Vitamin Supplements

The American Academy of Pediatrics says “the normal breast-fed infant of the well-nourished mother has not been shown conclusively to need any specific vitamin and mineral supplement. Similarly, there is no evidence that supplementation is necessary for the full-term, formula-fed infant and for the properly nourished normal child.”

Many physicians recommend supplements, nevertheless – especially for breast-fed infants. “There is definitely some controversy here,” says Wallingford. The controversy on supplements usually revolves around the following:

Iron – Although the amount of iron in breast milk is very low (0.3 milligrams of iron per liter), the infant absorbs almost half. In contrast, while iron-fortified formulas contain 10 to 12 mg per liter, babies absorb only 4 percent, amounting to 0.4 mg per liter to 0.5 mg per liter. In either case, those amounts of iron are adequate for the first 4 to 6 months, according to the American Academy of Pediatrics. The infant formulas currently available in the United States are either “iron-fortified”–with approximately 12 milligrams of iron per liter–or “low iron”–with approximately 2 milligrams of iron per liter.

“There should not be a low-iron formula on the market for the average child because a low-iron formula is a nutritionally deficient formula,” says Klish. “It doesn’t provide enough iron to maintain proper blood cell counts or proper hemoglobin.” (Hemoglobin is a blood protein that carries oxygen from the lungs to the tissues, and carbon dioxide from the tissues to the lungs.)

In addition, studies have shown that school children who had good iron status as infants because they were fed iron-fortified formula performed better on standardized developmental tests than children with poor iron status. However, However, Wallingford says that “FDA has permitted marketing of low-iron formulas because some pediatricians prefer to use them, with the caveat that the physician would be monitoring iron status and prescribing iron supplements when appropriate.”

Why is there low-iron formula on the market? “In the past there have been a lot of symptoms that have been attributed to iron, including abdominal discomfort, constipation, diarrhea, colic, and irritability,” says Klish. “Also there was some concern about too much iron interfering with the immune system. All of those concerns and questions have been laid to rest with appropriate studies.” Over the past 10 years, based on several studies, the American Academy of Pediatrics does not believe there is any evidence connecting these problems to iron and recommends that iron-fortified formula be used for all formula-fed infants.

Another reason for originally producing low-iron formulas was that human milk contains low amounts of iron, less than a milligram per liter. However, it is now understood that an infant absorbs virtually 100 percent of the iron from human milk, but considerably less from infant formula.

Researchers continue to try to determine the best amount of iron for infant formula. While low-iron formulas don’t supply enough iron, the best amount of iron for formulas has not been established. “We did not have much data at the time the regulations were written for different intake levels of iron,” says Wallingford. He explains that the current amounts give good developmental results, “but, based on European experience, half [of the high level] is probably good enough to do the same thing.” Currently, the Federation of American Societies for Experimental Biology is evaluating what the best levels may be and will make recommendations to FDA on what levels of iron to require in formulas. The study is also reviewing the level of all other nutrients in infant formula, as well as the need for nutrients not currently included.

Vitamin D – Insufficient vitamin D can cause rickets, a disease that results in softening and bending of the bones. Although the amounts of vitamin D in breast milk are small, rickets is uncommon in the breast-fed term infant. This may be because, like iron in breast milk, the vitamin D in breast milk is easily absorbed by the baby. Sunlight is important for the formation of vitamin D, but probably as little as a few minutes exposure a day is all the baby needs, say Schanler, and exposure to the whole body isn’t necessary – just the arms and face is enough.

Fluoride – No one knows for sure if giving fluoride during the first six months of life will result in fewer cavities. Reflecting the uncertainty surrounding fluoride supplements, the American Academy of Pediatrics recommends starting fluoride supplements shortly after birth in breast-fed infants, but also says that waiting up to six months is acceptable. Because there is no fluoride in infant formula, the twofold recommendation also applies when ready-to-feed formula is used or when the water used for powdered or concentrated formula has less than 0.3 parts per million of fluoride.

Courtesy articles provided by www.cfsan.fda.gov, and www.familyassociation.org