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Information on the latest vitamin D news and research.

Find out more information on deficiency, supplementation, sun exposure, and how vitamin D relates to your health.

Vitamin D status of exclusively breastfed infants

Dr Clare Wall and colleagues of the University of Auckland recently reported in an interesting paper the vitamin D levels of exclusively breastfed infants in New Zealand.

Wall CR, Grant CC, Jones I. Vitamin D status of exclusively breastfed infants aged 2-3 months. Arch Dis Child. 2013 Jan 8.

They studied 94 infants, mostly of European ancestry, whose average age was 10 weeks. They reported the following:

  • The average vitamin D levels of the 94 infants were 21 ng/ml.
  • In all, 24% of infants had serum 25(OH)D concentration <11 ng/ml, levels associated with rickets.
  • Infants enrolled during winter had a median level of 8 ng/ml while infants tested in the summer had a median concentration of 30 ng/ml. The highest level was 40 ng/ml.
  • Because of ozone depletion in the southern hemisphere, New Zealand’s peak summer ultra violet index values are 40% greater than at corresponding northern hemisphere latitudes.

The authors concluded,

“The infants in this study were predominantly European and considered low risk; however, they still demonstrated low 25(OH)D levels particularly during the winter months. The clinical significance of the low levels particularly in the winter months is not yet understood but there is much evidence to support the importance of vitamin D sufficiency for health.

Furthermore, they recommended,

“Sunlight exposure is the most effective way to improve vitamin D status but is not practical or safe for young infants. Also the enormous seasonal variability in ultraviolet B irradiation and the diversity of skin pigmentation in New Zealand’s population make recommendations around sun exposure and vitamin D very difficult to apply to the individual. Vitamin D supplementation of exclusively breastfed infants should be considered as part of New Zealand’s child health policy.”

I agree with this advice, at least for very young infants whose mothers are not sufficient in vitamin D. As we have blogged on before, mothers who supplement with vitamin D at 5000 IU/day or more can give their child enough vitamin D in their breast milk.

For the 99% of mothers who don’t take that much vitamin D, supplementing their babies is most practical. Since babies’ skin may be more delicate than older children, I think it’s best to be fairly sensible in giving your infant sun exposure, limiting it to ten minutes per day of full body sun exposure when your shadow is shorter than you are. While infants should still receive some sun exposure, just remember they may burn faster than adults, especially while they are vitamin D deficient. I believe that historically, infants were hidden away by paleolithic mothers, and got most of their vitamin D from breast milk and not sun exposure.

  About: John Cannell, MD

Dr. John Cannell is founder of the Vitamin D Council. He has written many peer-reviewed papers on vitamin D and speaks frequently across the United States on the subject. Dr. Cannell holds an M.D. and has served the medical field as a general practitioner, emergency physician, and psychiatrist.

8 Responses to Vitamin D status of exclusively breastfed infants

  1. amecrepes says:

    How much do you recommend supplementing infants with Vitamin D3? Any more than the recommended 400 IU, especially during the winter months? Thank you.

  2. Brant Cebulla says:

    @amecrepes, the Vitamin D Council recommends 1000 IU/day per 25lbs of body weight, rounding up.

    So if a baby weighs 15lbs, the recommendation is 1000 IU/day.

  3. Mark Haymond says:


    I am a long time reader of Dr Cannell and the Vitamin D Council newsletter. 1000 IU/day per 25 lbs of body weight, equals 40 IU per pound per day. So if a baby weighs 15 lbs, the recommendation is 600 IU/day.

    Your calculation equates to 66.6 IU per pound per day. This is closer to what Dr Cannell would recommend for a child with Autism.

  4. p2j2@shaw.ca says:

    Dr. Cannell writes that it is sensible to limit your infant’s full body sun exposure to ten minutes per day when your shadow is shorter than you are. The question is, would this exposure time result in vit D sufficiency for the exclusively breastfed infant whose mum is insufficient, or would the infant still need to be supplemented? Is this suggested time exposure derived from knowledge about vit D manufacture rates in the skin and first principles or is there also supporting research? Pam.

  5. Brant Cebulla says:

    Thanks for the comment Mark. Dr Cannell has stated it both ways, getting detailed, like the example you laid out, and being general and rounding up. Here is an example of the latter: http://blog.vitamindcouncil.org/2012/06/05/influencing-change-one-at-a-time/

    The Vitamin D Council’s health professional’s position statement does not specify whether to round up or to further tailor the recommendation to 40 IU/day per lb. While tailoring the recommendation (ie 600 IU for a 15lb baby) will still well-ensure sufficiency, the greatest goal is to keep it simple for family and parents, as that best ensures they’ll supplement their family if recommendations are simple.

    Tailoring can get really complicated and turn a parent off. If they have a 35lb child, for example, they need 1400 IU/day. As ridiculous as it sounds, a 1400 IU/day recommendation begins to stress a parent out. They start to ask, “Where can I find a 1400 IU supplement?” Then they wonder why it’s not on the market. Then they wonder if 1400 IU is really the right amount if Nature Made doesn’t make it. If you say, “Just round up to 2,000 IU,” it’s much simpler and the parent can follow the lead much easier and feel more comfortable about supplementing.

    I think as vitamin D enthusiasts, we all have the tendency to really complicate recommendations and get detailed, when the opposite approach is more effective. Patients and the public will always follow through the simplest path/advice/approach.



  6. Brant Cebulla says:

    @Pam, great questions.

    “Would this exposure time result in vit D sufficiency for the exclusively breastfed infant whose mum is insufficient, or would the infant still need to be supplemented?”

    I don’t believe this has ever been studied, so it’s hard to comment. Anyone know?

    “Is this suggested time exposure derived from knowledge about vit D manufacture rates in the skin and first principles or is there also supporting research? ”

    I think the advice is primarily founded on both (a) avoiding sun-burning and (b) what we know about adults manufacturing vitamin D. If a person with skin type II is fully naked with the sun high in the sky, they can make lots of vitamin D in 10 minutes, maybe around 5000 IU. Again, not sure if it’s known how much an infant could make. Certainly a lot less with less skin exposed with the smaller body.