From birth, give the child 400 international units of vitamin D every day, and do not skip it if the child is breastfed; a full-term baby generally does not need extra calcium in the first 6 months

Breast milk has very little vitamin D, and an infant should not be in the sun for long, so it has to be supplemented every day. In a rural area of Turkey, 3.8% of the children who were not supplemented got rickets within 1 year, and not 1 of the children who were supplemented got it. Give the amount the doctor says. A normal full-term child generally does not need extra calcium in the first 6 months.

Cost

1 bottle of vitamin D drops is a few dozen yuan, given 1 time a day. The hard part is remembering every day, at least until 1 year of age.

Benefit

A Cochrane review in 2020 says breast milk is low in vitamin D, and an infant who takes only breast milk is likely to fall short. The American Academy of Pediatrics says a child who stays outside for long needs sun protection, so every infant needs vitamin D. The National Health Commission's 2020 core feeding messages say: "From birth, an infant should receive 400-800 international units of vitamin D every day, under a doctor's guidance." The same passage also says: "A normal full-term infant generally does not need a calcium supplement in the 6 months after birth." The 2016 global consensus on rickets had 11 international academic bodies taking part. The consensus says 400 IU (10 micrograms) a day is enough to prevent rickets. Every infant should be supplemented from birth to 12 months, whether breastfed or formula-fed. That is a strong recommendation, and the evidence quality is moderate. In a study in rural northeastern Turkey, no child who received 400 IU a day got rickets. Among the children who were not supplemented, 3.8% newly developed rickets over 12 months. The consensus also says that, worldwide, there is no report of radiographically confirmed rickets in an infant who received 400 IU on time every day. In 1992 China ran a grouped study in 4 cities, north and south, supplementing 100, 200, or 400 IU a day. By 6 months, no child in any of the 3 groups had rickets. But vitamin D in the cord blood of northern newborns was only about 1/3 of the southern level (12.5 against 35.0 nmol/L). The more that was supplemented, the higher the level at 6 months, and the authors suggest 400 IU a day.

Notes

The grade is B because the figures on preventing rickets come from comparisons that were not randomly assigned. A Cochrane review in 2020 pooled the trials that supplemented infants. At 400 IU a day, children short of vitamin D were fewer by about 4 in 10 (RR 0.57). The trials were all small, and they could not show whether rickets fell. The benefit is set at medium by judgment, because how common infant rickets is in China was not found. The advice for formula-fed infants is not the same everywhere. The American Academy of Pediatrics says that if the child drinks more than about 800 milliliters (27 ounces) a day of formula with vitamin D added, no extra supplement is needed. The domestic core messages say every infant is supplemented, and the exact amount follows what the doctor says. Do not raise the dose yourself. In a Canadian trial, the group on 1600 IU a day had vitamin D in the blood that was too high, and that arm was stopped early. Growth and bone did not differ across the groups from 400 to 1200 IU. An adult who is not short of vitamin D should not supplement it in order to live longer. See Section 6, item 3 (people who are not short of vitamin D).

Sources · 7

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