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Does My Baby Need Vitamins?By Kelly Bonyata, IBCLC
Vitamin and mineral supplements are not necessary for the average healthy, full-term breastfed baby during the first year. Breastmilk is all that your baby needs for at least the first six months of life. Studies have shown that vitamins, fluoride, iron, water, juice, formula and solid foods are rarely beneficial to healthy breastfed babies during the first six months, and some can even be harmful. There are certain cases where a vitamin supplement may be needed for a breastfed baby during the first year, but these cases are the exception, not the rule (see below for specifics). The American Academy of Pediatrics (Breastfeeding and the Use of Human Milk) states:
AAP recommendations on specific vitamins are noted below. Some very premature babies (weighing less than 1500 grams/3.3 pounds) may need extra vitamins and minerals, which can be added to their mother's milk before being given to the baby. Following is more specific information on baby's needs for certain vitamins and minerals. [top]
Breastmilk is a natural, excellent source of vitamin A. Promoting breastfeeding is the best way to protect babies from Vitamin A deficiency. Vitamin A deficiency is rare in breastfed babies even in areas of the world where vitamin A deficiency is widespread.
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If mom is getting enough thiamine, then her milk has enough for baby and supplements are not needed. If mom is thiamine-deficient, then adding additional thiamine to mom's diet should increase the amount of thiamine in her milk (since this vitamin is water-soluble) to the necessary levels. Thiamine deficiency (beriberi) is rare in the United States. [top]
Supplements are not recommended for breastfed babies, as riboflavin deficiency is rare in developed countries. The levels of riboflavin in human milk are quite constant and are usually affected only by large maternal supplements (3x the maternal RDA). [top]
If mom gets adequate amounts of vitamin B6, then additional supplements are not necessary for a healthy baby. If mom is not getting enough vitamin B6, then adding additional vitamin B6 to mom's diet will increase the levels in her milk to the required levels. [top]
See Does my baby need vitamin B12 supplements? [top]
Breastfed babies should not be routinely supplemented with vitamin C except in cases of obvious scurvy (vitamin C deficiency). FDA requirements for nursing mothers for this vitamin are 100 mg per day. Supplements of vitamin C for the mother do not alter the amounts in breastmilk, as they remain fairly constant no matter what mother's intake levels (assuming the mother does not have scurvy). How much vitamin C in breastmilk? by Debbie Donovan, IBCLC [top]
Breastfed babies do not need additional calcium over that which they get from breastmilk and (during the second 6 months) complementary foods. According to the American Academy of Pediatrics Policy Statement on Calcium Requirements of Infants, Children, and Adolescents:
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See Does my baby need vitamin D supplements? [top]
No known deficiencies of vitamin E have been described in healthy term infants fed human milk. Vitamin E supplements for mothers and their breastfed babies are not indicated. [top]
Currently there is no conclusive evidence indicating that fluoride supplements in infancy improve a breastfed baby's dental health. Dr. Ruth Lawrence (author of "Breastfeeding: A Guide for the Medical Profession") states:
The American Academy of Pediatrics has released an interim policy statement on fluoride supplementation: "Fluoride Supplementation for Children: Interim Policy Recommendations". Their stance is this:
Many city water systems add fluoride to the water. If you use well water or bottled water, it's unlikely that fluoride has been added to your water, but it may still be there. Fluoride occurs naturally in most water, so you really need to know how much fluoride is in your water before you decide whether to supplement. How do you find out how much fluoride is in your drinking water?
