having a darker skin tone, which requires larger quantities of sun exposure to make vitamin D.1

How Much Vitamin D Should I Give My Baby

The AAP recommends supplementing with vitamin D when breastfeeding, so infants receive 400 IU per day from the first few days of life and throughout their breastfeeding period. That dose is also recommended for partially breastfed babies and infants receiving less than 28 ounces of “commercial infant formula” daily.7

The AAP’s guidance states that maternal supplementation can be considered an alternative to infant supplementation of vitamin D. A breastfeeding mother can supplement with 6,400 IU of vitamin D per day to help their baby meet vitamin D needs through breast milk.7 Some women might prefer this method to meet the baby’s needs and their own.6

When it comes to giving supplements and determining if you should give vitamin D directly to your infant or start supplementing yourself, you should always consult your healthcare team for correct dosing and guidance.

Effects of Vitamin D Deficiency on Infants

Vitamin D deficiency can lead to some serious problems. For infants, a major concern is the development of rickets, a painful disease where a child’s bones become very weak and soft.1 With rickets, it is common to see a deformity that causes “bowing” of the legs of children who are walking and the widening of the bones in the area above the wrist for those children who are crawling. If calcium levels become low enough, the risk of developing seizures also rises.2

When to Stop Vitamin D Supplements

Supplementing with vitamin D when breastfeeding can stop when your baby weans from breastfeeding and starts to drink whole milk, usually around 12 months. It is important to ensure your little one’s diet includes good sources of vitamin D. Some examples include eggs, whole milk, yogurt, salmon, and some fortified cereals. Make sure to speak with your healthcare team about stopping vitamin D and guidance on ensuring your baby maintains recommended levels.8

While giving vitamin D as a supplement might have thrown you a curve ball, research has shown how important it is for your little one’s health and yours. But giving your little one a supplement is always a big decision. Make sure to speak with your healthcare team, which can help answer all your questions and for guidance on vitamin D supplementation for both you and your baby.

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Casey Williams Registered Nurse and IBCLC
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Casey Williams is a registered nurse and IBCLC. Her expertise is in pediatrics and lactation. Casey has worked in all different areas in pediatrics, including inpatient and outpatient roles. While… Read more

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