What nutrient does not need to be supplemented in a breastfed infant before the age of 6 months?

Reviewed by Dan Brennan, MD on June 12, 2020

Your baby is about to go through an amazing growth spurt. In their first year, babies triple their birth weight. To grow that much, they need a lot of nutrients -- more than at any other time in their life.

Experts say breast milk is the best source of nutrition for babies during the first 6 months, but formula can be a good alternative.

Some of the nutrients babies need to grow and stay healthy include:

Calcium. Helps build strong bones and teeth.

Fat. Creates energy, helps the brain develop, keeps skin and hair healthy, and protects against infections.

Folate. Helps cells divide.

Iron. Builds blood cells, and helps the brain develop. Breast-fed babies should receive iron supplements.

Protein and carbohydrates. They provide energy and fuel growth.

Zinc. Helps the cells grow and repair themselves

Your baby also needs vitamins such as:

Vitamin A. Keeps skin, hair, vision, and the immune system healthy.
Vitamin B1 (thiamine). Helps the body turn food into energy.
Vitamin B2 (riboflavin). Helps the body turn food into energy, and protects cells from damage.
Vitamin B3 (niacin). Helps the body turn food into energy and use fats and protein.
Vitamin B6. Keeps the brain and immune system healthy.
Vitamin B12. Keeps nerve and blood cells healthy, and makes DNA -- the genetic material in every cell.
Vitamin C. Protects against infections, builds bones and muscles, and helps wounds heal.
Vitamin D. Helps the body absorb calcium from food, and keeps bones and teeth healthy. Breast-fed babies may need a D supplement.
Vitamin E. Protects cells from damage, and strengthens the immune system.
Vitamin K. Helps the blood to clot.

Most infant formulas today are made from cow's milk. They are fortified to make them as close to breast milk as possible, and to give babies all the nutrients they need to grow and be healthy.

Most cow's milk formulas contain:

Carbohydrates, in the form of the milk sugar "lactose"
Iron
Protein
Minerals, such as calcium and zinc
Vitamins, including A, C, D, E, and the B vitamins

Some formulas add other nutrients to make them even more like breast milk, such as:

Essential fatty acids. ARA and DHA are fatty acids that are important for the baby's brain and vision.

They're naturally found in breast milk when the mother includes them in their own diet. Many formulas add them. Yet there's not a lot of evidence that formulas supplemented with fatty acids offer kids any real advantages as they grow.

Nucleotides. These building blocks of RNA and DNA are also found in breast milk and added to some formulas.

They are thought to boost the baby's immune system and help the digestive organs develop.

Prebiotics and probiotics. Probiotics are "good" bacteria that might help protect against the "bad" types of bacteria that cause infection. Prebiotics promote the growth of these good bacteria in the gut.

Formula that's supplemented with probiotics may prevent babies from getting the skin condition eczema, but it doesn't seem to help with diarrhea or colic.

Babies who were born early (before 37 weeks) or at a low birth weight (less than 5 pounds, 8 ounces) need special nutrition to help them catch up on growth. Breast-fed babies may get a fortifier added to the milk, which contains:

Extra calories
Extra fat
Protein
Vitamins
Minerals

Babies who can't breast-feed will need a special formula made for preterm babies. These formulas are higher in calories. They also contain extra protein, vitamins, and minerals.

One thing you don't want to give your baby during the first 12 months is whole cow's milk. It doesn't have enough iron, vitamin E, and essential fatty acids for your baby. Also, it contains too much protein, sodium, and potassium for your child's body to absorb and can cause harm. Wait to introduce cow's milk until your baby is 1 year old.

You also don't want to give your baby soy milk or homemade formula. These substitutes may not have the balance of nutrition baby needs right now.

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Until you start introducing solid foods around six months of age, breast milk is a complete source of nutrition for most infants. However, some babies may need supplemental nutrients. Ask your doctor for advice.

Iron for Healthy Tissues and Organs

Why is iron important? Iron helps make hemoglobin, which carries oxygen throughout the body to all your baby's cells. Plus, iron is needed for your baby's brain development and growth.

Premature infants who breastfeed may need iron supplements. Born early, these babies had less time to build adequate iron reserves before birth. Thus, your preemie may need an iron supplement.

Around four months of age, full-term babies who are exclusively breastfed may also require an iron supplement due to their iron stores getting low. However, talk with your health care provider before adding an iron supplement. Between four to six months old, infants start to show signs of being developmentally ready for solid foods. Iron-rich sources are recommended as a baby’s first food, so this will also influence whether a supplement will be needed. If you are feeding your baby formula, also ask your doctor about iron needs. The American Academy of Pediatrics (AAP) recommends that if formula is used, it be iron-fortified for the first year of life.

