Vitamin D for Infants and Young Children

Vitamin D is essential for bone health. Vitamin D helps calcium absorption in the gut, and maintains normal levels of calcium and phosphate in blood, keeping bones strong. Also, vitamin D is important for regulating cell growth, neuromuscular and immune function in the body.

Most of the vitamin D is produced in body when our skin is exposed to sunlight. A small amount of vitamin D comes from our diet.

Vitamin D deficiency

In infants and children, persistently low vitamin D levels may cause rickets, resulting in soft bones, deformed bones, bone fractures, poor growth, and a low blood calcium level, which may lead to convulsion.

How much vitamin D do children need?

Healthy infants need 400 IU (10 micrograms) of vitamin D daily. Children above 1 year of age require 400 to 600 IU (10 to 15 micrograms) of vitamin D daily.

Infants (below 12 months) Get enough vitamin D

(Watch related video: https://s.fhs.gov.hk/92nyf)

• Breastmilk has many benefits and is the ideal food for babies. However, like other foods, breastmilk does not contain much vitamin D and is not sufficient to meet the daily requirement of infants.
• Vitamin D is produced when the skin is exposed to sunlight. However, infants are at a higher risk of suffering UV damage. They are recommended to stay in the shades.
• All breastfed infants (exclusively breastfed and those taking both breastmilk and infant formula) are recommended to take a vitamin D supplement of 400 IU (10 micrograms) daily. This can help them maintain a sufficient and stable vitamin D level.

  (Joint Recommendation on Prevention of Vitamin D Deficiency among Infants, Young Children, and Pregnant Women)

• Infant formula is fortified with vitamin D. Infants who are formula-fed exclusively do not need to take supplement.
• Note: Some infants may need vitamin D supplement due to their medical conditions. The amount of vitamin D needed may be different. Parents should follow their doctor's instructions to provide the vitamin D supplement their babies require.

How do I give my baby vitamin D supplement?

• Vitamin D supplement is usually in form of vitamin D drop. The amount of vitamin D per drop may vary among different products.
• Infants only need 400 IU of vitamin D daily. You should not give your baby more than this level unless advised by your doctor.
• Follow the dosage and frequency instructions from your doctor or pharmacists when giving your baby vitamin D supplement. The instructions are shown on the drug label of supplement dispensed.

  An example of the instructions on the drug label :

  
• If choosing one yourself, pay attention to the product label and check the vitamin D content. Choose the vitamin D supplement with a daily dosage of 400 IU (10 micrograms) and give it according to the instructions on the product to avoid overdosing your baby. If you have any questions, please consult a healthcare professional.
• Store the product in an appropriate place and within the range of temperature according to the instructions.
• Excessive intake of vitamin D can cause high calcium level in blood which can affect health. Infants taking vitamin D supplements should avoid taking cod liver oil and other nutrient supplements containing vitamin D.
• You can give the vitamin D supplement in one of the following ways:
  1. Give the supplement directly into your baby's mouth; or
  2. Mix the supplement with a small amount of breastmilk, formula milk, or purée foods (for babies after 6 months of age) in a sterilised spoon and offer the mixture to your baby; or
  3. Put the supplement onto the nipple or surrounding area (areola) of the breast and let your baby suckle for 30 seconds.

  Watch video: How to offer vitamin D supplement to your baby?

When should I open a new bottle of vitamin D supplements?

• Parents should pay attention to the expiry date on the package of the supplement. Change to a new bottle if expiry date has passed.
• Some supplement products can only be used within a specified period after the bottle is opened. Parents should read the instructions on the product package or drug label and change to a new bottle if the specified period has passed.

What should I do if I have forgotten to give my baby vitamin D supplement for a few days?

• Give the dose for today (400 IU of vitamin D) to your baby. Then continue to give it daily.
• Here are some ways to help you remember:
  • Place a reminder near the place you nurse your baby;
  • Use an alarm or a daily reminder in your calendar on your mobile phone.

My 6-month-old baby starts taking solid foods, should I continue offering her the supplement?

• If your baby is still taking breastmilk, she should continue to take vitamin D supplement until 12 months of age.
• Your baby can also get vitamin D by consuming oily fish (such as salmon, halibut) and eggs after 6 months of age.

Young Children and Vitamin D

After 12 months of age, engaging in outdoor physical activities and eating a healthy diet helps children get enough vitamin D and supports healthy bone growth.

Outdoor play and sun exposure

• Young children are active and full of energy. They need to play outdoors and engage in physical activities regularly.
• Exposing the skin to sunlight while playing outdoors helps children maintain adequate vitamin D level.
• Playing outdoors provides more space for a wider range of activities. This supports children's development. Let your child play in parks or playgrounds, e.g. walking, blowing bubbles, running, jumping, throwing and chasing balls, using playground facilities, etc.
• Safety under the sun: Strong sunlight can cause skin burn. Parents and children should pay attention to sun safety tips during outdoor activities, such as using sunscreen. Research shows that using sunscreen does not reduce the vitamin D production in the body¹.

Consume vitamin D-containing foods

• Include foods with vitamin D in your family's diet regularly as part of a balanced diet.
• Choose oily fish, eggs, etc. Consume cow's milk, milk products and calcium-fortified soy milk with vitamin D added. How do I know if the food product is fortified with vitamin D?

After 1 year old, do children need to take vitamin D supplements?

Most of the vitamin D in our body comes from sun exposure on our skin. Children with limited sun exposure or certain conditions such as having dark skin, always wearing clothing covering their arms and legs when being outdoors, staying indoors most of the time, being obese, or having medical conditions (e.g. liver disease, kidney disease), etc. may need a vitamin D supplement of 400 IU per day. Parents are advised to consult healthcare professionals if they have concerns.

(Joint Recommendation on Prevention of Vitamin D Deficiency among Infants, Young Children, and Pregnant Women)

Obtain adequate calcium in diet to support bone growth

• Inadequate calcium intake may increase the risk of rickets.
• Babies under 12 months can meet their calcium requirement by consuming breastmilk or infant formula.
• Children of 1 to 3 years old need 500 mg of calcium every day². They should consume 360 to 480 ml of milk and milk products or calcium-fortified soy milk every day and include a variety of foods in their diet while continuing to be breastfed.