Recommendations for Breastfed Infants

Vitamin D deficiency and severe vitamin D deficiency presenting as rickets and other serious conditions such as cardiomyopathy, hypocalcemic seizures, and fractures still occur among infants and children in Canada.

The Canadian Pediatric Society and Health Canada recommend a vitamin D supplement of 400 IU per day for all infants that are receiving breastmilk, unless they are at higher risk of deficiency.¹  For infants at higher risk of deficiency, a daily supplement of  800 IU is recommended. Generally, the vitamin D content of breastmilk is insufficient.² This supplement should continue until two years of age; when the diet typically includes sufficient amounts of vitamin D from other sources.

Babies are most at risk of vitamin D deficiency if:

• they are breastfed;
• their mothers receive insufficient  vitamin D from diet or supplements;
• they have darker skin pigmentation;
• their skin is often covered with clothing or sunscreen;
• they live in northern communities (north of 55 latitude); or
• they live in low socioeconomic conditions.

Recommendations for Formula Fed Infants

Vitamin D supplementation is not routinely recommended for formula fed infants. However, for babies at risk of vitamin D deficiency, a daily supplement of 400 IU should be considered.³ The amount of vitamin D found in a typical daily amount of infant formula, along with a daily supplement of 400 IU, will likely not exceed the daily tolerable upper intake level of 1000 IU vitamin D for infants 0-6 months, and 1500 IU for infants 6-12 months.⁴ 

Healthcare Provider Tools

• Pediatric Nutrition Guidelines (Birth to 6 Years) for Health Professionals

Programs and Services

• Dietitians of Canada - Unlock Food
• Telephone support for families
• Healthy Babies Healthy Children
• Registered Dietitians in our Community

Patient Handouts

• Vitamin D and Breastfed Babies - English, French, Arabic, Spanish (PDF)
• Vitamin D: How to Give Baby a Vitamin D Drop Everyday - English, Arabic, Spanish (PDF)
• Healthy Eating for New Moms - English, French, Arabic, Spanish (PDF)

Key Documents/Best Practice Guidelines

• Infant Nutrition
• Nutrition for Healthy Term Infants: Recommendations from Birth to Six Months
• Nutrition for Healthy Term Infants: Recommendations from Six to 24 Months
• Dietary Reference Intakes Table: Reference Values for Vitamins
• Preventing Symptomatic Vitamin D Deficiency and Rickets Among Indigenous Infants and Children in Canada