In most cases, breast milk or formula provides just about everything a baby needs for the first four to six months. The exception is vitamin D, which is recommended as a supplement for breastfed babies and babies who drink less than 32 ounces of formula per day. (See below for more details.)
After age 4 to 6 months, as your baby’s diet gradually changes from an all-liquid diet to one that contains more and more solid food, your doctor may or may not recommend additional vitamin supplements.
Babies who eat a variety of foods over time shouldn’t need them, but there are exceptions. For example, supplements may be necessary if your baby was born prematurely, at a low birth weight, or small for gestational age; consistently drinks less breast milk or formula than other babies his age and doesn’t make up the difference with food: or has chronic health problems that affect his ability to eat. Be sure to ask your baby’s healthcare provider if you have special concerns.
If you follow a vegan diet, tell your baby’s healthcare provider. Vitamin B12, iron, zinc, calcium, and omega-3 fatty acids are nutrients that vegan moms and babies may need to make an extra effort to consume through diet or a multivitamin-mineral supplement.
Once you start serving solid food, your baby may be getting more vitamins and minerals than you think – especially if he eats fortified foods, which often have added vitamin A, zinc, and folate. Check food labels. A study by the American Dietetic Association showed that while supplements were helpful for infants who had marginal intakes of some nutrients, other infants received excessive amounts.
Here are the supplements your baby’s doctor may suggest:
Breast milk and formula both contain iron, but about the time your baby starts solid foods, the iron requirement jumps (from 0.27 mg daily through 6 months to 11 mg daily from 7 to 12 months). At that point, it’s important for your baby to have a good source of iron from food. Good sources include pureed meats, iron-fortified cereal, and pureed legumes such as lentils, kidney beans, lima beans, black beans, and pinto beans.
Your baby’s doctor may recommend an iron supplement if your baby doesn’t eat iron-rich foods. Babies born prematurely have less stored iron at birth and usually need to take an iron supplement.
Only small amounts of vitamin D are transferred in breast milk. That’s why the American Academy of Pediatrics (AAP) now recommends that you give your breastfed baby a supplement of 400 IU per day of vitamin D, starting in the first few days of life. Babies who are fully or partially formula fed but drink less than 32 ounces of formula a day also need a daily 400 IU vitamin D supplement .
Our bodies produce vitamin D after the skin is exposed to sunshine. But ideally your baby won’t be sunbathing at all in the first six months, so he won’t get enough vitamin D from the sun – even if you live in a relatively sunny place, such as Florida.
The skin of very young babies is extra thin and delicate, and every minute of sun exposure contributes to skin cancer risk and wrinkling later in life – even if the skin doesn’t burn. Sunscreen helps keep babies safe in the sun, but it also blocks the rays that enable the body to produce vitamin D.
Vitamin B12 is critical for development of the nervous system and to prevent anemia. This vitamin is naturally found in fish, meat, poultry, eggs, milk, and milk products. If you’re breastfeeding and you don’t eat much (or any) animal protein, it’s important to have a regular and reliable source of vitamin B12 – whether it’s from a supplement or fortified foods – so that your baby’s diet will also contain adequate amounts of the vitamin.
DHA, an important omega-3
DHA, an omega-3 fatty acid important for infant brain and eye development, shows up in your breast milk in proportion to the amount of DHA and essential fatty acids in your diet. (Formula is fortified with adequate amounts of DHA.)
DHA supplements aren’t usually recommended for babies, but breastfeeding moms who don’t consume a dietary source of DHA – vegetarians and vegans, in particular – may want to consider taking a supplement. Vegetarians and vegans and their infants have been found to have lower blood levels of DHA than those who eat meat.