Vitamin D is known as the “Sunshine Vitamin”. Actually vitamin D is actually a hormone manufactured by the body when the skin is exposed to sunlight. Dietary sources also provide some vitamin D; fatty fish, especially salmon, herring, and tuna, provide high amounts of the vitamin if they are eaten two to three times a week. Some other foods, such as cow’s milk, orange juice, and dry cereal, are “fortified” with small amounts of vitamin D.
Vitamin D is important in many ways. Because it promotes calcium absorption in the intestinal tract, it is essential for the health of bones. Infants and children who get too little vitamin D are at risk for developing rickets, a painful bone-softening disease that has recently been reported in some American babies. Vitamin D is also a vital part of the immune system and so may make babies less prone to infection. A deficiency of vitamin D is also associated with the onset of Type-1 diabetes, multiple sclerosis, rheumatoid arthritis, and cancer.
Sunlight, not food additives or supplements, is “the biologically normal and most common way for humans of all ages to develop adequate levels of the hormone ‘vitamin D,’” according to Cynthia Good Mojab, a research associate at La Leche League International. The amount of sunlight exposure needed to prevent vitamin D deficiency depends on such factors as latitude, season, altitude, weather, time of day, air pollution, how much skin is exposed, whether sunscreen is applied (since sunscreen prevents vitamin D production), and skin pigmentation. In general, babies achieve adequate vitamin D levels when exposed to sunlight for 30 minutes per week while wearing only a diaper or for two hours per week while fully clothed without a hat. Infants living in northern latitudes may need more sun exposure than this; infants living closer to the equator may need less. Dark-skinned infants may need more sun exposure than light-skinned infants, although researchers have yet to ascertain this. In any case, the exposure must be direct; sunlight that has passed through window glass, Plexiglas, or almost any other plastic does not allow the body to produce vitamin D, because these materials absorb ultraviolet B radiation.
Pediatricians and dermatologists, however, warn parents to keep their babies out of the sun, particularly during the first six months of life. Because sun exposure in infancy has been associated with an increased risk of skin cancer later in life, the American Academy of Pediatrics (AAP) now recommends that all children, including babies who are exclusively breastfed, consume at least 400 International Units (IUs) of vitamin D per day beginning as soon as possible after birth and continuing through childhood. All infant formulas, like commercially produced cow’s milk, are fortified with vitamin D, and babies fed at least 500 milliliters (17.6 ounces) of formula daily get as much vitamin D as the AAP recommends.
But breast milk contains little vitamin D unless the mother takes the vitamin orally in high doses. For exclusively breastfed babies, vitamin D is available in over-the-counter liquid supplements, to be given by dropper. D-Vi-Sol, made by Enfamil, contains 400 IUs of vitamin D per dose; Tri-Vi-Sol, made by the same company, contains vitamins A and C as well as 400 IUs of vitamin D. Because breastfed babies don’t need supplemental A and C, D-Vi-Sol is generally the better choice between these two. Although the daily dose of each of these preparations is only 1 milliliter, it must be given slowly so that the baby does not gasp, gag, and cough.
Cod liver oil, a supplement much hated by children of generations past, also contains vitamin D as well as vitamin A. The oil is no longer recommended for babies, however, because it can contain mercury and can be toxic at high doses.
There is some controversy about giving oral vitamin D to babies. According to Cynthia Good Mojab, no one has investigated the potential risks, such as aspiration of the liquid, harmful changes in the baby’s gut, or increased susceptibility to infection. Since vitamin D is often given in combination with other vitamins, future studies should include the risks of supplementing with those vitamins, too.
An alternative to liquid vitamin-D supplements are the more concentrated Baby Ddrops, which are made by Carlson Laboratories and available at health-food stores and through online pharmacies. One daily drop, providing 400 IUs of vitamin D, can be placed on the nipple for the baby to take while nursing. The drops are odorless, tasteless, and colorless. They can be ordered on line or at some health food stores.
The AAP recommends that a breastfed baby be given supplemental vitamin D until she is weaned to infant formula or, preferably, until she is at least a year old and is drinking a quart of whole milk per day.
If you want to avoid giving your baby vitamin D supplements, you have a couple of choices. While you’re pregnant, you can get plenty of sunshine and dietary vitamin D. This will ensure that your baby is born with enough vitamin D stores to last two months even if she is never exposed to the sun. Then you can postpone giving supplements at least until your baby is two months old.
After your baby is born, you can also take supplemental vitamin D yourself, in the amount of 4,000 to 6,000 IUs per day. This will increase the amount of D in your milk enough to protect your baby. The recommended form of supplemental vitamin D is cholecalciferol, or vitamin D3.
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