Vitamin D Supplements to Protect Baby’s Bone Development

Tuesday 22^nd February 2011

Vitamin D Supplements to Protect Baby’s Bone Development

Parents of all babies, from birth to twelve months, are being advised to give their infants a daily vitamin D supplement to protect their growing bones. This advice comes to parents and guardians from the Health Service Executive (HSE), the Food Safety Authority of Ireland (FSAI) and the Department of Health and Children.

All babies in Ireland aged from birth up to 12 months, both breastfed or formula fed, should be given a daily supplement of 5 micrograms (5μg) of Vitamin D.

Vitamin D is essential for healthy bones, but is present in very few foods. It is also known as the sunshine vitamin, because it is made in the body when ultraviolet rays from sunlight strike the skin. However, Ireland’s northerly latitude and lack of winter sunlight means that we cannot make enough vitamin D in this way.

Severe and prolonged vitamin D deficiency can cause softening of the bones or bone deformities, known as Rickets in children or Osteomalacia in adults. Less severe vitamin D deficiency also affects bone health, may increase the risk of osteoporosis, and some studies have also linked it to conditions like Rheumatoid Arthritis, Multiple Sclerosis and Diabetes.  Babies need a daily supplement of vitamin D because their delicate skin cannot be safely exposed to the sun, and because their feeds or diet alone do not provide enough of this important vitamin to ensure healthy bone growth.

Rickets in children was known as a problem in Ireland up to the mid 20th Century, but due to better nutrition in our population over recent decades, it was thought to have been eradicated. However, a number of cases of rickets have been seen here in recent years.

According to Dr. Mary Flynn, Chief Specialist in Public Health Nutrition, FSAI, “the cases of rickets that we have seen are likely to be the tip of the iceberg, and indicate that there is a wider, undetected level of vitamin D deficiency in our population. There is growing evidence that this can increase the risk of conditions like rheumatoid arthritis, multiple sclerosis or diabetes.”

Commenting on the introduction of the new National policy on Vitamin D Supplementation for Infants, Dr. Teresa Bennett, Senior Health Promotion officer with the HSE said that “the introduction of Vitamin D supplementation for all infants from birth to 12 months will benefit all infants immediately, and in years to come will improve our population’s bone health and prevent chronic illness”.

She added that “Vitamin D supplementation for infants is common in other countries, and this step for Ireland aligns with similar policies in place in the UK, in Canada and across the EU.”

The introduction of the policy will see HSE staff and healthcare workers like paediatricians, midwives, public health nurses, GPs, Pharmacists and Dieticians routinely informing pregnant women and parents and carers of infants under 12 months of the benefits of vitamin D and the need to give their infant a vitamin D supplement.

Products that contain other vitamins as well as vitamin D (such as multivitamin products) should not be used.The only vitamin we recommend to give all babies is vitamin D₃. Premature infants or infants who are under on-going medical care may require other vitamins or a higher dose of Vitamin D₃. Multivitamin products or higher doses of vitamin D3 should only be given to your baby on the advice of your baby’sdoctor, nurse or dietitian.

A number of Vitamin D only products that are suitable for infants are available for purchase in pharmacies and other locations across Ireland. A prescription is not required.

It is important that parents carefully read the packaging and instructions for the product they purchase, as each one can require a different amount of product to deliver the required 5 micrograms (5μg) of vitamin D.

The HSE has set up a dedicated web page, which will answer the questions of parents and health professionals, and also outlines the suitable vitamin D products that are available in Ireland. An information leaflet for parents and factsheet for health professionals is also available.

Visit www.hse.ie/go/vitaminD to read more, or call the HSE Infoline on 1850 24 1850 for an information leaflet on Vitamin D.

NOTES FOR EDITORS:

The correct daily dosage of vitamin D is 5 micrograms (μg). Some media reports on this topic have erroneously quoted this as 5 milligrams (mg), which is the same as 5000 micrograms. In the interest of child safety, please take great care to ensure the correct daily dose of 5 micrograms (μg) is used.

What type of Vitamin D supplement is recommended for infants?

Vitamin D3 (cholecalciferol) is the preferred form of vitamin D supplement for infants. Parents should use an oral supplement in a form suitable for infants (liquid or drop form), containing only vitamin D and that provides 5 micrograms (5 μg) of vitamin D. Products that contain other vitamins as well as vitamin D (such as multivitamin products) should not be used.

Why give Infants a Vitamin D supplement?

The policy is being implemented on foot of publication of the Food Safety Authority of Ireland’s (FSAI’s) evidence based report on Recommendations for a National Policy on Vitamin D Supplementation for Infants in Ireland. Most infants don’t get enough vitamin D so it is recommended that all infants receive a daily vitamin D supplement to develop healthy bones and prevent rickets.

Infants’ aged 0-12 months are considered at high risk from vitamin D deficiency because they undergo rapid growth during this period. Vitamin D supplementation during infancy will help to ensure healthy bone development and will help to prevent rickets. Infants aged 0 to 12 months are particularly at risk of vitamin D deficiency and will require a daily vitamin D supplement because:

• They do not have the capacity to safely get Vitamin D from sunlight as infants’ skin is very sensitive and burns easily and should not be directly exposed to the sun. Babies’ skin should not be exposed to direct sunlight, and should be protected by clothing, shade and sunscreen.
• An Infant’s diet, whether breastfed, formula fed or spoon-fed (or a combination of these) does not commonly include sufficient vitamin D.
• Infants between 0-12 months grow very quickly so may be at greater risk of vitamin D deficiency.
• Newborn infants are dependent on their mothers’ vitamin D status during pregnancy to build up their vitamin D stores. At birth they only have 50-60% of their mothers’ stores of vitamin D.
• Infants with African, Afro-Caribbean, Middle-Eastern or Indian ethnic backgrounds are at even higher risk of vitamin D deficiency. Their stores of vitamin D may be particularly low when born as their mothers’ skin may not be as efficient at making vitamin D from the amount and type of sunlight in Ireland.