Vitamin D
What is vitamin D and why is it important?
Vitamin D is an essential vitamin, but it is a peculiar vitamin. Normally we say that vitamins are essential in the diet. However, vitamin D can actually be made from the skin, so dietary sources of vitamin D are not totally essential. It depends on the situation.
Lack of vitamin D will cause a condition called rickets.
What is rickets?
Rickets is softening of the bone related to lack of vitamin D. Lack of vitamin D harms the baby's ability to absorb calcium and phosphorus into the blood; both calcium and phosphorus are necessary to form healthy bones. In vitamin D deficiencies, the bones become bowed, the infants are short, and, in uncommon circumstances, there may even be an effect on the rib cage with resulting poor breathing and pneumonia.
What happens when there is too much vitamin D?
When there is too much vitamin D, the body will have high calcium in the blood. High calcium in the blood can cause damage to the brain and kidney, so it can be quite dangerous. That is why we are very cautious about giving too much vitamin D.
If vitamin D is good for bones, shall I add some extra vitamin D to my baby's diet?
If you choose to give your baby vitamin supplements, you should not add more than what is recommended by your doctor or is given on the bottle. Large amounts of vitamin D can be harmful and may reduce the growth of your baby.
Are vitamin (A, D, and C) supplements for my baby necessary during breastfeeding?
I am taking prenatal vitamins, and my baby is receiving fluoride from the water I use to make her apple juice. If your baby is going outdoors regularly and her body is not completely covered, she should be making vitamin D. Half an hour of sunlight exposure on the face and hands in a week, or 10 minutes each week with just a diaper on, is thought to be enough sunlight exposure to make sure your baby does not become deficient in vitamin D. This sun exposure is especially important during the winter months in northern climates. Even if you take vitamin D from your prenatal vitamins, generally not enough gets into your milk unless you are on high doses of vitamin D. However, extremely high doses actually may be harmful to you, so take the dosage that is sensible and recommended by your physician.
My doctor wants me to use the strongest sunblock when we take the outdoors. Will this affect how much vitamin D my baby will make?
It may. The sun screen lotions that are being recommended for babies to protect their skin from the un also block out the sunlight that is responsible for making vitamin D in the skin. If you always use a high SPF sunscreen lotion on your breastfed infant, you may want to consider a vitamin supplement that contains vitamin D. Babies who are formula fed receive enough vitamin D in the formula, and you do not need to worry about whether they are making enough in their skin.
I heard that vitamin D can be dangerous. If I'm giving my 1 year old milk with vitamin D, how do I prevent it from causing problems in my child?
In the United States and Canada, milk is fortified with vitamin D. Vitamin D can be dangerous if given in too large an amount. However, the amount in milk that is fortified with vitamin D should be very safe since these amounts are regulated by the U.S. and Canadian governments.
They say vitamin D is important for bones; how do I know if my baby has received enough vitamin D?
Normally if the baby's face and hands are exposed to sunshine, even for only a short duration (half an hour a week) that should be sufficient to produce enough vitamin D for normal bone development. Otherwise, if your baby is not exposed to sunshine, he should receive 300 to 400 units of vitamin D a day. In the United States and Canada, cow's milk is fortified with vitamin D, and commercially available milk formula is also fortified with vitamin D. Generally speaking, it is not necessary to give the baby extra vitamin D, unless there is no sunshine exposure at all and you are breastfeeding the child.
I heard that babies with dark skin are more likely to develop rickets. Is that true?
Many case reports of rickets have been among dark-skinned babies. Why that is so is not quite clear. In some instances, it is related to mothers who have been breastfeeding for a very long period, with no exposure of the infant to sunshine, and no vitamin D provided in the diet. If dark-skinned babies are exposed to sunshine or if they are taking a formula with vitamin D, they will probably not develop rickets. However, they may need to be exposed to slightly more sunlight than fair-skinned babies in order to make the same amount of vitamin D.
If I take my baby out in the sun, will that produce enough vitamin D?
Yes, the sunshine effect is extremely powerful in producing vitamin D and that is generally efficient. Very little exposure to sunlight is needed to make enough vitamin D, and parents should be sure not to take the baby out for so long that he gets sunburnt.
What about in the winter? Is there enough sun in the winter?
There is some concern that the winter sun may not be very effective in producing vitamin D in big cities. That is because the amount of sun rays hitting the earth is very small in winter. In scientific terms, the sun's angle is small and air pollution in many cities may cut down the effect of the rays. If there is some concern during the winter, in heavily polluted and very northern cities, giving vitamin D drops to breastfed infants may be appropriate. Formula-fed infants should receive a sufficient amount of vitamin D, since all infant formulas are fortified with vitamin D.
If I take my baby near a window, will she get enough vitamin D?
