Give the child 400 international units (IU) of vitamin D every day from birth, and don't skip it especially if breastfed; a full-term baby generally doesn't need extra calcium within the first 6 months

Cost

A bottle of vitamin D drops costs a few dozen yuan, one drop a day. The hard part is remembering every day, and keeping it up until at least 1 year old.

What you get

A 2020 Cochrane review says the vitamin D content of breast milk is low, so infants fed only breast milk easily fall short. The American Academy of Pediatrics says that children who spend long periods outdoors need sun protection, so all infants need vitamin D supplements. The National Health Commission's (国家卫健委) 2020 core feeding messages say: "From birth, infants should take 400-800 international units of vitamin D daily under a doctor's guidance." The same passage also says: "Normal full-term infants generally do not need calcium supplements within 6 months of birth." The 2016 global consensus on rickets involved 11 international academic organizations. The consensus says that 400 IU (10 micrograms) a day is enough to prevent rickets. All infants from birth to 12 months should be given it, whether breastfed or formula-fed. This is a strong recommendation with moderate evidence quality. In a study in rural northeastern Turkey, no child who was given 400 IU a day got rickets. Among children who were not given it, 3.8% newly developed rickets within 12 months. The consensus also says there is no report anywhere in the world of X-ray-confirmed rickets in an infant who was given 400 IU every day on schedule. In 1992 in China, a group comparison in four cities in the north and south gave 100, 200 or 400 IU a day. By 6 months, no child in any of the three groups had rickets. But the vitamin D in umbilical cord blood of newborns in the north was only about a third of that in the south (12.5 versus 35.0 nmol/L). The more given, the higher the level at 6 months, and the authors recommend 400 IU a day

Notes

Rated B because the rickets figures come from comparisons without random assignment. The 2020 Cochrane review pooled trials of supplementing infants. At 400 IU a day, about 40% fewer children had vitamin D insufficiency (RR 0.57). But the trials were small, and could not show whether rickets was reduced. The size of the benefit is set at medium by judgment, because how common infant rickets is in China was not found. Advice for formula-fed babies varies. The American Academy of Pediatrics says that if a baby drinks more than about 800 milliliters (27 ounces) of vitamin D-fortified formula a day, no separate supplement is needed. China's core messages say all infants should be supplemented, and the specifics follow what the doctor says. Don't raise the dose yourself: in a Canadian trial, the group on 1600 IU a day had too much vitamin D in the blood and was stopped early. The groups on 400 to 1200 IU showed no difference in growth or bones. Adults who aren't deficient shouldn't take it for longevity; see §6.3 (people who aren't deficient in vitamin D).

Evidence grade

B : Supported by research but without a precise number, or based on small or single studies.

Sources

1. 国家卫生健康委办公厅 (2020). 婴幼儿喂养健康教育核心信息. https://www.gov.cn/zhengce/zhengceku/2020-08/01/content_5531915.htm
2. Munns CF, Shaw N, Kiely M, et al. (2016). Global Consensus Recommendations on Prevention and Management of Nutritional Rickets. Journal of Clinical Endocrinology & Metabolism, 101(2), 394-415. https://doi.org/10.1210/jc.2015-2175
3. Beser E, Cakmakci T (1994). Factors affecting the morbidity of vitamin D deficiency rickets and primary protection. East African Medical Journal, 71(6), 358-362. https://europepmc.org/article/MED/7835254
4. Specker BL, Ho ML, Oestreich A, et al. (1992). Prospective study of vitamin D supplementation and rickets in China. Journal of Pediatrics, 120(5), 733-739. https://doi.org/10.1016/s0022-3476(05)80236-7
5. Tan ML, Abrams SA, Osborn DA (2020). Vitamin D supplementation for term breastfed infants to prevent vitamin D deficiency and improve bone health. Cochrane Database of Systematic Reviews, 12, CD013046. https://doi.org/10.1002/14651858.CD013046.pub2
6. American Academy of Pediatrics (2022). Where We Stand: Vitamin D & Iron Supplements for Babies. HealthyChildren.org. https://www.healthychildren.org/English/ages-stages/baby/feeding-nutrition/Pages/Vitamin-Iron-Supplements.aspx
7. Gallo S, Comeau K, Vanstone C, et al. (2013). Effect of different dosages of oral vitamin D supplementation on vitamin D status in healthy, breastfed infants: a randomized trial. JAMA, 309(17), 1785-1792. https://doi.org/10.1001/jama.2013.3404

Translated from the Chinese original. Original book, section 20, tip 16. This section is about health and medicines. It is general information, not a substitute for a doctor’s diagnosis or prescription. Content may be out of date and rules differ by place. When you actually deal with an agency, a doctor or a court, follow what local officials, doctors and lawyers tell you. Disclaimer