Here’s a guide to the most common supplemental nutrients your baby’s doctor may prescribe:
This vitamin, which is necessary for proper bone development and protects against diseases such as rickets, is naturally manufactured by the skin when it is exposed to sunlight. But because not all babies get enough sun to fill their vitamin D quota (about 15 minutes a week for fair-skinned babies, more for dark-skinned babies) due to protective clothing, sun screen and long winter months in certain instances, and because breast milk contains only a small amount of D supplementation for infants who are breastfed – often in the form of ACD drops (which contains vitamin A, C and D) – beginning within the first two months of life.
Since all the vitamins and minerals a baby need (including D) are provided by commercial baby formula, bottle-fed infants who receive more than 450 ml (16 fl oz) of formula a day do not need any additional supplementation. (Too much vitamin D can be toxic).
Since iron deficiency during the first eighteen months of life can cause serious developmental and behavioural problems, it’s important that babies get enough iron. Your newborn, unless premature or low birth-weight, probably arrived with a considerable iron reserve, but this will be depleted somewhere between four and six months of age.
If you’re formula feeding, iron-fortified formula will fill baby’s needs. Breast milk contains sufficient iron during the first six months, so if you’re nursing, there’s no need for supplemental iron until the half-year mark is reached. Once solids are started, you can guarantee that your baby will continue to fill his or her requirement for this vital mineral by serving up foods that contain meats and green vegetables. Adequate vitamin C intake will improve iron absorption, and once your baby begins taking a lot of solids, it’s a good idea to give a vitamin C food at meal so that the benefits of any iron taken are maximized. Supplement iron drops are not a first choice of babies (though they may be recommended for premature babies) because they are not well tolerated and can cause staining on the teeth. Also, the mineral can be toxic in large doses, so pediatricians use drops only when necessary.
Most doctors agree that babies do not need fluoride supplementation during the first six months; a fluoride supplement should be given if there isn’t adequate fluoride in your water system. If you’re uncertain of the fluoride levels in your tap water, your baby’s doctor may be able to advise you. Or you can call your local water company or water authority. If your water is from a well or other private source, you can have its fluoride content checked by a lab (ask the health department how to have this done). Then check with your doctor to see if any additional fluoride is necessary.
With fluoride, as with most good things, too much can be bad. Excessive intake while the teeth are developing in the gums, such as might occur when a baby drinks fluoridated water (either pain or mixed with formula) and takes a supplement, can cause ‘fluorosis’, or mottling (while striations appearing on the teeth). Excessive intake can also occur if a baby or young child uses fluoridated toothpaste, which they tend to swallow. The lesser forms of mottling are not noticeable or aesthetically unattractive. More serious mottling, however, is not only disfiguring, but the pitting can predispose the teeth to decay, eliminating the good that fluoride is supposed to do.
Babies and young children, because of their small size and because their teeth are still developing, are particularly susceptible to fluorosis. So be wary of overdose. Once brushing is started, don’t use toothpaste unless your baby insists (and then use a tiny drop, or you can choose an unfluoridated baby toothpaste). Cap the paste whenever it’s not in use, and put it out of baby’s reach – some babies and toddlers love to eat the stuff.