Fluoride for Strong Teeth

Before you can even see them, your baby's teeth are already forming under the gumline. Fluoride, a mineral found naturally in water, helps develop strong teeth. And, it also helps to prevent cavities later. Although many sources of tap water are fluoridated, breast milk contains little fluoride. The amount of fluoride in formula will depend on the water that is used to prepare it. For the first six months, healthy babies will not need additional water if they are consuming enough breastmilk or formula. When babies are 6 months or older, the AAP recommends a fluoride supplement be discussed with your child's pediatrician or dentist to determine if it is needed

Vitamin D for Growing Bones

Vitamin D is the sunshine vitamin. Because, when exposed to sunlight, our skin can make vitamin D. However, you must protect your baby's tender skin from sunlight with sunscreen or clothing. Because infants can’t rely on the sun for their vitamin D, they may also need a vitamin D supplement.

This vitamin helps your baby use calcium from breast milk (and infant formula) to help bones grow and develop. Babies who do not get enough vitamin D may develop rickets. Rickets, which is weak bones, may cause the legs of young children to bow.

The AAP recommends all breastfed babies receive at least 400 International Units (IU) of vitamin D daily, starting within the first few days of life. Talk with your pediatrician about supplemental vitamin D drops for your baby.

All infant formula in the United States is fortified with vitamin D to help babies meet their needs. If your baby is only partially formula fed or if you're worried about your baby's appetite, ask your doctor if a vitamin D supplement is needed.

1. Willer CJ, Dyment DA, Sadovnick AD, Rothwell PM, Murray TJ, Ebers GC. Timing of birth and risk of multiple sclerosis: population based study. BMJ. 2005;330:120–4. [PMC free article] [PubMed] [Google Scholar]

2. Kamen DL, Cooper GS, Bouali H, Shaftman SR, Hollis BW, Gilkeson GS. Vitamin D deficiency in systemic lupus erythematosus. Autoimmun Rev. 2006;5:114–7. [PubMed] [Google Scholar]

3. Garland CF, Comstock GW, Garland FC, Helsing KJ, Shaw EK, Gorham ED. Serum 25(OH)D and colon cancer: eight-year prospective study. Lancet. 1989;2:1176–8. [PubMed] [Google Scholar]

4. Giovannucci E, Liu Y, Rimm EB, Hollis BW, Fuchs CS, Stampfer MJ, et al. Prospective study of predictors of vitamin D status and cancer incidence and mortality in men. J Natl Cancer Inst. 2006;98:451–9. [PubMed] [Google Scholar]

5. Thacher TD, Fischer PR, Strand MA, Pettifor JM. Nutritional rickets around the world: causes and future directions. Ann Trop Paediatr. 2006;26:1–18. [PubMed] [Google Scholar]

6. Hatun S, Ozkan B, Orbak Z, Doneray H, Cizmecioglu F, Toprak D, et al. vitamin D deficiency in early infancy. J Nutr. 2005;135:279–82. [PubMed] [Google Scholar]

7. Najada AS, Habashneh MS, Khader M. The frequency of nutritional rickets among hospitalized infants and its relation to respiratory diseases. J Trop Pediatr. 2004;50:364–8. [PubMed] [Google Scholar]

8. Ladhani S, Srinivasan L, Buchanan C, Allgrove J. Presentation of vitamin D deficiency. Arch Dis Child. 2004;89:781–4. [PMC free article] [PubMed] [Google Scholar]

9. Matsuoka LY, Wortsman J, Haddad JG, Kolm P, Hollis BW. Racial pigmentation and the cutaneous synthesis of vitamin D. Arch Dermatol. 1991;127:536–8. [PubMed] [Google Scholar]

10. Matsuoka LY, Wortsman J, Hollis BW. Suntanning and cutaneous synthesis of vitamin D3. J Lab Clin Med. 1990;116:87–90. [PubMed] [Google Scholar]

11. Matsuoka LY, Wortsman J, Haddad JG, Kolm P, Hollis BW. Racial pigmentation and the cutaneous synthesis of vitamin D. Arch Dermatol. 1991;127:536–8. [PubMed] [Google Scholar]

12. Matsuoka LY, Wortsman J, Dannenberg MJ, Hollis BW, Lu Z, Holick MF. Clothing prevents ultraviolet-B-radiation-dependent photosynthesis of vitamin D3. J Clin Endocrinol Metab. 1992;75:1099–103. [PubMed] [Google Scholar]

