It has been common for pediatricians to tell mothers that “since they were breastfeeding” their baby would need to take a vitamin supplement . . . since formula is “fortified” with vitamins. In reality, breast milk has the perfect balance of vitamins and minerals, the amounts it has are incredibly bioavailable for baby, and taking supplements actually inhibits the absorption of nutrients in breast milk!
After the first six months of life, the two nutrients that there is evidence of babies needing more of are iron and zinc. Therefore, as complementary foods are introduced alongside continued breastfeeding, make sure to include foods rich in these minerals (meat is an excellent source of both; perhaps one of the reasons it is considered an ideal early food to introduce around the world).
Below is a list of the most common vitamins that can be of concern for babies, with the current recommendations for supplementation. Please note that when there is a deficiency, it is preferable to improve maternal diet or give mothers supplements rather than beginning solids at a younger age for babies.
Vitamin D is important for your bones and overall health and is the only Vitamin that is usually not available in adequate levels solely from breast milk or other foods; babies (kids and adults too!) need contact with direct sunshine in order for our bodies to synthesize this Vitamin. It is naturally found in very few foods; Cod Liver Oil is one source as are some fortified milks and cereals, but the sunshine is the best source. Vitamin D is a fat soluble vitamin and its absorption from the sun is inhibited by clothes, sunscreen, distance from the equator, time of day, season, and skin pigmentation.
Most mothers are deficient, which is why a Vitamin D supplement beginning in the first few days of life is recommended in many countries for breastfed babies. Recent research has shown that high-dose maternal supplementation can increase levels in breast milk. 1 Make sure to discuss your specific situation with your doctor.
Vegan mothers need to be particularly aware of the fact that deficiencies in Vitamin B12 are common in breastfed babies of vegan mothers; they are also common in mothers who have undergone bariatric surgery. Food sources of Vitamin B12 are found in animal products such as milk and beef, organ meats, sardines, trout, eggs, cheese, etc. It can also be found in fortified cereals and nutritional yeast. It is strongly recommended that babies who are at risk for Vitamin B12 deficiency be supplemented, beginning at birth.
A healthy, term baby who is exclusively breastfed has sufficient iron stores for the first 6-9 months of life. Delayed cord clamping will increase a baby’s iron stores. Though iron levels are low in breast milk, its absorption rate is quite high compared to formula. The best ways to maintain adequate iron stores for the first six months of life are to exclusively breastfeed and to avoid cow’s milk 2 When a baby begins solids, it is important to offer iron-rich foods, including meat, poultry, fish, and/or organ meats. Serving iron-rich foods alongside dairy or whole grains will inhibit the absorption of iron; serving foods high in Vitamin C will enhance iron’s absorption.
Since a baby receives 80% of his iron stores during the third trimester of pregnancy, preterm babies are at risk for iron deficiency. Preterm breastfed babies may need to take an iron supplement beginning at one month through the rest of the first year of life. 3
The Bottom Line
Most babies and young children receive adequate vitamins and minerals from breast milk, and then complementary foods alongside breast milk, with the exception of Vitamin D. If your baby is not regularly exposed to direct sunshine (without sunscreen, hats, gloves, etc.) then a Vitamin D supplement will most likely be necessary. Iron supplements are usually only necessary for preterm babies. Vitamin B12 supplements are usually necessary for babies of vegan mothers or mothers who have had bariatric surgery.
- Saadi, H.F., et al. (2009). Effect of combined maternal and infant vitamin D supplementation on vitamin D status of exclusively breastfed infants. Maternal and Child Nutrition, 5, 25-32. ↩
- Rao, R. & Georgieff, M.K. (2007). Iron in fetal and neonatal nutrition. Seminars in Fetal and Neonatal Medicine, 12(1), 54-63. ↩
- Dee, D.L., et al. (2008). Sources of supplemental iron among breastfed infants during the first year of life. Pediatrics, 122, S98-S104. ↩