Your Newborn Needs Vitamin D | Pediatrician Shares Everything You Need to Know

Full disclosure, as a first-time mom, despite going through medical school and being a board-certified OB-GYN, I did not realize that newborn babies need vitamin supplementation. Yeah, and if that's you too, you're not alone. There's so many little things to think about when raising your little one, and it's pretty easy to miss some things along the way, which is why we are going to dive into the recommendations for vitamin supplementation in advance of this episode. And also some special data about how you can get your baby more vitamin D without ever having to give them a supplement. Yeah, if this is your first time meeting us, I'm Kurt. I'm a board-certified pediatrician and now a dad of three. I'm Sarah. I'm a board-certified OB-GYN and mom for those same three, and we are The Doctors Bjorkman. Welcome back. There is so much to know about taking care of tiny newborn babies, and vitamin supplementation was not on my radar when we had our first. I had just barely mastered taking my own prenatal vitamin every day, and then Kurt said that hey, there's actually some recommendations from the American Academy of Pediatrics about vitamin supplementation for little babies too. Yes, and most importantly of all this, the American Academy of Pediatrics, the AAP, recommends that all infants get vitamin D supplementation for at least the first four months. We get lots of questions about other supplements too. What about iron, zinc, or other things? So let's jump into the data on this. And don't forget to stick around to the end for our in real life portion about how we are doing this for our breastfed baby number three. So first off, let's talk about vitamin D. Vitamin D is really important. It is a hormone that's involved with calcium absorption. Think about bone formation, bone mineralization, and also immune function. And in its most severe form, vitamin D deficiency appears as something called a rickets, which is a condition with bony abnormalities that includes having bowed legs, splayed wrists, and also associated muscle weakness. In the past 30 years, both high and low resource countries have experienced a resurgence in rickets associated with dark skin pigmentation, living further from the equator with winter seasons, practices of body covering, and exclusive breastfeeding. Yeah, and you might be surprised to hear this, but breast milk often has pretty low levels of vitamin D. Say, for instance, a mom is actually getting the normal recommended amount of vitamin D herself, so she's getting 400 IUs a day. Breast milk itself is only going to have 80 IUs in a whole liter. But with this, if baby's just eating breast milk, they're going to not meet their daily recommended amount of vitamin D. And so with this, vitamin D supplementation is recommended for all infants who are breastfed, and also recommended for babies who are formula fed until four months of age. But, so why is it recommended? I thought that vitamin D was in infant formula. Yeah, absolutely. There is vitamin D in infant formula, but babies usually aren't eating enough volume each day to get the adequate amount of vitamin D until they're about four months of age. Turns out most infants need about 27 ounces of that standard formula to get their recommended daily amount of vitamin D from standard formulas. Got it. So how much vitamin D do infants need, and how do you give it? Yeah, so there's been multiple randomized controlled trials about supplementation for exclusively breastfed infants. But what these studies have shown that babies who are breastfed should really get vitamin D for the first year of life, beginning shortly after birth. And that dose ideally is somewhere 400 to 800 IUs a day. And then the form of vitamin D here is also important. It should be cholecalciferol or vitamin D3 because that's actually what helps with superior absorption, helping it actually get into the gut so that they can use it. And again, formula fed kiddos also still need vitamin D supplementation for the first four months of life until they're getting a little more than 26 ounces of formula every 24 hours. So how do you actually give vitamin D to these little babies? They're clearly not swallowing pills. No, they are not. But the nice thing is that the most common way is to give concentrated drops. One drop of ultraconcentrated vitamin D is all the baby needs for a day. So you can put a drop in a bottle, you can put a drop on a pacifier, you can put a drop on mom's nipple if she's direct breastfeeding. Yep, so this direct option is nice, but the challenge here is that you have to remember to give it to baby every day. Yeah, and so then the question is like, hey, is there any way to do this? Sarah, what is your favorite way to get baby vitamin D that they need? Yes, so there have also been randomized control trials that look at the breastfeeding mom taking an increased dose of vitamin D herself and that goes into the breast milk and has been shown to be adequate as well. Yes, which is really cool to say, hey, if mom actually gets higher doses of vitamin D herself, that's gonna go into that breast milk and get the baby what they need. And so then the question comes, how much does mom need for this? Yes, so there again have been multiple different randomized control trials that have looked at different doses of vitamin D supplementation. One of the studies kind of looked at 2,400 IUs versus 6,400 IUs daily and the 2,400 IUs was not enough, but 6,400 IUs daily for mom was enough to get adequate levels of vitamin D for baby. And they've even looked at even higher doses of daily or monthly vitamin D for breastfed babies and no vitamin D toxicity was observed at these higher levels of daily or monthly vitamin D. For mom or baby. So again, if you missed it, the amount for mom is 6,400 IUs, so 6,400 IUs per day per mom, make sure