Apr 24

Vitamin Information

Vitamin D

Vitamin D is important for healthy bones. If babies don’t get enough, they can get weak bones, a disease called rickets.

Vitamin D comes from the foods we eat and sun exposure. Direct sunlight can be dangerous for young babies.

Although breast milk is best for baby, it does not contain enough vitamin D.

The American Academy of Pediatrics (AAP) recommends vitamin D for all infants. The dose is 400 international units (IU) per day.

The amount of liquid varies based on the brand you purchase. Read the directions carefully.

Vitamin D should be started in the first days of life and continued for as long as your baby is breastfed, or until a formula-fed baby takes more than a quart (32 ounces) a day.

Insurance will sometimes cover Vitamin D; Medi-Cal covers Trivisol and Trivisol+ iron.

Most private insurance do not cover food or vitamins, but they are not very expensive.

Some premature babies will need iron as well as Vitamin D- your baby’s doctor will let you know.

Most vitamin D products are available at any pharmacy, on-line, or through your hospitals pharmacy before you head home after delivery.

Vitamin K

Did you know? In the past, one out of every 100 babies had some bleeding and one out of every 1000 babies had serious bleeding—often brain bleeding—in the first days after birth.

This ‘Hemorrhagic Disease of the Newborn’ is now called Vitamin K Deficiency Bleeding (VKDB). Since the US began to give babies vitamin K shots in 1961, VKDB has become a very rare event.

In the past, most babies, even breastfed babies, got a lot of formula (which is supplemented with vitamin K) -another reason why VKDB has been so rare in the last 50 years that you may not have ever heard about it.

A brain bleed due to VKDB is very bad for the young brain. Many of these babies are disabled or die.

In the developing world where they don’t have resources to give vitamin K, VKDB is still a major health problem.

If you plan for your son to be circumcised, most physicians will require that baby has received vitamin K by injection.

What is the story about natural vitamin K levels in babies?

Infants get very little vitamin K from mom during pregnancy. At birth the baby’s blood level is very low compared to adults, and then on day 2 and 3 of life vitamin K levels drop even further.

Newborn infants require daily intake of vitamin K as little is stored up in the body and unfortunately very little vitamin K gets into mom’s breast milk-even if she takes a supplement.

On top of that, exclusively breastfed babies are at higher risk of bleeding, especially in the first days -weeks of life when they are getting low volumes of mother’s milk.

For all these reasons we recommend all newborns get a shot of vitamin K at birth.

What About Oral Vitamin K?

There is no studied or tested liquid form appropriate for babies in the US. Most European and Asian countries that use oral vitamin K have more babies with brain bleeding than countries that use the  vitamin K shot.

Some oral vitamin K routines used in the past in places like Denmark and Holland were  as effective as the shot. But, a unique oral vitamin K liquid not available in the US was used, and the  dose had to be repeated weekly.


In 2000, Denmark changed to giving the shot instead of oral because the unique oral liquid was no longer available in Europe. In Holland, they tried a newer oral vitamin K  liquid after the old one became unavailable, but it turned out to be associated with more brain bleeds.

Now, Dutch families that choose the oral route have to give vitamin K daily for 12 weeks. Because vitamin K is so fatty, oral vitamin K liquid requires a special solvent to be effective.

All vitamin K liquids are therefore not alike.

We cannot assume the vitamin K is working just because the baby swallows it.

Lastly, there is no standard regimen for oral vitamin K, and no standard preparation available for babies, so families that choose this route do not have the security of knowing it will be effective at preventing their baby from having a brain bleed.

Why Is The Injection Better?

The injection places the vitamin K in the muscle where it will be gradually released into the bloodstream over several weeks. The injection also avoids all the problems with unreliable absorption into the baby’s blood that we worry about with oral vitamin K.

Vitamin K injection protects best against all types of VKDB, even the type that happens after 1 month of age.

The shot can be given to your baby when they are skin-to-skin or on the breast, a momentary discomfort for a major benefit.

Is Vitamin K Toxic?

There are no known harmful effects from a standard 1 mg shot. Large studies have not found an association between vitamin K shots at birth and childhood leukemia.

Older vitamin K preparations used prior to the 1960s were associated with anemia and jaundice, but we don’t use this form anymore.

The currently available preparation does not cause this side effect, even when given in doses up to 25 mg. There is no mercury preservative in vitamin K.

There is no controversy within the American Academy of Pediatrics about the 1 milligram injectable dose we use in the US.

Recommendation:

The American Academy of Pediatrics recommends that you give your baby the 1 milligram injection of vitamin K within 2 hours of birth to prevent bleeding and other life-threatening complications.

Most hospitals will delay the shot until the baby has had some breastfeeding and skin-to-skin time.


Lisa Stellwagen MD, FAAP  Professor of Clinical Pediatrics at UC San Diego Health
Tia Hubbard MD FAAP UCSD Associate Professor of Clinical Pediatrics at UC San Diego Health