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Vitamin
D
Vitamin D is a hot topic in medical literature. Besides its crucial
role in maintaining healthy bones, Vitamin D is an immune system
regulator and linked to cardiovascular health as well as prevention
of obesity, asthma and arthritis. Vitamin D is added to all infant
formulas, as well as to infant cereal and cow’s milk.
An alarming number of adults have low levels of Vitamin D. The
breastfeeding mom may herself have Vitamin D insufficiency or
deficiency. Furthermore, a significant number of moms with plenty
of Vitamin D don’t pass enough in their milk to their baby.
Although rickets is not a common condition, doctors are now seeing
plenty of cases in otherwise healthy babies with healthy, well-nourished
moms.
For this reason, I highly recommend a vitamin D supplement given
directly to your breastfed baby starting at week two of life.
The recommended dose is 400 mcg or IU once per day, and this dose
is found in all formulations of infant vitamin D liquid drops.
If you can find the concentrated version, then the one drop of
liquid can be placed on your nipple right before nursing. If you
get the 400 mcg/IUs per milliliter then you’ll have to drop
the one ml in the baby’s mouth directly. I recommend continuing
this for as long as you nurse your baby.
Multivitamins
Vitamins and minerals are better absorbed and digested when obtained
directly from foods. With that said, there are a great many toddlers
that simply refuse to eat their veggies! My advice has always
been to be open about giving a daily multivitamin—but it
is not necessary for kids who are great eaters.
There are many different brands and formulations. As long as your
multivitamin has the right dose of iron, calcium and vitamin D,
it is safe and effective. I am open to the newer combination ones
that have fish oil, probiotics and other supplements, but there
isn’t a great deal of evidence regarding the effectiveness
or exact dosing of some of these supplements.
Probiotics
Probiotics is one of the more exciting aspects of medicine today.
Their role in both prevention and treatment in a host of conditions,
including diarrhea, infections, eczema and autoimmune diseases,
is currently being studied. The problem is that there isn’t
yet enough research to recommend the exact dosage or formulation.
Even among reliable brands, there are very different combinations
of probiotics, as well as varying dosages.
For now, most doctors are encouraged enough by the data to recommend
using a probiotics if your young child is going to be on a lengthy
course of antibiotics, or is suffering from protracted diarrhea.
But in cases of eczema and inflammatory bowel disease, more research
needs to be done.
Although there are many trusted brands out there, I can’t
recommend one over the other definitively until head-to-head double-blinded
placebo-controlled studies have been done. Nonetheless, I would
trust the local health food store to guide you to the most reliable
brand. Start with a low dose, especially if your child is very
young.
Iron
Iron is a crucial element in the developing child. While anemia
itself can cause fatigue and weakness, iron deficiency specifically
is related to cognitive development in the infant and toddler.
The iron levels in breast milk are lower than in formula, but
since the iron from breast milk is much better absorbed, iron
deficiency is not a common issue in the breastfed infant. With
that said, when doctors check babies’ blood at one year
of age, they tend to see a small but significant amount of iron
deficiency.
For this reason, many pediatricians are recommending a low dose
of iron supplementation for the breastfed infant at four to six
months of age. I am still on the fence about this. Giving a “treatment”
dose of iron can have minor side effects such as constipation
and staining of the teeth, but the prevention dose of iron for
most babies is only half of that dose, or 7.5-10 milligrams. This
would mean giving only half of the 15mg/ml dropper of infant over-the-counter
iron drops once a day. One could also give the recommended dose
of vitamin D, as well as a small dose of iron in the one ml of
daily infant multivitamin drops.
If a breastfeeding mom decides not to supplement, she should be
very conscious of giving the baby enough iron rich foods as he
gets older. It is important to remember that a nursing mother
cannot increase the iron levels in her breast milk by increasing
her own iron intake. For those babies who reveal a true iron deficiency
at the one-year screening, we will recommend an iron supplement.
This will be a treatment dose, to be taken for three months daily
with juice or something that has vitamin C, as iron is better
absorbed when given with Vitamin C.
See the following links for more about iron-rich foods:
http://www.umm.edu/blood/aneiron.htm
http://www.bnl.gov/hr/blooddrive/iron-rich.asp
Here is the link to the actual American Academy of Pediatrics
article on iron supplementation in breastfed infants:
http://pediatrics.aappublications.org/cgi/reprint/peds.2010-2576v1
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