Window panes are different in how they screen out the sun rays. Most window panes screen out the sun rays that are responsible for making vitamin D in the skin. The best kind of sunshine is when the baby is taken outdoors.
I have been breastfeeding my baby for 12 months. My friend told me that she read that breast milk does not have much vitamin D. Can that be a problem?
Yes, indeed, breast milk does not have very much vitamin D. However, the amount of vitamin D in breast milk is affected by the diet of the mother and by how much sunshine the mother has received. So there is a variable amount of vitamin D in breast milk. In general, we feel that it is important for babies to receive sunshine to produce their own vitamin D, and not to depend on the amount of vitamin D in breast milk, since that is low. Ask your health care professional about giving your baby vitamin D supplements.
I understand that there is an argument about how much vitamin D is necessary. Some say that even 400 units might be too much for babies. Is that true?
Yes, there is some concern that even 400 units might be too much and that 200 units or even less might be sufficient. Unfortunately, the very few studies on this subject are not conclusive. Some infants may indeed appear to be overly sensitive to vitamin D but that is a rarity. In rare situations where infants have very high calcium in their blood, vitamin D is omitted from the diet so as not to worsen the blood calcium problem. For the majority of infants, the recommended 300 to 400 units each day is probably fine.
I believe that breast milk is best, so why should I add any more vitamins when I am breastfeeding my baby?
Breast milk is best, and it is probably not necessary to add vitamins if the circumstances are right. One of these circumstances is natural sunshine for the vitamin D system to work well. If the baby receives natural sunshine, this will certainly be the natural way of producing vitamin D.
I live in Calgary, Canada. There is not much sun for long periods during the year. Can that be a problem?
Yes, if you live in a very northern climate with not much sun, vitamin D deficiency can occur. In those circumstances, it is generally advisable to ensure an adequate amount of vitamin D intake during the year, especially for growing infants.
I live in Mexico City and it is very polluted. Should I worry about my baby getting enough vitamin D?
Pollution generally has a very significant effect in reducing the effect of the sun's rays on the earth. Therefore, if you are living in a polluted city, you should take special precaution to ensure that your baby receives the normal amount of vitamin D. Use of vitamin D supplements for breastfed babies may be necessary.
I am breastfeeding my baby. Can I take a lot of vitamin D in my diet so that my baby will get enough vitamin D?
When you are taking a lot of vitamin D in your diet, the baby will get vitamin D through the breast milk. Fortunately, that is generally not toxic to the child. However, you should not take huge amounts of vitamin D since they can be harmful to you.
Some people have told me that if I go to the tanning parlor, the amount of vitamin D in my breast milk will increase. Is that really true?
Vitamin D in breast milk is increased by sunshine exposure or the ultra- violet lights in tanning parlors. However, the amount of vitamin D in breast milk is generally rather low, and it is probably not the natural way of providing all of the vitamin D requirements for the baby. Sunshine exposure to the baby is probably the best way to achieve that.
I use an ointment for my baby's diaper rash which contains vitamins A and D. Can the baby get too much of vitamins A and D from the ointment?
Generally speaking, the infant will not receive too large an amount of vitamin A and D from the ointment, although the skin of infants is generally quite vulnerable to passing of chemicals. If there are very large areas of injury and you are applying this ointment, there could, in theory, be some problems. Even though that has not been reported, we would not advise putting large amounts of vitamin A and D ointment on large areas of raw skin.
Is vitamin D deficiency still a problem? I thought this was an old disease.
Yes, it is still a problem because in places where there is little exposure to sunshine, babies can be deprived of vitamin D and develop rickets. Also, it occurs worldwide on a very large basis in countries in the Middle East, and in India and China.
I thought that places like the Middle East and India should have plenty of sunshine. How would infants there develop rickets?
The problem is that even though there is lots of sunshine, babies may be protected from the sun by cultural habits. For example, among the Bedouin Arabs, there is a tendency to clothe babies entirely and allow very little sunshine exposure. So the infants are sunshine deprived and can develop rickets.
Is that what happens in Africa also?
Yes, in some parts of Africa, such as in Ethiopia, there is a concern among mothers that the sun is the "evil eye," and that infants should not be exposed to the sun. Hence, the infants become deficient in vitamin D.
What about in China?
We don't know exactly what the cause of rickets is in China. There does seem to be a big difference in the north versus the south, and we assume that since in the north there is less sunshine exposure, that could be a big problem. In many countries, such as in China, dairy products are not normally fortified with vitamin D, so that if infants are not exposed to sunshine, there is no protection for the child. In the United States, most dairy products have vitamin D fortification. For instance, cow's milk is highly fortified with vitamin D, up to 400 units per liter. This is not a common practice in other countries.
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