Well, that’s not really the question. But is there an amount of Vitamin D that a breastfeeding mom can take in order for the breast milk to contain recommended levels of Vitamin D for her baby?

There have been numerous studies confirming the fact that breast milk does not contain enough Vitamin D to meet the nutritional needs of an infant. Even in mothers who are still taking prenatal vitamins; there’s not enough that makes its way into the milk ducts. 

The American Academy of Pediatrics recommends that all babies should be given a daily Vitamin D supplement which provides 400 International Units (IU) of the vitamin. Yes, even formula-fed babies need it (at least until they’re consuming a daily minimum of 32 oz per day of a Vitamin D fortified formula)!

There’s been some new light shed on this topic, however. Some studies have suggested that lactating mothers who take 4000 IU to 6400 IU of daily Vitamin D, will produce an adequate amount of the vitamin present in the breast milk to meet the nutritional requirements of the infant. This is pretty awesome news! Especially if you’re like me and forget to give your little one their daily dose; or better yet, if your little one gives the Vitamin D right back to you (stained clothes or furniture anyone?). 

It’s important to note that the research noted that adequate Vitamin D levels weren’t reached until about 4-5 months AFTER taking the increased dose. 

With that being said, we still recommend that you give your baby a Vitamin D supplement until there is more research done in this area. I would also highly recommend that mothers who are interested in breastfeeding discuss taking an increased dose of Vitamin D with their OB/Gyn as elevated Vitamin D levels in the body can pose some health risks. 

In the wake a baby is dead and her mom has been charged with her murder. In addition, the baby’s dad has been charged with aggravated battery and cruelty to a child for diluting their baby’s breast milk with water, then refusing to take the child for medical care.

By the time they did take her to the hospital, she was already dead.

Unfortunately, this is not uncommon. I remember a similar case from years ago in which a child’s family was desperate for money and thought they could use extra water to make their formula last longer. In a study from Clinical Pediatrics, up to 25 percent of families considered “food-insecure” admitted to using various methods to make their formula last longer.

The problem is that extra water is not safe for babies. It causes the sodium level in their blood to drop. Low sodium will lead to brain swelling which can cause poor feeding, lethargy, seizure and eventually death.

Giving free water to babies is not just an issue of formula stretching. Families commonly ask during the summer months if their babies need extra water due to the heat. The answer is NO!

Some reasons babies don’t need water:

• Breast milk and formula is mostly water (80-90 percent). Babies don’t get thirsty. Their diet is primarily liquid.
• Water does not have nutrition or electrolytes babies need. If a baby is going to be drinking something, why not make it be something that can help them grow?

Babies can safely start to drink some water after six months but they still don’t need a lot. They can get one to three ounces during their meals if parents want to introduce and practice with a sippy cup.

They were doing great, breastfeeding or taking a bottle and eating some solids but now what?!??! You're expected to change everything. First off, remember that if you plan to continue to breastfeed (which is awesome if that’s your choice!), some of this won’t apply to you but some of it will.

With everything else going on, I’m here to tell you it doesn’t have to be that complicated.

Here are my 5 simple rules for transitioning to milk at 1 year of age (and only two low-stress choices for you to make):

1. Remember that there’s nothing magical about milk.

Cow’s milk is an easy source of calcium, calories, and protein but if they are eating those things then they actually don’t have to drink milk at all. Especially keep that in mind when you make the change if their milk intake falls off. It’s OK. I generally recommend 18-24 ounces per day. This should be enough to get your baby some extra calories, but not be so much that it can lead to constipation. Also remember that yogurt and cheese have similar nutritional content so they can be included in the total as well.

2. Transition to a cup before 15 months.

The closer to 1 year that you can transition to a cup, the better. Hopefully you’ve been offering some water at meal times with a cup for a while. Don’t buy any large quantities of a cup until you find out what your baby likes. Put the cup in front of them, they’ll eventually drink.

3. Decide on a milk. You have some choices.

Remembering rule  No. 1, it’s OK to give yourself some flexibility in the milk that you choose. I’m not worried about cow’s milk or dairy intake as a general rule. Depending on baby’s weight, I am Ok with either whole milk or 2% milk. Talk to your doctor about which might work for your child. There are a few milk alternatives that closely resemble cow’s milk in nutritional content (pea and soy milk are examples) but there are others that are basically water (almond milk). I don’t routinely recommend toddler formula unless medical indicated or recommended by your doctor.

