Vitamin D for babies and toddlers

Why babies need vitamin D

Vitamin D helps the body take up calcium and build strong bones. Without enough of it, growing bones can become soft, a condition called rickets (CDC, AAP). The AAP says the classic sign is legs that bend or bow once a child starts walking, and babies who crawl can get wider wrists.

Breast milk usually doesn’t provide all the vitamin D a baby needs (CDC). That isn’t a flaw in breastfeeding: it’s why a daily supplement is recommended. The AAP says breastfed babies who don’t get extra vitamin D are at the highest risk of rickets, especially if the breastfeeding parent is low in vitamin D too.

This guide goes deeper on vitamin D. For every vitamin together, including the UK vitamins A, C and D drops and iron, see vitamins for babies and toddlers.

How much, by age and feeding type

Breastfed or partly breastfed babies

• US: 400 IU (10 mcg) of vitamin D every day, starting shortly after birth, for babies fed only breast milk and for babies who have both breast milk and formula (CDC). The AAP gives the same 400 IU (10 mcg) up to age 1.
• UK: a daily supplement with 8.5 to 10 mcg of vitamin D from birth, whether or not you take vitamin D yourself (NHS).

Formula-fed babies

Infant formula has vitamin D added, so babies who drink enough of it don’t need drops.

• US: the CDC says no supplement is needed if your baby drinks 32 oz (about 950 ml) or more of formula a day. The AAP page uses more than 27 oz (about 800 ml). Most young babies drink less than this, so ask your pediatrician.
• UK: babies having more than 500 ml (about a pint) of formula a day should not be given a vitamin D supplement. Below 500 ml a day, they need 8.5 to 10 mcg a day, like breastfed babies (NHS).

Toddlers

• US: children aged 12 to 24 months need 600 IU (15 mcg) a day (CDC, NIH), from fortified milk, food and, if needed, drops. Ask your pediatrician whether your toddler still needs drops. See vitamins for babies and toddlers for the AAP’s milk cut-off.
• UK: all children aged 1 to 4 should have a daily supplement with 10 mcg (400 IU) (NHS), all year round.

A note on units: 1 mcg of vitamin D is 40 IU, so 10 mcg is 400 IU (NHS).

Why sunlight isn’t the answer for babies

The body makes vitamin D when sunlight falls on bare skin, but babies’ skin needs protecting. The AAP and the NHS both say to keep babies under 6 months out of direct sunlight. The AAP also notes that sunscreen, which matters for preventing sunburn, means the skin makes much less vitamin D.

• The NHS says young children should still have vitamin drops even if they get out in the sun.
• In the UK, the NHS says people don’t make enough vitamin D from sunlight between October and early March.
• Darker skin makes less vitamin D from sunlight (NIH), and the AAP says vitamin D deficiency is more common in people with dark skin. The drop advice is the same for every baby; if you’re worried, ask your pediatrician or health visitor.

You can’t overdose on vitamin D from sunlight (NHS), but sunburn is a real risk, so the drops are the safer route.

Choosing and giving drops

• Read the label for the amount per dose. Products differ in strength and in how many drops make a dose. Give exactly the dose on the product, or the dose your doctor gives you.
• Use the dropper or syringe that comes with it. The AAP’s rule for liquid medicines applies here too: use the dosing device that came with the product, never a kitchen spoon.
• One supplement at a time. The NHS says not to give 2 supplements together, such as cod liver oil and vitamin drops, because both contain vitamin D. One supplement is enough if it has the recommended dose.
• In the UK, your health visitor can advise on drops. Families on Healthy Start can get free vitamin drops with vitamins A, C and D from birth to age 4 (5 drops a day), unless the child has 500 ml or more of formula a day (Healthy Start).
• In the US, ask your pediatrician which product to use. The AAP notes that standard infant vitamin drops often contain vitamins A, D and C together.

Food sources from 6 months

Very few foods contain much vitamin D, and the NHS says it’s hard to get enough from food alone. That’s why drops continue after solids start. Foods that help (CDC, NIH, NHS):

• Oily fish: salmon, trout, sardines and mackerel, cooked and flaked, with bones checked. Canned light tuna has a little. See fish for babies.
• Eggs: well-cooked egg yolk has a small amount.
• Fortified foods: some cereals, yogurts and fat spreads (check the label). In the US, almost all cow’s milk is fortified, about 120 IU (3 mcg) per cup (NIH), and is a main drink from 12 months (CDC). In the UK, cow’s milk generally isn’t fortified (NHS).
• Mushrooms: a little, more if they’ve been exposed to UV light (NIH). Cook mushrooms soft for babies.

Egg and fish are common allergens: offer each on its own first. See how to introduce allergens.

Too much vitamin D

Too much vitamin D, almost always from supplements, can cause too much calcium to build up in the body, which can weaken bones and damage the kidneys and heart (NHS, NIH). Signs can include nausea, vomiting, muscle weakness, confusion, loss of appetite, and being very thirsty and passing a lot of urine (NIH).

Upper limits from all sources together:

• NIH: 1,000 IU (25 mcg) a day from birth to 6 months, 1,500 IU (38 mcg) at 7 to 12 months, and 2,500 IU (63 mcg) at 1 to 3 years.
• NHS: no more than 25 mcg (1,000 IU) a day under 12 months, and 50 mcg (2,000 IU) a day at 1 to 10 years.

The everyday dose is well below these, so following the label keeps you safe. If your doctor prescribes a higher dose to treat a deficiency, follow their advice (NHS).

Keep vitamin drops out of reach. If your child swallows a large amount of vitamin D drops or any other supplement: call Poison Help at 1-800-222-1222 right away, even if they seem fine. The AAP says the line is free, expert and confidential. If they’re unconscious, not breathing or having a seizure, call 911.call 999 or go to A&E (NHS). If you’re not sure whether the amount was harmful, call NHS 111.call your local emergency number (such as 112 in Europe or 000 in Australia) or your local poison information center right away. Don’t try to make your child sick (NHS), and take the bottle with you.

When to talk to your doctor

Talk to your pediatrician, GP or health visitor if:

• you’re not sure whether your baby needs drops, for example with mixed feeding
• your baby was born early or has a condition that affects how they absorb fat or nutrients
• your child’s legs look bowed once they walk, or their wrists look wide
• your child refuses drops and you need another way to give them

Where US and UK advice differs

• Breastfed babies. US: 400 IU (10 mcg) a day from shortly after birth. UK: 8.5 to 10 mcg a day from birth. These are very close.
• Formula cut-off. US: no drops needed at 32 oz (about 950 ml) a day or more (CDC; one AAP page says more than 27 oz). UK: no drops at more than 500 ml a day.
• Toddlers. US: 600 IU (15 mcg) a day from all sources, with drops if your child doesn’t get enough from fortified milk and food. UK: a 10 mcg (400 IU) supplement every day for all children aged 1 to 4.
• Milk. Most US cow’s milk is fortified with vitamin D; most UK cow’s milk isn’t.