Vitamin D is an essential nutrient. It helps the body use calcium and phosphorous to build and maintain strong bones and teeth (IOM, 2011). Although sunlight stimulates the formation of vitamin D in the skin, current practice advises that infants and young children avoid direct sunlight due to the risk of skin cancer (Health Canada, 2012). A daily vitamin D supplement is recommended from birth for all breastfed infants. This is an effective preventative measure against vitamin D-deficiency rickets (Lerch & Meissner, 2007).
For advice about vitamin D for infants and young children who are not breastfed or receiving breastmilk see In Practice: Talking with families about nutrition for older infants and young children.
Six to 12 months of age
Limited data are available on supplementation practices between six and 12 months of age. Nationally, available data suggests that 79.6% of infants are given a vitamin D supplement when they are breastfed or receiving breastmilk (Statistics Canada, 2013). Of these infants, 88.2% were given the supplement "every day" or "almost every day" (Statistics Canada, 2013). It is important to keep recommending a vitamin D supplement of 10 ?g (400 IU) for older infants while they are breastfed or receiving breastmilk.
12 to 24 months of age
Young children who are breastfed or receiving breastmilk should continue to receive a daily vitamin D supplement of 10 ?g (400 IU). Advising the continuation of this supplement is a conservative approach to achieving adequate vitamin D intakes. It also provides a consistent and straight forward public health message. In individual practice, the decision to discontinue the supplement beyond 12 months of age can be informed by a dietary assessment of other contributors of vitamin D, such as cow milk.
There is no national survey data, but smaller studies suggest that young children may be at increased risk of vitamin D deficiency if they are breastfed without vitamin D supplementation or with only occasional supplementation (Gesser, Plotnik & Muth, 2003; Gordon et al., 2008). Continuing the supplement while a young child is breastfed or receiving breastmilk will minimize that risk.
Excessive intake is not a concern for children who continue to receive a vitamin D supplement, regardless of the child's intake of cow milk and other food sources. Total intake is unlikely to approach the Tolerable Upper Intake Level of 2500 IU per day.
After two years of age, a vitamin D supplement is no longer recommended. It is recommended that children's eating patterns follow Canada's Food Guide.
References
Gessner, B.D., Plotnik, J., & Muth, P.T. (2003). 25-hydroxyvitamin D levels among healthy children in Alaska. J Pediatr. 143:434-7.
Gordon, C.M., Feldman, H.A., Sinclair, L., Williams, A.L., Kleinman, P.K., Perez-Rossello, J., & Cox, J.E. (2008). Prevalence of vitamin D deficiency among healthy infants and toddlers. Arch Pediatr Adolesc Med. 162:505-12.
Health Canada. (2012). Sun safety tips for parents.
Institute of Medicine. (2011). Dietary reference intakes for calcium and vitamin D. Washington DC: The National Academies Press.
Lerch, C., & Meissner, T. (2007). Interventions for the prevention of nutritional rickets in term born children. Cochrane Database of Systematic Reviews. Issue 4, Article No.: CD006164.
Statistics Canada. (2013). Canadian community health survey - Annual component: 24-month shared file, 2011-2012. Maternal experiences - Breastfeeding. Unpublished raw data
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