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Do breastfed infants need other nutrition?

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What is vitamin D supplementation for infants?

Although breastfeeding is the recommended method for feeding infants and breast milk provides most of the nutrients an infant needs, it does not provide infants with adequate vitamin D. Vitamin D is required to prevent rickets, a type of vitamin D deficiency. This disease is rare among breastfed infants but can occur if vitamin supplementation or exposure to sunlight is inadequate. (Exposure to sunlight helps the body to make vitamin D in place of supplementation.)1

The current AAP-recommended daily vitamin D intake is 400 IU per day for all infants and children beginning from the first few days of life.2 Human breast milk contains a vitamin D concentration of 25 IU per liter (about 4 cups) or less. Therefore, to meet the 400 IU daily requirement, supplementation is required.

If an infant is weaned to a vitamin D-fortified infant formula and consumes at least 4 cups per day, then additional supplementation with vitamin D is not necessary.1

When to Supplement Breastfeeding

Breastfeeding is supplemented by feeding an infant expressed breast milk from a bottle, formula, or breast milk from another mother. Such supplementation may be needed in the following situations:3

In the Mother:

  • Breast surgery or other trauma
  • Primary breast insufficiency that prevents adequate milk production
  • Physical separation from the infant
  • Serious illness

In the Infant:

  • Weight gain insufficient to maintain health (also sometimes called failure to thrive)
  • Cleft lip and/or palate or other abnormality that prevents normal suckling ability
  • Jaundice or liver problems
  • Serious illness or prematurity that requires the infant to be cared for in a special nursery

Many of these conditions require a health care provider's care. You should always talk with your child's health care provider about whether to supplement your breastfeeding.

To keep supplementation from shortening or otherwise interfering with breastfeeding, you should supplement only after your infant is breastfeeding effectively and thriving on your breast milk.3

Mixing Formula with Breast Milk

Mixing formula with breast milk in the same container is one way of supplementing breast milk.  You may want to supplement your breast milk with infant formula if your milk supply is low or when you are physically separated from your infant.3

Supplementing your breast milk with formula, however, may not be nutritionally the same as giving breast milk.4 Discuss the practice with your infant's health care provider before starting to mix formula with your breast milk.


  1. Centers for Disease Control and Prevention (CDC). (2009, October 20). Breastfeeding: Vitamin D supplementation. Retrieved April 27, 2012, from http://www.cdc.gov/breastfeeding/recommendations/vitamin_D.htm [top]
  2. Wagner, C. L., Greer, F. R., & American Academy of Pediatrics Section on Breastfeeding and Committee on Nutrition. (2008). Prevention of rickets and vitamin D deficiency in infants, children, and adolescents. Pediatrics, 122(5), 1142–1152. [top]
  3. La Leche League International. (2007, October 14). Supplementing the breastfeeding baby. Retrieved April 27, 2012, from http://www.llli.org/llleaderweb/lv/lvaugsep99p75.html External Web Site Policy [top]
  4. American Academy of Pediatrics. (2012, February 27). Breastfeeding and the use of human milk. Pediatrics, 129, e827–e841. Retrieved April 27, 2012, from http://pediatrics.aappublications.org/content/129/3/e827.full.pdf+html External Web Site Policy [top]

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Last Updated Date: 11/30/2012
Last Reviewed Date: 12/19/2013
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