Curriculum · Pediatric / Nutrition & Growth / EPI / Routine Child Examination
Vitamin D supplementation in breastfed infants
What it is
The American Academy of Pediatrics recommends a daily intake of 400 IU of vitamin D in infants, children, and adolescents. Breastfeeding does not provide adequate levels of vitamin D: vitamin D is consistently low in breast milk and cannot be stored in sufficient amounts, which makes deficiency more likely from birth unless it is supplemented. Iron behaves differently, because newborns typically have sufficient iron stores from birth, acquired during the third trimester, that last until about 4-6 months.
Causes and risk
Rickets secondary to vitamin D deficiency is attributed to insufficient synthesis due to low UV radiation exposure, for example northern climates and dark skin, insufficient oral intake, for example in infants who are exclusively breastfed, malabsorption, and defective vitamin D metabolism. Nutritional rickets is caused by vitamin D, calcium, or phosphate deficiency due to poor intake or lack of sun exposure. Two dependent forms are also listed: vitamin D-dependent rickets type 1, from 1a-hydroxylase enzyme deficiency, autosomal recessive, with impaired conversion of 25(OH)D to the active form, and vitamin D-dependent rickets type 2, from end-organ resistance with a mutation in the vitamin D receptor.