Infant formulas and many first foods, such as infant cereal, are fortified with a number of vitamins and minerals, but what if you choose not to incorporate these foods into your baby’s diet? Is there another way to ensure that your child is getting adequate nutrition? At what point should your child be tested for deficiencies? These are good questions. Hopefully the following information will provide useful suggestions and guidelines to help keep your baby or young child as healthy as possible.
While breast-milk is generally considered to be the best source of nutrition for infants and is recommended by the World Health Organization through the age of 2, the fact of the matter is that certain nutrients are not passed through breast-milk in adequate amounts. For those that argue that breast-milk is all the nutrition an infant needs, consider the fact that the nutrient deficient status of the breastfeeding mom may be contributing to the rise in pediatric nutrient deficiencies and may not be what nature intended! Fortunately, there are ways to prevent these deficiencies from developing.
Even if your child has had nutrient fortified foods or was fed infant formula as a baby, he or she could still be at risk of developing certain nutrient deficiencies. Deficiency in any of the nutrients discussed either alone or in combination may lead to growth and development issues in infants and children.
1) Vitamin D–Vitamin D deficiency is common in infants born to mothers with low levels of Vitamin D. Severe deficiency of this nutrient in infancy and early childhood can lead to the development of Rickets, a disease that affects bone formation and causes bow-legs. Vitamin D is also essential for many other functions in the body including a healthy immune system.
Pregnant women should have their levels checked and consider supplementing up to 5000 I.U. daily (or more, if prescribed by your health-care provider) in order to prevent deficiency in the baby. Continuing to supplement while breastfeeding may be an adequate way to keep levels high enough in infants. Alternatively, infants can be given Vitamin D drops containing 400 I.U. of Vitamin D3. The dose for infants age 0-1 is 1 drop daily. You should consult with your child’s health-care provider prior to giving any supplements, since there can be contraindications in some people.
2) Vitamin K–If your baby is born in a hospital, he or she will most likely be given a shot of Vitamin K shortly after birth. This is to prevent a rare condition called Hemorrhagic Disease of the Newborn that causes bleeding into the brain. Vitamin K is necessary for proper blood clotting and is especially recommended prior to any surgical procedures (such as circumcision). Oral Vitamin K is becoming a more acceptable alternative to the injection for parents who desire the least invasive option for their child. There has also been some controversy in the past about whether high dose Vitamin K at birth may lead to higher childhood cancer rates. Although this assertion has largely been refuted, some parents and health-care providers are more comfortable with a combination of oral supplementation of the infant and supplementation of the breastfeeding mother. Parents to be should discuss the Vitamin K options with their obstetrician or midwife prior to birth.
After birth, Vitamin K is another nutrient that is not adequately passed from mother to child through breastmilk alone. Breastfed infants are therefore, at greater risk of being Vitamin K deficient in the first 12 weeks (infant formula contains high amounts of Vitamin K, so deficiency in formula fed infants is rare). Breastfeeding mothers who choose oral supplementation for their infant in the first few weeks should also talk to their healthcare provider about supplementation for themselves in order to ensure adequate Vitamin K levels for their infant in the first 12 weeks.
3) Iron–Infants who are exclusively breastfed longer than six months are at a greater risk of developing iron deficiency in the first year. Iron stores will generally be adequate for the first 6 months, but after that, an infant who is exclusively breastfed is likely to develop a deficiency of iron, which can lead to anemia (decrease in blood’s ability to carry oxygen to the cells) as well as decreased brain function, since neurotransmitters made in the brain require iron. Premature infants may require supplementation with iron or iron fortified formula earlier than six months, since they are born with lower iron stores.
Many of the infant cereals available at the grocery store are fortified with iron (and a reason that cereal is recommended as a first food by many pediatricians). If you choose not to introduce an iron fortified food when your baby starts solids, you may want to introduce some iron rich foods early on such as prunes and prune juice, apricots, blackstrap molasses; of the grains, quinoa and amaranth are both high in iron. For toddlers and older children, heme sources of iron (found in animal proteins such as meat and eggs) are generally easiest to absorb. Children that eat a vegetarian diet or do not eat much meat are at greater risk of becoming iron deficient, so talk to their health-care provider if this is a concern.
