Does my breastfeeding baby need Vitamin D drops?

I am breastfeeding; does my baby need a Vitamin D supplement?

Many mothers are questioning whether they need to give vitamin D drops to their baby while breastfeeding.  Their first question is usually, whether they can take a supplement and boost their own levels instead. Why don’t mothers want to give vitamin D drops?  Reasons include that they are inconvenient, the baby does not like them or mothers don’t want baby to take something they really doesn’t need.   The truth is that only about 15% of moms follow the recommendations of their pediatricians and often tell them they are giving the drops when they are not.

Let’s look at the latest and break down the facts:

What is the current recommendation on giving vitamin D to babies?

The American Academy of Pediatrics(AAP) recommends that all breastfeeding newborns, whether exclusively or partially on breastmilk, should be supplemented with 400 International Units (IU) of vitamin D daily. The drops should be continued until baby is weaned or is on whole milk after 1 year of age.

Why is Vitamin D important?  

Vitamin D is needed to support healthy bone development and to prevent rickets, a condition that causes weak or deformed bones. Vitamin D deficiency rickets among breastfed babies in the US is rare, but it could occur if an infant did not receive additional vitamin D from foods, a vitamin D supplement, or adequate exposure to sunlight. 

Isn’t there plenty of Vitamin D in Breastmilk?

Most scientist who have tested Vitamin D levels in human breastmilk agree that in most cases it is a very poor source of vitamin D, usually containing less than 50 IU per quart which would notmeet the 400 IU daily recommendation for babies

How does the body get Vitamin D? 

A regular, well-balanced diet should provide all the vitamins necessary for both nursing mothers and their babies. However, pediatricians recommend that mothers continue taking a daily prenatal vitamin supplement to ensure the proper nutritional balance. See How a Healthy Diet Helps You Breastfeed for more information. Along with ingesting Vitamin D, the body makes it form sunlight exposure.  Many factors you may not think about decrease the amount of vitamin D a person can make from sunlight. These include: living at high latitudes (closer to the polar regions), particularly during winter months, high levels of air pollution, dense cloud covering and the use of sunscreen.  Vitamin D levels of many mothers are not within the normal range and some are even deficient.  Adequate sun exposure is also not a recommended option to increase levels due to the risks of developing skin cancer in mothers, and infants should never be exposed to direct sunlight without proper attire or protection.

If I take a supplement and know that my vitamin D blood level is “normal” does that mean my milk will contain enough vitamin D?

NO! The 25(OH)D in your blood is not a good reflection of the amount of vitamin D that is available to pass into breastmilk. They are two different compounds. Since Vitamin D (rather than the active metabolite 25(OH)D) is the form that passes into a mother’s milk, the only sure way to know it is there, is to measure that specific metabolite in the breastmilk every day. This is impractical and expensive. This is why the AAP maintains it recommendation to give vitamin D drops to breastfeeding infants as a supplement.

Is there any new research?

Yes. A recent double-blinded randomized controlled trial was conducted at two medical centers, The Medical University of South Carolina and the University of Rochester in Rochester, NY. The findings, published in October 2015, can be read in detail in the journal Pediatrics (the official journal of the AAP). In this study, one group of women exclusively breastfed and gave vitamin D drops per the AAP recommendation.  In the second group, the women took 6400 IU of vitamin D during pregnancy and breastfeeding and did not give the vitamin D supplement.  The results concluded that all infants in both groups achieved the same blood level of 25(OH)D whether they received vitamin D directly as drops (400 IU per day) or via breastfeeding.  That is great news, right?  There are concerns.  The level of vitamin D supplement given to the mothers in the study exceeds the recommend level of vitamin D currently recommended by the Institute of Medicine which has set the “upper limit” of recommended intake at 4000 IU.  So, what is a safe level of vitamin D for adults to take and should they be monitored? These questions are being considered and at this time, this regimen would be an individual practice by each physician.

So, what are my options?

Educate yourself on vitamin D.  Present the evidence to your baby’s doctor.  Discuss the new research study with your pediatrician and bring a copy of the article to your next visit.  If they are not attentive or will not consider your request, you may need to find an open-minded health care provider who is not totally wedded to what they were taught in medical school or who blindly follows what a given organization such as the AAP recommends. 

More Info on Vitamin D:

Dr. Michael Greger has read the recent literature and condensed it into a set of 4-minute videos for the general public:

Will You Live Longer if You Take Vitamin D Supplements? by Michael Greger, MD

How much vitamin D should you take? by Michael Greger, MD

The Optimal Dose of Vitamin D Based on Natural Levels by Michael Greger, MD