Although breast milk contains a rich mélange of nutrients, such as fatty acids and antibodies, the American Academy of Pediatrics (AAP) reports that it is missing adequate amounts of vitamin D and recommends that mothers supplement their breast-fed infants' diet with 200 international units (IU) of vitamin D daily.
Vitamin D is essential for babies because it encourages intestinal cells to absorb more calcium, which helps bone growth and development. Infants receive vitamin D in two ways: from sunlight and from fortified formula or milk. However, fear of skin cancer is keeping them heavily protected from sunlight, which leaves just one reliable source. This means breast-fed babies may be missing out, because when it comes to vitamin D, formula—which has been supplemented—is better than breast milk. (Two cups of formula contain at least 10 times more vitamin D than breast milk does, according to Ruth Lawrence, M.D., of the AAP's Committee on Breast-Feeding.)
So, should mothers abandon breast-feeding in order to fulfill the need for vitamin D?
Breast-feeding advocates insist that human milk is better than formula—and for good reason. Breast milk's ingredients have been shown to stimulate brain development and help protect children against infections, digestion problems, asthma, and other diseases. "Breast milk is a perfect food," says Amy Spangler, former president of the International Lactation Consultants Association. "However, it was never intended to be the primary source of vitamin D."
The AAP agrees, which is why it continues to encourage women to breast-feed but to be mindful about also providing their babies with adequate vitamin D. "The good news is that more babies are being breast-fed," says Nancy Krebs, M.D., chair of the AAP's Committee on Nutrition, "but we should be mindful of the special nutritional issues for breast-fed infants."
All breast-fed babies need to begin taking the recommended 200 IU of vitamin D by the time they're two months old, when their inborn reserve usually runs out, says Lawrence. Mothers should use multivitamin drops containing vitamin D, which can be found at any local pharmacy. They can stop once the child has graduated to drinking at least two cups (16 ounces) of fortified milk a day. However, the supplements should be continued if the child becomes lactose intolerant. And don't worry about vitamin D supplements having any side effects. Lawrence says infants have used them for decades without any evidence of harm.