Does My Baby Need Vitamin D, Iron or Other Supplements?

Vitamin D

Breast milk is the ideal food, but it's naturally low in vitamin D, and babies should stay out of direct sun. - Breastfed and partly breastfed babies: 400 IU of vitamin D a day, starting in the first days. - Formula-fed babies: formula contains vitamin D. A baby drinking less than about 32 oz (1 liter) of formula a day needs a supplement too. - From age 1, children need about 600 IU a day from milk, food (fortified foods, fish, eggs) or a supplement. Ask the pediatrician whether your toddler gets enough. - Give drops on the nipple, in the cheek, or in a little milk. Drops come in different strengths; use only the dropper that came with the product and check the label each time. - Another option: a breastfeeding parent can take a high-dose vitamin D supplement instead of giving the baby drops, but only with their clinician's guidance.

Iron

Babies are born with iron stores that run low around 4-6 months. - Formula-fed babies get iron from iron-fortified formula. Low-iron formulas are not recommended. - From about 6 months, offer iron-rich foods daily: meat, poultry, fish, beans, lentils, tofu, egg and iron-fortified cereal. Pair plant iron with vitamin C foods to boost absorption. - The AAP suggests some exclusively breastfed babies may need an iron supplement from about 4 months until they eat iron-rich foods. Practice varies; ask at the 4-month visit. - Preterm and low-birth-weight babies usually need iron drops. - Around 12 months, doctors check for anemia. More than 24 oz (710 mL) of milk a day raises the risk of low iron in toddlers.

Fluoride

• From 6 months, if your tap water isn't fluoridated or you use well water, ask about a fluoride supplement. Don't add one if your water already has fluoride.
• Fluoride varnish at checkups starts with the first tooth. See the toddler teeth guide.

Plant-based and vegan families

Breastfed babies of a vegan parent need that parent to take vitamin B12, and some babies need B12 drops. Plant-based toddlers need planned sources of B12, iron, zinc, calcium, vitamin D, omega-3 fats and protein. A pediatric dietitian can help build a plan that fits your family's values.

What babies usually don't need

• Multivitamins, if they're growing well and eating varied foods.
• Herbal products, teas and gripe water, which aren't regulated like medicine.
• Probiotics for healthy babies: evidence is mixed. Ask before trying.
• Protein powders or adult supplements of any kind.

When to check in

• Ask the pediatrician about vitamin D at the first visit and about iron at 4-6 months.
• Mention pale skin, low energy, or a toddler who drinks lots of milk and eats little.
• Store all supplements, especially iron, locked and out of reach. If a child swallows some, call Poison Control at 1-800-222-1222, or 911 if they are very sleepy or vomiting.