The following is a student blog post by a Cynthis Sears
Vitamin D and the Breastfed Baby
Vitamin D is essential for the proper absorption of calcium, bone growth and bone remodeling, controls cell growth, neuromuscular function, immune function, and also acts as an agent that reduces inflammation (NIH, Vitamin D Factsheet). While Vitamin D is present in some foods, added to others, and available as a nutritional supplement, it also exists as a steroid hormone produced by the human body in response direct exposure of the skin to the ultraviolet B (UVB) radiation in sunlight. The AAP and the Canadian Paediatric Society recommend supplementation of vitamin D for all infants, as a preventative measure. Severe pediatric deficiency of vitamin D may result in seizures related to suboptimal calcium levels, growth failure, lethargy, irritability, and a predisposition to respiratory infections during infancy, and long term suboptimal vitamin D levels in developing children can cause Rickets, a disease that causes bones to soften and twist or bend, sometimes to such a degree that affected children cannot walk (Balasubramanian, 1). The American Academy of Pediatrics (AAP) recommends all children, including infants, get 400 international units (IU) of vitamin D/day.
The risk for suboptimal vitamin D levels for the infant overlaps with risks for the mother, as is often the case in many other aspects of maternal and child health. When breastfeeding exclusively, a mother’s pre-existing deficiency in vitamin can result in lower levels of vitamin D in the breastmilk that she produces. If baby gets enough sunlight, mom’s deficiency is unlikely to be a problem for baby. However, if baby is not producing enough vitamin D from sunlight exposure, breastmilk will need to meet a larger percentage of baby’s vitamin D needs. When mom has minimal exposure to sunlight and is not consuming enough foods or supplements containing vitamin D, then she may be vitamin D deficient.
Exposure to natural sunlight allows the human body to make its own vitamin D, and this is the best way to ensure that both you and your baby produce adequate vitamin D, but the amount of the vitamin produced is dependent on a variety of factors. Per Cynthia Good Mojab, MS, IBCLC, RLC, “The amount of sunlight exposure needed to prevent vitamin D deficiency depends on such factors as skin pigmentation, latitude, degree of skin exposure, season, time of day, amount of pollution, degree of use of sunscreen, altitude, weather, the vitamin D status of the lactating mother, and the current status of vitamin D stores in the infant’s body. Recommendations do and should, therefore, vary around the world, taking into account local conditions and practices.” For Caucasian infants under 6 months of age who are exclusively breastfed, 30 minutes per week in diaper only or 2 hours per week full clothed has been shown to be sufficient, but there is currently no evidence-based standard that serves as a recommended amount of sunlight exposure for more darkly pigmented infants.
The decision to give vitamin D supplements to an infant can and should be made in conjunction with the advice of a qualified healthcare practitioner. The Vitamin D Council advises mothers that they can choose to either supplement their infant, or take a high-dose supplement of vitamin D, themselves, when exclusively breastfeeding. Maternal supplementation of 6,000 IU of vitamin D per day would prevent the need for infant supplementation – the breastmilk would have enough vitamin D for baby. If mom isn’t taking a supplement or getting a good amount of sun exposure, or if she’s taking less than 5,000 IU/day of vitamin D, baby might need a vitamin D supplement. Before embarking on high dose maternal vitamin D supplementation, it is advisable that mothers consider getting a 25(OH) D blood test to provide a baseline indicator of vitamin D status.
Dietary sources of vitamin D include fatty fish, fish liver oils, in varying levels in various types of mushrooms, and small amounts of vitamin D are found in beef liver, egg yolks, and cheese. Orange juice and milk are also often fortified with vitamin D (NIH, Vitamin D Factsheet).
Bio: Cynthia Sears, MS, CHES, has a Master’s degree in Health Education and is a Certified Health Education Specialist. She is also the mother to two exclusively, full-term breastfed boys, a breastfeeding advocate, and is currently in the process of obtaining her doctoral degree in Health Behavior from the University of Florida. She is passionate about Maternal and Child Health, reducing health disparities, and increasing mother’s access to accurate information that can help each mother achieve her individual breastfeeding goals.
American Academy of Pediatrics (AAP). Vitamin D Supplementation for Infants. (2010). Web. Accessed
Balasubramanian, S. “Vitamin D Deficiency in Breastfed Infants & the Need for Routine Vitamin D
Supplementation.” The Indian Journal of Medical Research 133.3 (2011): 250–252. Print.
Good-Mojab, C. Frequently Asked Questions about Vitamin D, Sunlight, and Breastfeeding.
(2002). Web. Accessed May 28, 2015.
NIH. Vitamin D – Fact Sheet for Health Professionals. (2014). Web. Accessed May 28, 2015.
Vitamin D Council. Vitamin D during pregnancy and breastfeeding. (2013). Web. Accessed May
28, 2015. http://www.vitamindcouncil.org/further-topics/vitamin-d-during-pregnancy-and-breastfeeding/