A new publication in the International Journal of Circumpolar Health reports that even infants placed on formula are at risk for severe vitamin D deficiency.
In this publication, doctors report on a series of six infants in the hospital with general and focal seizures. They reported between the years 2003 and 2005 from First Nation communities located at 54 degrees north in the Canadian province Manitoba. The infants were between 6 and 49 days old and all were on cow’s milk formula containing 400 IU of vitamin D per liter.
What the doctors found is that all suffered from severe vitamin D deficiency and subsequent low blood calcium, which was causing seizures. How low were the vitamin D levels? Four had levels below 6 ng/ml, one had a level of 6.4 ng/ml and one had a level of 10 ng/ml.
All six infants were treated with vitamin D, calcium and activated vitamin D.
Currently, there is not clear guidance from the Canadian Pediatric Society or the American Academy of Pediatrics on vitamin D requirements for formula fed infants, while their recommendations are much clearer for breast-fed infants. The Canadian Pediatric Society simply states that formula should be a good source of vitamin D if consumed adequately, even though many young infants may not consume 1 liter of milk per day. Meanwhile, the American Academy of Paediatrics recommends that infants that don’t consume a minimum of 1 liter of formula per day receive supplementation to achieve an intake of 400 IU/day.
In this case report, the infants likely suffered from severe vitamin D deficiency due to maternal deficiency during pregnancy and because they didn’t consume much formula. This highlights the need for better awareness of vitamin D supplementation during pregnancy and the need for clearer guidance for formula fed infants. Especially at latitudes as high as 54 degrees north, where good UV exposure and intensity is absent for much of the year.
In the future, we need clearer and easy guidelines for formula fed infants from major pediatric societies. In the first few months of an infant’s life, it is unlikely that they will get a full liter of milk per day and get their 400 IU of vitamin D per day. Furthermore, it is unlikely that the majority of families will calculate how much more vitamin D their baby needs based on how much milk they consumed.
Much simpler guidance may be to recommend a 400 IU supplement in addition to whatever formula is providing. A recent randomized controlled trial demonstrated that doses of up to 1200 IU in the first three months of an infant’s life are well tolerated and perhaps optimal. Supplementation in addition to formula would likely deliver between 600-800 IU/day, well within what is safe and healthy.
Vitamin D during pregnancy and early childhood is a complicated subject, so please be sure to read our page “Vitamin D during pregnancy and breastfeeding” for more information on requirements.