13. Matsuoka LY, Wortsman J, Hollis BW. Use of topical sunscreen for the evaluation of regional synthesis of vitamin D3. J Am Acad Dermatol. 1990;22:772–5. [PubMed] [Google Scholar]

14. Webb AR. Who, what, where and when: influences on cutaneous vitamin D synthesis. Prog Biophys Mol Biol. 2006;92:17–25. [PubMed] [Google Scholar]

15. Grant WB, Garland C, Holick MF. Comparisons of estimated economic burdens due to insufficient solar ultraviolet irradiance and vitamin D and excess solar UV irradiance for the United States. Photochem Photobiol. 2005;81:1276–86. [PubMed] [Google Scholar]

16. Reichrath J. The challenge resulting from positive and negative effects of sunlight: how much solar UV exposure is appropriate to balance between risks of vitamin D deficiency and skin cancer? Prog Biophys Mol Biol. 2006;92:9–16. [PubMed] [Google Scholar]

17. Wagner CL, Greer FR. Prevention of rickets and vitamin D deficiency in infants, children, and adolescents. American Academy of Pediatrics Section on Breastfeeding; American Academy of Pediatrics Committee on Nutrition. Pediatrics. 2008;122:1142–52. [PubMed] [Google Scholar]

18. Mahomed K, Gulmezoglu AM. The Cochrane Library. Oxford, United Kingdom: Update Software; 2002. Vitamin D supplementation in pregnancy. [Google Scholar]

19. Hollis BW, Wagner CL. Assessment of dietary vitamin D requirements during pregnancy and lactation. Am J Clin Nutr. 2004;79:717–26. [PubMed] [Google Scholar]

20. Moncrieff M, Fadahunsi TO. Congenital rickets due to maternal vitamin D deficiency. Arch Dis Child. 1974;49:810–1. [PMC free article] [PubMed] [Google Scholar]

21. Markestad T, Aksnes L, Ulstein M, Aarskog D. 25-Hydroxyvitamin D and 1,25-dihydroxy vitamin D of D2 and D3 origin in maternal and umbilical cord serum after vitamin D2 supplementation in human pregnancy. Am J Clin Nutr. 1984;40:1057–63. [PubMed] [Google Scholar]

22. Hollis BW, Pittard WB. Evaluation of the total fetomaternal vitamin D relationships at term: evidence for racial differences. J Clin Endocrinol Metab. 1984;59:652–6. [PubMed] [Google Scholar]

23. Brooke OG, Butters F, Wood C. Intrauterine vitamin D nutrition and postnatal growth in Asian infants. Br Med J (Clin Res Ed) 1981;283:1024. [PMC free article] [PubMed] [Google Scholar]

24. Javaid MK, Crozier SR, Harvey NC, Gale CR, Deninison EM, Boucher BJ, et al. Maternal vitamin D status during pregnancy and childhood bone mass at age 9 years: a longitudinal study [published correction appears in Lancet 2006;367:1486] Lancet. 2006;367:36–43. [PubMed] [Google Scholar]

25. Kreiter SR, Schwartz RP, Kirkman HN, Charlton PA, Calikoglu AS, Davenport ML. Nutritional rickets in African American breast-fed infants. J Pediatr. 2000;137:153–7. [PubMed] [Google Scholar]

26. Daaboul J, Sanderson S, Kristensen K, Kitson H. Vitamin D deficiency in pregnant and breast-feeding women and their infants. J Perinatol. 1997;17:10–4. [PubMed] [Google Scholar]

27. Basile LA, Taylor SN, Wagner CL, Quinones L, Hollis BW. Neonatal vitamin D status at birth at latitude 32 degrees 72’: evidence of deficiency. J Perinatol. 2007;27:568–71. [PubMed] [Google Scholar]

28. Jain V, Gupta N, Kalaivani M, Jain A, s0 inha A, Agarwal R. Vitamin D deficiency in healthy breastfed term infants at 3 months & their mothers in India: s0 easonal variation & determinants. Indian J Med Res. 2011;133:267–73. [PMC free article] [PubMed] [Google Scholar]

29. Hollis BW, Wagner CL, Drezner MK, Binkley NC. Circulating vitamin D 3 and 25-hydroxyvitamin D in humans: an important tool to define adequate nutritional vitamin D status. J Steroid Biochem Mol Biol. 2007;103:631–63. [PMC free article] [PubMed] [Google Scholar]

30. Wagner CL, Howard C, Hulsey TC, Lawrence RA, Taylor SN, Will H, et al. Circulating 25-hydroxyvitamin d levels in fully breastfed infants on oral vitamin d supplementation. Int J Endocrinol. 2010 (in press) doi: 101155/2010/235035. [PMC free article] [PubMed] [Google Scholar]