Vitamin D
Vitamin D is a hot topic in medical literature. Besides its crucial role in maintaining healthy bones, Vitamin D is an immune system regulator and linked to cardiovascular health as well as prevention of obesity, asthma and arthritis. Vitamin D is added to all infant formulas, as well as to infant cereal and cow’s milk.
An alarming number of adults have low levels of Vitamin D. The breastfeeding mom may herself have Vitamin D insufficiency or deficiency. Furthermore, a significant number of moms with plenty of Vitamin D don’t pass enough in their milk to their baby. Although rickets is not a common condition, doctors are now seeing plenty of cases in otherwise healthy babies with healthy, well-nourished moms.
For this reason, I highly recommend a vitamin D supplement given directly to your breastfed baby starting at week two of life. The recommended dose is 400 mcg or IU once per day, and this dose is found in all formulations of infant vitamin D liquid drops. If you can find the concentrated version, then the one drop of liquid can be placed on your nipple right before nursing. If you get the 400 mcg/IUs per milliliter then you’ll have to drop the one ml in the baby’s mouth directly. I recommend continuing this for as long as you nurse your baby.
Multivitamins
Vitamins and minerals are better absorbed and digested when obtained directly from foods. With that said, there are a great many toddlers that simply refuse to eat their veggies! My advice has always been to be open about giving a daily multivitamin—but it is not necessary for kids who are great eaters.
There are many different brands and formulations. As long as your multivitamin has the right dose of iron, calcium and vitamin D, it is safe and effective. I am open to the newer combination ones that have fish oil, probiotics and other supplements, but there isn’t a great deal of evidence regarding the effectiveness or exact dosing of some of these supplements.
Probiotics
Probiotics is one of the more exciting aspects of medicine today. Their role in both prevention and treatment in a host of conditions, including diarrhea, infections, eczema and autoimmune diseases, is currently being studied. The problem is that there isn’t yet enough research to recommend the exact dosage or formulation. Even among reliable brands, there are very different combinations of probiotics, as well as varying dosages.
For now, most doctors are encouraged enough by the data to recommend using a probiotics if your young child is going to be on a lengthy course of antibiotics, or is suffering from protracted diarrhea. But in cases of eczema and inflammatory bowel disease, more research needs to be done.
Although there are many trusted brands out there, I can’t recommend one over the other definitively until head-to-head double-blinded placebo-controlled studies have been done. Nonetheless, I would trust the local health food store to guide you to the most reliable brand. Start with a low dose, especially if your child is very young.
Iron
Iron is a crucial element in the developing child. While anemia itself can cause fatigue and weakness, iron deficiency specifically is related to cognitive development in the infant and toddler. The iron levels in breast milk are lower than in formula, but since the iron from breast milk is much better absorbed, iron deficiency is not a common issue in the breastfed infant. With that said, when doctors check babies’ blood at one year of age, they tend to see a small but significant amount of iron deficiency.
For this reason, many pediatricians are recommending a low dose of iron supplementation for the breastfed infant at four to six months of age. I am still on the fence about this. Giving a “treatment” dose of iron can have minor side effects such as constipation and staining of the teeth, but the prevention dose of iron for most babies is only half of that dose, or 7.5-10 milligrams. This would mean giving only half of the 15mg/ml dropper of infant over-the-counter iron drops once a day. One could also give the recommended dose of vitamin D, as well as a small dose of iron in the one ml of daily infant multivitamin drops.
If a breastfeeding mom decides not to supplement, she should be very conscious of giving the baby enough iron rich foods as he gets older. It is important to remember that a nursing mother cannot increase the iron levels in her breast milk by increasing her own iron intake. For those babies who reveal a true iron deficiency at the one-year screening, we will recommend an iron supplement. This will be a treatment dose, to be taken for three months daily with juice or something that has vitamin C, as iron is better absorbed when given with Vitamin C.
See the following links for more about iron-rich foods:
http://www.umm.edu/blood/aneiron.htm
http://www.bnl.gov/hr/blooddrive/iron-rich.asp
Here is the link to the actual American Academy of Pediatrics article on iron supplementation in breastfed infants:
http://pediatrics.aappublications.org/cgi/reprint/peds.2010-2576v1