Which nutrients may need to be supplemented during infancy?

Breast milk is the ideal food for your baby. It's full of nutrition to help them grow, develop, and fight off illnesses. That said, you might be wondering if breast milk contains everything that your child needs and whether or not your breastfed baby should take vitamins.

While most of your child’s nutrients come from your breast milk, there are a few vitamins and minerals that healthy breastfed newborns might not get enough of through breastfeeding alone. Pediatricians typically recommend these vitamin and mineral supplements for breastfed babies. Learn more about supplements for breastfed babies.

Vitamin K

There is only a small amount of vitamin K in breast milk, and all babies have low levels of vitamin K when they're born. Babies need vitamin K to clot the blood and control bleeding. Every child—whether breastfed or not—is given a shot of vitamin K immediately after birth. This injection helps your baby’s blood to clot and prevents a rare but dangerous newborn bleeding disorder.

After the initial newborn dose of vitamin K, a healthy child will not need any additional vitamin K supplements. 

Vitamin D

There is a risk of a vitamin D deficiency in children who are breastfeeding exclusively as well as those who are fed with a combination of breastfeeding and formula feeding. Your child's body needs vitamin D to absorb calcium and build strong bones and teeth. Vitamin D also plays a role in the immune system and might help prevent infections. If a child does not have enough vitamin D, they can develop a condition called rickets.

Rickets can lead to the softening of the bones and problems with a child's bone development. It can also cause slow growth, pain, and bone deformities such as bow legs.

While breast milk does contain vitamin D, the amount of vitamin D in breast milk differs from one person to the next. Our body's main source of vitamin D is the sun. When you expose your skin to sunlight, it makes vitamin D. However, the amount of vitamin D you get from the sun depends on your skin color, the amount of time you spend in the sun, and your use of sunblock.

Your baby can also get vitamin D from the sun. However, putting infants in direct sunlight is not recommend. When they do spend time outdoors, infants and young children should stay covered and wear sunscreen (while necessarily, this protection from the sun prevents the production of vitamin D).

Recommendations for Vitamin D

Babies who are exclusively formula-fed with an infant formula that contains vitamin D (at least 400 IU/L) do not need additional vitamin D supplements.

To prevent vitamin D deficiency and bone problems, the American Academy of Pediatrics (AAP) recommends a supplement for all breastfed babies. Starting on the first day of life, vitamin D is given in liquid drops. The recommended dose is 400 IU a day.

Studies show that people who are nursing and who supplement with 6400 IU/day of vitamin D can safely produce breast milk with enough vitamin D to satisfy their baby's requirement. This is a good alternative for people who do not want to supplement their babies directly.

Iron

Iron is an essential mineral for your baby's growth and development. It’s needed to make the red blood cells that carry oxygen throughout the body. If your child doesn’t get enough iron, it can lead to anemia. Iron deficiency anemia does not always have symptoms, but it can cause pale skin, a fast heartbeat, feeding difficulty, and weakness. Long-term iron deficiency can lead to problems with the development of the body and the brain. 

There is iron in breast milk. While it might only be a small amount, it’s enough for your child because babies absorb the iron in breast milk very well. In fact, they absorb the iron in breast milk better than they absorb the iron in infant formula.

Babies also store iron in their bodies toward the end of pregnancy. Around 6 months of age, a baby's iron stores begin to deplete. However, the timing coincides perfectly with the introduction of foods, during which time iron-rich foods should be the focus. Not all breastfed babies will need iron supplementation once they reach 6 months of age.

Recommendations for Iron

According to the AAP, after four months of exclusive breastfeeding, there is a greater risk of iron deficiency. Between four and six months of age, your baby's pediatrician will recommend an iron supplement.

Iron is given as a liquid in a dose of 1mg/kg/day until your child is getting enough iron through their diet. At 1 year old, your child's doctor will test them for iron deficiency and let you know if you need to continue giving them iron supplements.

Fluoride

Fluoride is an essential mineral that strengthens the enamel on your child’s teeth and helps prevent cavities. Your breast milk contains fluoride, and your child does not need a supplement during the first six months of life. A supplement may or may not be necessary after the age of 6 months, depending on your child's diet and your water supply.

After six months, your child's pediatrician might recommend a fluoride supplement if:

• Your drinking water doesn’t contain enough fluoride. In many places, fluoride is added to the local drinking water supply. If you use the public water supply in your home and it contains fluoride in an amount less than 0.3 parts per million, your child might need a supplement. You can call your water company to get information about the fluoridation of your water.
• You use bottled water. If your child uses bottled water, it might not have enough fluoride. However, check the label on the bottle, as some brands add fluoride to their water.
  You use well water. If you have well water at home, test it for fluoride. Water usually contains some natural fluoride, but it might not be enough to address your child's needs.

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Special Circumstances

The recommendations for vitamin K, vitamin D, iron, and fluoride are for healthy full-term infants. Some babies have conditions that require other vitamin supplements. Your breastfed baby might need additional supplements if:

• They were born prematurely. Preemies have different needs than babies born at full-term. Premature infants don't have the same iron stores as full-term infants, and they might need more vitamins and minerals than breast milk or formula can provide. The types and amounts of supplements that a preemie will need will depend on how early the child was born and their overall health.
• They have special health concerns. Children born with certain health conditions or needs might need iron earlier than others, or they might need other vitamins and minerals. Your child's unique health situation will determine whether (and which) supplements are needed.
• You've had weight loss surgery. If you’ve had a gastric bypass, you can still breastfeed. But make sure that your child's doctor is aware of your surgery. It's likely that you will have to take additional vitamins and supplements after gastric surgery and your child might need them as well. Your health care team will monitor your health and the health of your child to ensure you are both adequately nourished.
• You are vegan. Meat and dairy products are the main sources of vitamin B12. If you follow a vegan diet, your breast milk might not have enough of this essential vitamin. Taking a B12 supplement during pregnancy and lactation might be enough, but your baby might need a supplement if your B12 levels are too low.

A Word From Verywell

Breast milk contains just about everything your baby needs, but you might need to give your child an extra boost of certain essential vitamins and minerals to ensure that they grow well. Vitamin supplements do not cause harm when they are given as directed, but a vitamin or mineral deficiency can present problems. Supplementation is an easy way to make sure each child gets what they need.

Make sure to take your baby to the pediatrician regularly for well-baby visits. These appointments are a great way to stay informed about the recommendations, get your questions answered, and ensure your child is getting everything they need.

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