If your baby seems pale or bruises easily, you should talk to your health-care provider–it may be necessary to test hemoglobin levels in order to recommend appropriate supplementation, if necessary. Because too much iron can be toxic, I do not recommend supplementing a baby with iron unless you have talked to a health-care provider.
Breastfeeding moms may choose to supplement with iron (the amount in a prenatal is usually sufficient) or eat plenty of iron rich foods while breastfeeding mainly to ensure that their iron levels are adequate, since supplementation will generally not affect the amount of iron present in breast-milk. Although only a small amount of iron is present in breast-milk, it is generally very well absorbed by the baby. While infant formula is generally fortified with iron, the dairy proteins in most infant formula can irritate the baby’s digestive tract making it harder to absorb certain nutrients, so the fact that it is fortified does not necessarily make it a better from a nutritional standpoint!
4) Vitamin A–In other parts of the world, Vitamin A deficiency is partly to blame for increased mortality rates among infants and young children. This is largely due to its role in the immune system and protecting children from the worst consequences of the many infections they will encounter in early childhood. Vitamin A is a fat soluble vitamin, so it is stored by the body; however, babies are born with very small reserves of this important Vitamin and are dependent on nutritional intake to maintain adequate levels as well as build up reserves to be used during times of stress or infection. Unlike the other nutrients discussed to this point, Vitamin A seems to be present in adequate levels in breast-milk to prevent deficiency in breastfed infants. Mothers who have insufficient levels of Vitamin A during pregnancy and while breastfeeding are more likely to have a baby with a deficiency of this important nutrient, so ensuring adequate dietary intake by mom throughout pregnancy (the Vitamin A precursor, beta-carotene, is the safest form to take in during pregnancy) and breastfeeding is important. Pregnant women should never take more than the recommended daily allowance of Vitamin A due to a risk of birth defects if larger amounts are taken.
Vitamin A is another nutrient that is found in fortified foods, so if you choose not to introduce these foods into your child’s diet, you should make an effort to incorporate foods that are naturally high in Vitamin A or its precursors (beta-carotene). Something else to keep in mind and discuss with your child’s health-care provider, is whether your child may have an increased need for Vitamin A due to frequent infections (uses up reserves). Babies who are weaned from breastfeeding earlier than one year may be at greater risk for deficiency due to an increased susceptibility to infections that deplete Vitamin A reserves, even if they are getting formula or other foods fortified with Vitamin A.
5) Zinc–Zinc is another nutrient that is necessary for healthy immune function and growth in infants. Zinc levels in breast-milk seem to correlate best with mom’s dietary intake of zinc during the third trimester of pregnancy. During breastfeeding, zinc levels in milk decline and do not respond to supplementation or increased dietary intake by mom, which means that a mom with insufficient zinc levels prior to birth is more likely to have insufficient levels of zinc in breast-milk, and their babies may benefit from supplementation. Food sources of zinc include nuts and seeds (in particular, cashews and pumpkin seeds), grains (amaranth, oats, wheat), and some fruits and vegetables (including avocado, peas, pumpkin, and potato). Infants who have had diarrhea from any cause may especially benefit from zinc supplementation and should be seen by a health-care practitioner.
If you are concerned about your child’s nutrient status, you should talk to a qualified health-care practicioner or pediatric nutritionist. This blog will be updated with additional resources in the near future, for those who want to read more.
About the Author: Dr. Bowker is a Naturopathic Physician and owner of Snohomish Valley Holistic Medicine. In addition to her clinical practice, Dr. Bowker serves as a Board member for the Washington Association of Naturopathic Physicians. She has also been a guest speaker for community organizations and instructor of several community health classes. For more information, please visit her primary website: www.snovalleyholistic.com