"Does my child need a vitamin?"
By Christine P. White, MD, FAAP
July 11, 2017
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– A question I hear regularly from parents of my patients.  Their child may be 2 weeks old or 20 years old.  The majority of the time the answer is, “No, your child does not need any vitamins”.  I can almost always tell parents that because their child is growing well, eats a well-balanced diet with a good mix of fruits and vegetables, animal protein sources such as chicken, turkey, beef and fish and consumes a healthy amount of calcium-rich foods he or she does not require a vitamin. Over the course of the next few weeks I’ll discuss some cases where these criteria may not be met, and it may be advantageous for your child to take a supplement.



The first group we’ll discuss are newborns and infants up to one year of age. Vitamin D is one supplement required by all members of this group. Our bodies must have vitamin D to absorb calcium and promote bone growth.  Too little vitamin D can result in rickets, a softening and weakening of bones.  Vitamin D also helps regulate the immune system as well as helping with nerve and muscle function. 

 

Vitamin D is so important our bodies can make it –but only after skin exposure to sufficient sunlight.  If you live north of a line drawn from Los Angeles to Columbia, South Carolina, you probably aren’t getting enough sunlight for vitamin D production throughout the year.  Kansas City is definitely north of this line.  For more information on how to get enough vitamin D through sunlight alone, click here.  Of course, this can put you at risk for skin cancer if you get too much sunlight. 

The other way to get vitamin D is through food or supplements.  Many Americans don’t consume enough foods high in vitamin D – such as salmon, mackerel, mushrooms, cod liver oil, tuna, sardines, or cow’s milk/yogurt/cheese fortified with vitamin D – to keep from becoming deficient in vitamin D.  A study in the journal Nutrition Resource in January of 2011 showed 42 percent of Americans were vitamin D deficient – which they defined as a vitamin D level less than 20 ng/ml.  This means 42 percent of new moms are likely vitamin D deficient, and this leads to a newborn deficient in vitamin D. 

Breast milk has everything a newborn needs – except vitamin D.  Babies born to mothers who are NOT vitamin D deficient are still at risk for becoming deficient, seeing as they definitely don’t eat enough of the above vitamin D rich foods.  They need to be given a supplemental form in a dose of 400 International Units (or IU) per day.  D-vi-sol™ and Tri-vi-sol™ can be found at most pharmacies and grocery stores.  They contain 400 IU vitamin D per 1 ml.  They taste decent and are really free of side effects.  They can be given alone or mixed with breast milk, formula or food.
  
So, if your baby is exclusively breast fed, he should start vitamin D supplementation with 400 IU in the first few days of life and continue it for the first year.  If your baby is fed both breast milk and formula, she should start 400 IU vitamin D in the first few days of life and continue for the entire first year, or until she is consuming 32 ounces of formula.  This is the amount of formula required to provide 400 IU of vitamin D.  Therefore, if your baby is fed formula from birth, he should receive 400 IU vitamin D supplementation until he is taking 32 ounces of formula a day.  This may not happen until around 3 to 4 months of age for some babies.
    
Recently there has been more evidence (Pediatrics, September 2015) that maternal supplementation with 6,400 IU of vitamin D per day will provide her breast-fed infant with 400 IU vitamin D per day through breast milk alone.  This is an alternative to supplementing the infant.  However, mothers should check with their health care providers to see if this dose is safe for them to take, as many references recommend the highest dose an adult should take is 4000 IU of vitamin D per day.  Side effects of too much vitamin D include weakness, fatigue, loss of appetite, dry mouth, metallic taste, nausea and vomiting. 

The other supplement needed by infants is iron.  Iron is important for brain growth and development.  It is also required for making red blood cells. Healthy, full-term infants (at least 37 weeks gestational age) have enough iron stored up from their time as a fetus to last them the first 4 months of life.  After 4 months of age, they need 10 mg of iron per day to prevent iron deficiency.  Symptoms of iron deficiency anemia may include:  pale skin, fatigue or weakness, irritability, shortness of breath, and inflammation of the tongue. Often babies with anemia show no symptoms at all.  Long-term iron deficiency can lead to decreased attention, reduced alertness and learning problems in children. 

Infant formula (with the exception of low-iron formula – which should never be used) contains about 2 mg of iron per 5 ounces of formula. Therefore babies who are exclusively formula-fed will get plenty of iron.  Babies who are fed both breast milk and formula who get at least 25 ounces of iron fortified formula a day do not require a supplement.  Those infants taking less than 25 mg of formula a day or who are exclusively breastfed should take a supplement.  The easiest one to find is Poly-vi-sol™ with Iron.  This provides 10 mg of iron per 1 ml of supplement.  It also provides the 400 IU of vitamin D these babies need each day. 

Cow’s milk formula should not be started until after 12 months of age as it doesn’t contain iron, so be sure to continue formula feeding up until 12 months of age, or to continue iron supplementation until 1 year of age if you are breast feeding. 

Another way to add iron to an infant’s diet is to feed your baby foods high in iron such as iron fortified baby cereals and leafy green vegetables such as spinach.  As she gets older feed her beans, chickpeas, lentils, eggs and eventually chicken and red meat.   
Premature infants (born before 37 weeks gestational age) should receive iron supplementation from birth.  Much of an infant’s iron stores are accumulated in the last few weeks of pregnancy, so these premature babies need the supplement from day one.
If you have any questions about vitamin D or iron needs for your child, please discuss them with your pediatrician.

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