A mother — referring to a recent post on The PediaBlog (Taste Buds — To D or Not To D?) — wonders whether her formula-fed baby needs extra vitamin D:
We are formula feeding our 4 week old and are now using Enfamil Gentlease. The newborn variety had extra vitamin D. Should we be doing anything extra since she is not getting that extra vitamin D now?
Joan Avolio, R.D., L.D.N. responds:
I would say yes to supplementing with 400 IU of liquid vitamin D/ day until your baby is taking ~1 liter or ~34 oz. of formula per day on a regular basis.
Joan arrives at this volume of infant formula this way:
- The daily requirement of vitamin D for infants is 400 IU.
- Infant formulas contain approximately 60 IU of vitamin D (Gerber Good Start and Enfamil Gentlease) to 75 IU of vitamin D (Similac Advance) per 5 ounces (150 ml).
- To receive 400 IU of vitamin D, a baby would need to take approximately 34 ounces per day of Enfamil and Gerber, and 27 ounces per day of Similac.
That’s a lot of formula for any baby. Many healthy babies never reach that total daily volume if they are formula-fed and, even if they do, studies show that many newborns start life deficient in vitamin D due to maternal deficiency. (It’s extremely important for expectant mothers to be taking prenatal vitamins daily to avoid such deficiencies.)
Pediatricians have prescribed vitamin D drops to babies who are breastfed for many years. A consensus is emerging to provide all infants with supplemental vitamin D.
For toddlers, children, teenagers, and adults, the recommended intake for vitamin D is higher:
Age Male Female Pregnancy Lactation 0–12 months* 400 IU
(10 mcg)400 IU
(10 mcg)1–13 years 600 IU
(15 mcg)600 IU
(15 mcg)14–18 years 600 IU
(15 mcg)600 IU
(15 mcg)600 IU
(15 mcg)600 IU
(15 mcg)19–50 years 600 IU
(15 mcg)600 IU
(15 mcg)600 IU
(15 mcg)600 IU
(15 mcg)51–70 years 600 IU
(15 mcg)600 IU
(15 mcg)>70 years 800 IU
(20 mcg)800 IU
(20 mcg)* Adequate Intake (AI)
(from NIH — Office of Dietary Supplements)
One cup (8 ounces) of milk (whole, low-fat, or skim) is fortified with 120 IU of vitamin D. This means a person between the ages of 1 and 70 years old would need to drink 5 cups of milk (40 ounces or 1.2 liters) every day in order to avoid vitamin D deficiency.
Vitamin D is also known as the “sunshine vitamin.” Ultraviolet rays in sunlight help synthesize vitamin D in the skin. But the amount of sun our skin actually sees varies day-to-day, depending on the season, the time of day, the use of sunscreen, the amount of clothing worn, and the amount of time spent in the sun (5-30 minutes per day twice a week might provide enough vitamin D synthesis). The skin’s melanin (pigment) content greatly affects vitamin D synthesis in the skin. Fair-skinned people should take all measures to limit sun exposure, while those with dark skin do not synthesize vitamin D very well, regardless of sun exposure. Both groups are therefore at increased risk of deficiency.
It’s no wonder that so many Americans are deficient in vitamin D. As Joan pointed out in her post, there are very few other dietary sources of vitamin D. It seems appropriate to conclude that most of us — especially our children — should be taking a daily supplement of vitamin D.
Read previous PediaBlog post by Joan Avolio here.
Read fact sheet on vitamin D from the National Institutes of Health here.