Vitamins for babies and toddlers

The short version

Most babies and toddlers who eat a varied diet get the vitamins they need from milk and food. The big exception is vitamin D, which is hard to get from food and isn’t in breast milk in large enough amounts. Advice on other vitamins differs between the US and the UK.

Vitamin D: why babies need it

Vitamin D helps children build strong bones and prevents rickets, a condition where growing bones become soft (CDC). The body makes vitamin D from sunlight on the skin, but babies should be protected from the sun, and the NHS says young children should still have vitamin drops even if they get out in the sun.

Breast milk usually doesn’t provide all the vitamin D a baby needs (CDC). That’s not a problem with breastfeeding: it’s why supplements are recommended.

Vitamin D: how much, by feeding type

Breastfed or mixed-fed babies

• US: a supplement of 400 IU (10 mcg) of vitamin D every day, starting shortly after birth (CDC, AAP). This applies to babies fed only breast milk and to babies who have both breast milk and formula (CDC).
• UK: a daily supplement of 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 extra:

• US: the CDC says a supplement isn’t needed if your baby drinks 32 oz (about 950 ml) or more of formula a day. One AAP page uses more than 27 oz (about 800 ml). If your baby drinks less than 32 oz, or you’re not sure how much they take, ask your pediatrician.
• UK: don’t give a vitamin D supplement if your baby has more than 500 ml (about 17 oz, or a pint) of formula a day (NHS).

Toddlers

• US: children aged 12 to 24 months need 600 IU (15 mcg) of vitamin D a day (CDC, NIH). Vitamin D-fortified foods like cow’s milk (from 12 months), yogurt and cereals help. The AAP says to keep giving vitamin D drops (600 IU a day) after age 1 if your child drinks less than 32 oz of milk a day. That’s more milk than toddlers should have: the AAP says no more than 24 oz (710 ml) a day after age 1, so most toddlers on this advice keep having drops. Don’t give more milk to skip the drops. For how much milk toddlers should drink, see cow’s milk at 12 months.
• UK: all children aged 1 to 4 should have a daily supplement with 10 mcg (400 IU) of vitamin D (NHS). In the UK, cow’s milk generally isn’t fortified with vitamin D, so it isn’t a good source (NHS).

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

Vitamins A, C and D in the UK

The UK government recommends that all children aged 6 months to 5 years have a daily supplement containing vitamins A, C and D (NHS). The exception is babies having more than 500 ml of formula a day, because formula is already fortified.

• Vitamin A helps the immune system, vision in dim light and healthy skin. Food sources include dairy, carrots, sweet potatoes and mangoes (NHS).
• Vitamin C supports general health and helps the body absorb iron. Food sources include oranges, kiwi, strawberries, broccoli, tomatoes and peppers (NHS).

Healthy Start vitamins. Families on the NHS Healthy Start scheme can get free vitamin drops containing vitamins A, C and D for children from birth until their 4th birthday. The daily dose is 5 drops. Children don’t need them if they have 500 ml or more of formula a day (Healthy Start). Ask your health visitor where to get them.

In the US: vitamins A and C

US advice doesn’t include a routine A and C supplement for babies. The AAP says a child offered a variety of foods from each food group is usually getting plenty of vitamins, and suggests asking your pediatrician which supplements, if any, your child needs. Some children may need more, for example on a vegan diet: see vegetarian and vegan babies, because vegan children also need vitamin B12.

Iron: only on medical advice

Iron is different. Babies need a lot of it from about 6 months, but iron supplements should only be given if your doctor recommends them, at the dose they prescribe.

• Breastfed babies. The AAP recommends an iron supplement from 4 months for babies who are partly or fully breastfed, until iron-containing foods are introduced. A newer AAP page says breastfed babies can benefit from iron supplements starting around 6 months. The CDC says to ask your doctor whether your baby needs iron drops. Babies born early or small may need iron sooner (AAP). Ask your pediatrician which applies to your baby, and don’t start iron drops on your own.
• Formula-fed babies. Standard iron-fortified formula meets a baby’s iron needs for the first 12 months (CDC).
• UK. The NHS doesn’t recommend routine iron drops: its routine supplement for children contains vitamins A, C and D only, not iron. Ask your health visitor or GP if you’re worried about iron.

Food comes first: offer iron-rich foods at most meals once your baby starts solids. See iron-rich first foods and iron deficiency.

More isn’t better

• Give one supplement, at the dose on the label. The NHS warns not to give two supplements at the same time: for example, cod liver oil and vitamin drops together, because both contain vitamins A and D.
• Vitamins A and D build up in the body. The AAP says too much can make a child sick. The NIH upper limit for vitamin D is 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. The NHS says babies under 12 months shouldn’t have more than 1,000 IU (25 mcg) a day, and children aged 1 to 10 no more than 2,000 IU (50 mcg).
• Store all supplements out of reach. Adult multivitamins, especially prenatal vitamins with iron, can cause a severe iron overdose if a child swallows them (NIH MedlinePlus).

If your child swallows supplements that contain iron, or a large amount of any vitamins: call Poison Help at 1-800-222-1222 right away, even if they seem fine. If they’re unconscious, having a seizure, struggling to breathe or vomiting blood, call 911.call 999 or go to A&E (NHS). If you’re not sure whether what they swallowed is 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, and don’t give them anything to eat or drink (NHS). Take the packaging with you.

Where US and UK advice differs

• Vitamin D for breastfed babies. US: 400 IU (10 mcg) a day from shortly after birth. UK: 8.5 to 10 mcg a day from birth. In practice, these are very close.
• Formula cutoff. US: no vitamin D supplement needed at 32 oz (about 950 ml) a day or more (CDC; one AAP page says more than 27 oz). UK: none needed 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) vitamin D supplement for every child aged 1 to 4.
• Vitamins A and C. UK: a daily A, C and D supplement for all children from 6 months to 5 years. US: no routine A and C supplement; ask your pediatrician.
• Iron. US: the AAP recommends iron drops from 4 months for partly or fully breastfed babies, until iron-containing foods are introduced, on your pediatrician’s advice. UK: the NHS doesn’t recommend routine iron drops.