that there's enough then vitamin D in the breast milk for that breastfed baby. Okay, that's vitamin D, but what about other vitamins for infants? Yeah, so as it turns out the AAP recommends that as long as baby is healthy, mom is healthy, and there's no other medical conditions, there's really no benefit of extra vitamin supplementation as long as the child has a well-balanced diet. This is true for toddlers or infants who are feeding breast milk or formula. Indeed. So maybe there's a benefit for some vitamins for some picky toddlers and we'll talk about some other things here. But really nothing else. Yeah, well almost nothing else. Now there are some special instances where things like iron supplementation can be helpful. So things that comes to mind here for iron would be being born preterm, being born gross-restricted, or if mom actually has low blood counts and is anemic herself. Iron is incredibly important. It helps with brain development, brain maturation, and also helps us make those red blood cells that carry oxygen to our tissues. So iron is incredibly important. The cool thing about iron for babies is that babies actually get this big dose of iron from the placenta at the time of birth, which is cool. And those stores actually stick around until four to six months of age. And usually around that age is also when they're starting to eat things that contain iron. So, you know, especially like iron fortified cereals are common, but other foods as well. And so that window where baby's going to have an opportunity to be deficient in iron is pretty low. For exclusively breastfed infants, you could consider iron supplementation starting around four months of age until they're getting a significant amount from their diet. The other thing we talked about the special populations, maybe in preterm infants or those who are growth-restricted or mom has anemia, think about iron supplementation as well. Yeah, if you are worried about iron, it is good to know that it is standard to screen all infants for anemia or low blood counts at 12 months of age. So there should be an extra safety check for your infant as long as you're keeping up with those routine well-child checks with your pediatrician. Yeah. And I should also just mention that there may be times where your pediatrician may recommend a multivitamin like polyvisol or even polyvisol with iron. These are very reasonable, but I do want to note that there are such things as overdosing vitamins. Vitamins A, D, E and K are actually fat soluble, which means they are stored in the fat and can hang around for a long time. So if you are regularly getting a lot, a lot more of these vitamins than your baby or child needs, they can actually end up with vitamin toxicity in some cases. Yeah, absolutely. Now these vitamin toxicities are relatively rare, but not unheard of. So at the end of the day, talk to your pediatrician about if your baby has any special vitamin needs or anything other than the standard vitamin D, which is again for all infants for the first four months of life and those who are exclusively breastfed for the first year of life. So, um, this is in real life and in real life when you shoot at home in the middle of the night, sometimes you have a toddler that joins you. Yeah. Cecilia wanted to be in this episode with us. So, but vitamin D, what are we doing for us? So with baby number one, when Cease was a little baby, I was like in the routine of taking a prenatal vitamin and I could remember that and I would remember that. Which you should continue on breastfeeding. Yeah. Yeah. And so the thought of having to add something was going to be tricky. The drops, can you show them those drops? Hold it up. Hold those little drops up. That is an option to give those little drops. Which is honestly pretty easy. It's easy. Put it on your finger, put it in on their mouth, put it on a pacifier, put it on your nipple, whatever. It's not hard. It's just something you have to do every day. But I was like, I can remember my prenatal and I'm gonna take this extra vitamin D. So I take 6,400 IUs of vitamin D every day and it was just very easy. Yeah, pretty easy. The other piece that comes up, you know, we mentioned that the AAP says, hey, if your kid is having a well-balanced diet, you really don't need any supplementation of vitamins above the recommended daily allowance each day. What does that mean for us? Well, we've got two wonderful toddlers who love lots of food, but maybe not the perfectly well-balanced diet. So they get a pretty standard multivitamin once a day. Yeah, do you take a vitamin every day? Do you have a gummy? Do you take a gummy? Yeah. Do you like it? It's pretty tasty. Yeah. And so with that just, you know, kind of getting a little bit closer to the recommended daily allowances. Again, be careful not to overdose. There's no benefit of overdosing any particular vitamin. There's no biohacks here. So really well-balanced diet should be perfect if your toddlers may be a little picky or you know, most toddlers are. Yeah, you can think about it, but nothing special needed there. Yeah, for Hank, I'm just trying to remember to take my prenatal and take some vitamin D or give him a vitamin D drop or something because it's the third kid. All right, so hopefully that was helpful. The big takeaways are your sweet little baby needs vitamin D supplementation. Yeah, that's 400 I use for them directly a day or 6,400 I use a day for mom taking yourself. Yeah, it's gonna get to the breast milk and get to baby. Hopefully you guys are subscribed. And if you have any questions, tips, please leave them in the comments below and we'll see you next week. Subscribe to our channel. We're doctors, but not your doctors. Anything we've said in this video is for education or entertainment purposes only. It is not medical advice. Any specific medical questions you have should be directed to your provider.