After you know how much fluoride is already in your drinking water, you can look at the AAP recommendations and decide whether fluoride supplementation might be beneficial. More information (both pro & con):Fluoridation and breastmilk from Debbi Donovan, IBCLC Should my 6 month old and my 3 year old take fluoride vitamins? from AskDrSears.com Fluoride in Your Water from AskDrSears.com What is Fluoride and Why You Won't Want to Use It by Carol S. Kopf, BS, MA, from DrJayGordon.com Debunking Fluoride: Cavity Fighter or Toxic Intruder? by Carol S. Kopf, BS, MA, from Mothering Issue 107, July/August 2001 Fluoride Links from DrJayGordon.com Teething and Dental Hygiene from the American Academy of Pediatrics Journal search on Fluoride and Human Milk [top]
Folic acid deficiency has not been reported in breastfed, full-term infants, and supplements are not recommended. [top]
Here's my information page on Is Iron Supplementation Necessary? [top]
Baby's vitamin K stores at birth are very low. Vitamin K is needed for proper blood clotting, and a deficiency of this vitamin causes a syndrome called hemorrhagic disease of the newborn. Increasing mom's vitamin K intake increases the amount of vitamin K in her milk. The review article "Do breastfed infants need supplemental vitamins?" (Greer 2001) recommends:
Additional information:Vitamin K at Birth: To Inject or Not by by Linda Folden Palmer, DC
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Niacin deficiency in breastfed infants in developed countries is extremely rare, and no supplementation is recommended. [top]
Healthy full-term breastfed babies do not need additional zinc past what they get from breastmilk and (after 6-8 months) from complementary foods. Good sources of zinc include meat (especially red meat) and yogurt. Signs of a mild zinc deficiency include: lessened appetite, lowered immune function, limited activity, growth faltering. Low birth weight, small for gestational age and premature infants are at risk for zinc deficiency. [top]
Studies have shown that when a mother is deficient in a certain nutrient, improving the mother's nutrition and/or supplementing her diet (multivitamins, etc.) may be as effective or more effective than giving her baby vitamin supplements. More information
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| Additional information |
Do I need to give my breastfed infant vitamin/mineral supplements? by Kelly Barger, RD, CLE, CDE
FAQ on Vitamin and Fluoride Supplements for the Breastfed Baby from La Leche League.
The Science of Feeding Your Children by Jay Gordon, MD
Supplementation for Breastfed and Bottle-Fed Infants from the American Academy of Pediatrics
Nutrient Information from the the American Society for Nutritional Sciences includes current information on food sources, diet recommendations, deficiencies, toxicity, clinical uses, recent research and references for further information for many micro- and macronutrients.
Nutrition Fact Sheets from Feinberg School of Medicine at Northwestern University
Nutrition Analysis Tool (NAT) from the Food Science and Human Nutrition Department at the University of Illinois
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| References |
American Academy of Pediatrics, Committee on Nutrition. Fluoride supplementation for children: interim policy recommendations. Pediatrics. 1995;95(5):777
American Academy of Pediatrics, Work Group on Breastfeeding. Breastfeeding and the Use of Human Milk. Pediatrics. 1997;100(6):1035
Baker SS, Cochran WJ, Flores CA, Georgieff MK, Jacobson MS, Jaksic T, Krebs NF. American Academy of Pediatrics. Committee on Nutrition. Calcium Requirements of Infants, Children, and Adolescents. Pediatrics 1999 Nov;104(5 Pt 1):1152-7.
Milner JD, Stein DM, McCarter R, Moon RY. Early Infant Multivitamin Supplementation Is Associated With Increased Risk for Food Allergy and Asthma. Pediatrics. 2004 Jul;114(1):27-32.
Greer, FR. Do breastfed infants need supplemental vitamins? Pediatr Clin North Am (United States), Apr 2001, 48(2) p 415-23
In conclusion, in healthy, breastfed infants of well-nourished mothers, there is little risk for vitamin deficiencies and the need for vitamin supplementation is rare. The exceptions to this are a need for vitamin K in the immediate newborn period and vitamin D in breastfed infants with dark skin or inadequate sunlight exposure.
Krebs NF, Westcott J. Zinc and breastfed infants: if and when is there a risk of deficiency? Adv Exp Med Biol. 2002; 503: 69-75.
Krebs NF. Dietary zinc and iron sources, physical growth and cognitive development of breastfed infants. J Nutr 2000 Feb;130(2S Suppl):358S-360S.
Mohrbacher, N. and Stock, J. BREASTFEEDING ANSWER BOOK. Schaumburg, Illinois, USA; LLLI 1997.
Hamosh M, Dewey, Garza C, et al: Nutrition During Lactation. Institute of Medicine, Washington, DC; National Academy Press 1991, pp. 133-140. This book is available free from the HRSA Information Center (look under Nutrition publications).
Butte NF, Lopez-Alarcon MG, Garza C. 
Nutrient
adequacy of exclusive breastfeeding for the term infant during the
first six months of life. Geneva, Switzerland; World Health
Organization 2002, pp. 26-30.
Dietary Reference Intakes (DRI) and Recommended Dietary Allowances (RDA) from the US Department of Agriculture's Food and Nutrition Information Center
Page last modified:
05/19/2006
Written: 09/13/1998