4. Decide on a plan for your transition.

I’ve seen families make the change cold turkey the first day it was possible. I’ve seen families slowly transition by adding in milk alternating bottles with formula. I’ve also seen families mix some formula and some milk in individual cups. I haven’t seen any one particular strategy work better than another. I think most babies would do fine with a quick transition or cold turkey swap…but every baby is different.

5. Try not to stress too much about this.

There are plenty of things to worry about in parenting. Deciding what to give them to eat and drink shouldn’t add to your stress. Provide them plenty of fruits and vegetables. Decide on your milk choice and your method of transition and don’t stress the rest.

They will have good days and bad days (just like us).

But, I promise everything is going to be OK in the end.

Most mothers eat a varied diet with fortified foods (usually milk) containing Vitamin D, take prenatal vitamins, and have some exposure to sunlight while pregnant and have plenty of Vitamin D to pass on to their babies.

However, due to an increase in vitamin D deficient babies, the American Academy of Pediatrics published guidelines in 2003, recommending that all breastfed babies receive 400 mgs IU of Vitamin D drops each day.

The increased number of vitamin D deficient babies is likely due to the less amount of time today’s moms and babies spend in the sun. Darker skin tones, vegan diets, babies born in northern regions and those who cover completely (like religious veils) are at a higher risk for deficiency.

Talk with your child’s health care provider about vitamin D options for your child.

Related Topic:

• How Much Calcium and Vitamin D Does My Child Need?
• Do Your Kids Need Vitamins or Supplements?
• Let's Learn About ... Giving Your Kids Vitamins
• The life-saving reason your baby needs vitamin K

Often, moms perceive that they do not make enough milk because they do not make “extra” milk.

Other times they think the baby is eating too often, or the breasts feel too soft, or the baby is fussy at certain times of the day, or they are unable to pump much milk.

Many complain they do not leak, that their baby nurses quicker than he or she once did, or that they are unable to feel a letdown.

Reality is, that none of these things mean that a mom has inadequate supply.

As the virtual lacation consult at Cook Children's, I ask questions like:

• Is the baby is growing?
• Are they having plentiful output (poops and urine diapers) each day?
• Are they waking often to feed and seeming satisfied after?

Since breastmilk is easily digested, breastfed babies may eat more often than bottlefed babies at somewhere between 8-12 times in a 24 hour period. The baby will be described as alert and active, and seems satisfied after feedings; often times with relaxed hands. Mom will also report hearing swallows during the feed.

The greatest indicator of sufficient milk intake is weight gain, though an initial loss is normal and expected as they shed the extra fluid in their tissues. Once the milk supply is in, we expect most babies to gain close to an ounce per day. After 3-4 months, the number will gradually slow down.

Another reliable indicator is output. By day 6 we expect to have 6 pale and mild smelling wet diapers and >4 bowel movements that have transitioned to the yellow, mustard, seedy stools. Over time, the number of stools will fluctuate and breastfed babies may go many days without a BM as their body is absorbing all of the nutrients. Even then, we expect soft and profuse stools.

The older the baby gets, the more adequate they feed, therefor spend less time at the breast and since many mothers do not feel their letdowns, that nor the firmness of the breast tell us how well the infant is being fed.

Virtual Lacation Consultation Program

Connect to an International Board Certified Lactation Consultant (IBLC) from the comfort of your own home. When caring for a newborn, it is important to have support for successful breastfeeding and nutrition. Cook Children's now offers that to you and your baby when and where you need it: in the comfort of your home. Click here to learn more about the program.

Schedule an appointment now

Consultation topics include:

• Correct latching
• Milk supply
• Feeding schedules
• Pump options and supplies
• Pumping routines/schedules
• Return to work planning
• Nutrition and skin care
• Newborn positioning
• Milk storage
• Pain or possible infection

Meet our Lacation Consultant

 

Holly Erwin, LVN, IBCLC, is a mom of three boys and has worked as a pediatric nurse for over 11 years within the Cook Children's Health Care System. When not working, she spends her time running to and from sports for her boys, being outside with her family and dreaming of traveling with her husband of 10 years. For now, she settles for their bi-annual date-night!

Through her own children and the thousands of moms that she has helped over the years, Holly found a special interest in infants and breastfeeding. In 2015, she became internationally board certified as a lactation consultant and now works as an IBCLC virtually through the Cook Children's telemedicine department.

