By April Segal, PharmD, APh, BCPS, Remedy Pharmacy Owner and New Mom
Motherhood is a brilliant mixture of bliss, exhaustion, love and defeat. As a new mom and a lover of supplements I was very eager to know how I could use my knowledge to improve the health of my son. The way I saw it was the earlier I started the better. Babies are in a stage of such rapid development, it only made sense that now would be the time that key nutrients would have the most substantial impact. Below are the supplements that I gave my son, from literally day 1 through current day (he is 6 months old now). I will say that there were a few more things (mostly herbs) that I did use when the needs arose, but the supplements listed below were the three tried and true staples that I made sure he did not miss on a daily basis.
Before we jump in, I should point out that the nutritional needs of infants are mostly based on whether they are exclusively breastfeed, formula feed or somewhere in between. I was lucky enough to be able to exclusively breastfeed and so that should be taken into consideration when reading this article.
Everyone can agree that breastfed babies should be getting vitamin D supplementation. It is not controversial at all. The National Academy of Medicine and the American Academy of Pediatrics recommends 400 international units (IUs) daily for infants. This recommendation is designed to maintain vitamin D levels of >20 ng/mL (50 nmol/L), which is the level that was shown to prevent the bone disease rickets in infants and children.1,2,3 Once this association became clear, the vitamin D fortification of foods in the US in the 1930s was very successful in almost eradicating the disease, and nowadays it is generally not a concern except for in exclusively breastfed babies.
I am not going to lie, it wasn’t the fear of rickets that really drove me to want to supplement my son. I guess that I took that for granted. It seems every day we learn something new about how important vitamin D is. Studies suggest associations between vitamin D deficiency and a variety of conditions including multiple sclerosis4; type 1 diabetes5; rheumatoid arthritis6; inflammatory bowel disease7; mood disorders8; cardiovascular disease9; certain cancers10-11, hypertension, hyperglycemia, metabolic syndromes, upper respiratory infections12, food allergies and asthma13,14, and last but not least dental cavities.
So what is a mom to do? The health benefits of breast milk are clear, but the vitamin D content of breast milk is low (even in moms who have normal vitamin D levels). On average breastfed infants only receive 10 to 40 international units/day of vitamin D. This is 10 times lower than what is recommended! The vitamin D levels in breastmilk drops even lower in moms with dark skin or low vitamin D levels themselves (very common, get tested!). Supplementation is easy and generally only requires 1 drop. That's right literally, one drop. Which can easily be placed on the tip of your finger and placed in baby’s mouth. Highly recommend.
What about letting your baby get vitamin D from the sun? For most infants, exposure to sunlight is generally not a sufficient source of vitamin D. It was once estimated that it would take 30 minutes in direct sunlight daily wearing nothing but a diaper to get adequate levels, and given the current recommendations to limit sun exposure in infants younger than six months old this wouldn't be advised, plus who wants diaper tan lines?
Omega 3s (DHA + EPA)
Omega-3 fatty acids DHA and EPA are especially important during the first years of life when baby's brain, eyes, and nervous system are rapidly developing. In fact, polyunsaturated fats account for approximately 20% of the brain's weight! There is actually paleontological evidence that links access to a diet high in omega 3 to increased brain size.15
Observational and interventional studies show that adequate omega-3 levels help support babies’ cognitive, social, and physical development by promoting:
- Visual acuity and retinal development 16-18
- Performance on measures of language and cognition 19,20
- Mental and motor skill development 21-23
- A healthy immune response to allergens 24, 25
- Attentional control 26, 27
So now that we have established how great omega 3s are, the question is whether supplementation is needed. This is going to be dependent on the mom’s omega-3 levels and therefore her diet. Given that the standard American diet is lacking in omega-3 fatty acids relative to omega-6 fatty acids15 and that if a high-quality omega 3 supplement is chosen there is basically no downside, it easy to see why supplementation is commonly suggested. A dose 500 to 800 mg of EPA+DHA daily is supportive for most healthy babies and can be found in high quality products such as this, which have been third party tested for impurities and sustainably sourced.
Today the gut microbiome in 97% of babies born in the US today is dominated with potentially harmful bacteria. This can have negative consequences both on babies daily digestion and comfort (ie blow outs, colic, gas) as well as their lifelong health. The imbalance of gut bacteria early in life is linked to inflammation, and increases risks for obesity, allergic diseases (such as asthma and eczema), inflammatory bowel disease 26-28, and diabetes mellitus (types 1 and 2) 29,30 later in life.
How does bacteria have such a big impact? The good bacteria is able to help babies digest breast milk, this in turn causes a lower pH in the intestinal tract, which is KEY. This lower pH supports nutrient absorption, creates an undesirable environment for potential pathogens, and prevents the infiltration of toxic molecules by improving intestinal barrier function and inhibiting inflammation 31,32.
Historically, babies' digestive tracts were well populated with Bifidobacterium (the good bacteria). However, over the last 100 years we have seen a “generational loss” of this good bacteria33. This shift is thought to be caused by antibiotic use, infant formula feeding, and cesarean section deliveries 34,35 , all of which have been linked to the increased risk for allergies and autoimmune diseases which are also common in resource-rich nations like the US 36-38. Even if you are lucky enough to have had a natural delivery without antibiotics, this imbalance can occur. This is because in countries like the US even most moms no longer colonize the strains babies need. This is why supplementation becomes so important.
If you are like me and have experienced some degree of allergies or autoimmune conditions it is a no brainer to add a B. Infantis probiotic like this one. Remember it is key to make sure you have this on board early. I even started the supplement myself a week before my due date so that my son could obtain the strain naturally from contact with me at delivery!
As your baby grows up their needs will change. This may occur if they have any health issues that come up or at least will at the time you start changing up their food sources (like introducing solids). If you are reading this article, I applaud you for taking the time to see how you can go above and beyond to help improve your child’s lifelong health! We can’t do everything right, but we can at least still try right?
- April Segal, PharmD, APh, BCPS, Remedy Pharmacy Owner and New Mom
- Misra M, Pacaud D, Petryk A, Collett-Solberg PF, Kappy M; Drug and Therapeutics Committee of the Lawson Wilkins Pediatric Endocrine Society. Vitamin D deficiency in children and its management: review of current knowledge and recommendations. Pediatrics. 2008 Aug;122(2):398-417. doi: 10.1542/peds.2007-1894. PMID: 18676559.
- Wagner CL, Hulsey TC, Fanning D, Ebeling M, Hollis BW. High-dose vitamin D3 supplementation in a cohort of breastfeeding mothers and their infants: a 6-month follow-up pilot study. Breastfeed Med. 2006 Summer;1(2):59-70. doi: 10.1089/bfm.2006.1.59. PMID: 17661565.
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