If you don’t know her name, you more than likely have seen her photo because she has blown up the Internet with a photo of her breastfeeding her own son and the son of a friend.

For some it’s a beautiful expression of what’s perfectly natural. For others, it’s caused a range of emotion from “yuck” to outrage.

And for our lactation experts at Cook Children’s, well, they look at it as an opportunity to educate the public.

The lactation nurses at Cook Children’s have been busy working and had not seen the photo making the Internet rounds until called for this story. They realize that it makes many of us uncomfortable in the United States to see such a bold expression of a natural process. But they say it’s a common practice in many other countries around the world and accepted and sometimes expected culturally.

From a medical aspect, the lactation experts say milk sharing is becoming a more common practice but not without risks. There are numerous transmittable diseases that can be passed on through a mother's milk as well as many medications that will be passed on through milk too. As milk sharing is becoming more common there are even websites out there where people can share breastmilk with one another. Again, caution must be used when sharing breast milk.

To be perfectly safe, for those babies that have a medical need and prescription for breastmilk, they recommend a place like Mothers’ Milk Bank of North Texas, which allows moms to donate breastmilk. The mothers go through a screening process and is then the milk is pasteurized to make sure there’s no harmful bacteria.

The consultants hope that people don’t focus on the photo as much as they do the benefits of breastfeeding.

And for those of you wondering, “Aren’t those kids a little old to be breastfeeding?” Come on. We know a lot of you are. The World Health Organization recommends breastfeeding babies until at least 2 years of age.

The lactation nurses aren’t willing to weigh in as far as the emotional aspect of the picture or how it impacts them developmentally. Breastfeeding in a personal choice and one that we hope every mother will attempt. How long to feed your baby is personal and will be very different for each mother. At the end of the day, breastfeeding is supported by the World Health Organization, Center for Disease Control, the American Academy of Pediatrics just to name a few.

The American Academy of Pediatrics recommends exclusive breastfeeding for the first six months of a baby’s life, “followed by breastfeeding in combination with the introduction of complimentary foods until at least 12 months of age, and continuation of breastfeeding for as long as mutually desired by mother and baby.”

About the source

Because research shows that breast feeding helps improve babies' health and helps moms bond with their little ones, Cook Children's has full-time lactation specialists on staff to assist mothers with pumping and breastfeeding. We offer breast pumps in every room and have an on-site milk bank available for safety and storage. There are numerous resources available through lactation services for moms that are having difficulty with nursing/pumping. While other nurses are focusing on the baby's care, the lactation consultant can provide extra attention to mom.

When deciding about starting a medication as a breastfeeding mother, here are some questions that need to be considered:

1. Has the medication been studied in humans or other mammals?

2. How important is the medication to the mother?  For example, what would happen if the mother did not take the medicine?

Clearly if something is well studied, safe and very important for mom, go for it. If something has been shown to be unsafe and not important, then skip it. In my mind, everything I see is a gray area. If you are not impressed with the helpfulness of this “brilliant” analysis, here are some resources you can use:

1. Your pediatrician or obstetrician. I don’t memorize all the possible drugs, but I do know where to look them up.
2. Infant Risk -Dr. Hale from Texas Tech is one of the national leaders in medication use during pregnancy and while breastfeeding.
3. LactMed –The National Library of Medicine’s Drug and Lactation Database

A Special Consideration: Anti-Depressant and Anti-Anxiety Medications

Because of the relatively small number of breastfeeding mothers on anti-depressants, they are still mostly unstudied. Many have been found to enter the bloodstream at less than 2 percent of the dose (adjusted for the babies weight), but some do reach higher levels (near 10 percent).

Here are some of the ones that enter at higher levels:

• Buproprion
• Fluoxetine
• Lithium
• Venlafaxine
• Diazepam
• Citalopram
• Lamotrigine

Even though we know this, we still don’t know the effects of the medication on the baby is in many ways. The AAP statement highlights the fact that these medications tend to have a build up over time. It is important to note also that baby’s kidneys and liver function (the primary way the we get rid of medications) are not fully mature. Because of this, I evaluate each mother/baby combination by these 3 criteria:

• Benefits of breastfeeding
• Risk of the medication
• Risks of mom’s depression on the child

In summary, I believe we should use caution with all medications with breastfeeding mothers.  If you are breastfeeding, please consult with your pediatrician or obstetrician prior to taking any medication.