Vitamin D3

Vitamin D3 plays a key role in the metabolism of calcium and phosphorus. It is also involved in the normal development of the skeleton. In addition, vitamin D plays an important role in many other metabolisms in the human body. Its effects include a protective effect in cardiovascular disease, diabetes, metabolic disorders and autoimmune diseases. Among European children, vitamin D deficiency is common, especially in toddlers from risk groups, which include, among others, breastfed infants - in case of non-compliance with recommendations for vitamin D supplementation, children with inadequate sun exposure (too frequent use of sunscreen creams, prolonged stay indoors, wearing clothes that cover most of the body, living in northern countries in winter), obesity.

The latest Polish guidelines from 2013 recommend vitamin D supplementation from the first day of life in term newborns, irrespective of the way the baby is fed (naturally, artificially or mixed feeding) at a dose of 400 IU/24 h in the first 6 months of life.

Between 6 and 12 months of age, depending on the daily intake resulting from the infant's diet, vitamin D supplementation of 400-600 IU/24 h is recommended.

For children >1 year of age, even higher supplementary doses of vitamin D (600-1000 IU/24 h) are recommended, depending on body weight, during the months of September to April and throughout the year in case of insufficient sunshine during the summer. Vitamin D doses above the age of 6 m should be determined by a doctor.

Vitamin K

One of the roles of vitamin K is to maintain normal concentrations of clotting factors. Its deficiency - especially in newborns and infants under three months of age - can cause life-threatening haemorrhages. According to the latest recommendations (2016), all newborns should receive vitamin K at birth. Healthy newborns and those born at term: 1 mg intramuscularly or 2 mg orally in situations where intramuscular administration is contraindicated (haemophilia) or when parents do not consent to intramuscular administration. Premature infants should receive 0.5 mg of vitamin K intramuscularly - for weights below 750 g, intravenous administration is also possible.

The single dose of vitamin K that a newborn baby receives at birth, irrespective of the route of administration, does not provide protection against the late form of vitamin K deficiency bleeding, which occurs between the 2nd week and the 6th month of life. (usually in the first 3 months of life). The risk of bleeding is greatest for breastfed infants, due to the small amount of vitamin K contained in breast milk, in contrast to milk mixtures. The diet-dependent composition of the gut microflora, is also a factor that influences the amount of vitamin K in the body. Vitamin K is produced by Enterobacteriaceae bacteria, which are present in greater numbers in the digestive tract of artificially fed children. The bifidobacteria that predominate in the intestinal microflora of breastfed infants do not produce vitamin K. Therefore, further supplementation of this vitamin is indicated in breastfed infants.

From the 3rd week of life onwards. (from 15 days of age), breastfed infants born at or above 34 t.w. should receive vitamin K at a dose of 150 µg/day until the end of 3 months of age. Breastfed babies born before 34 t.c. should receive vitamin K at a dose of 25 µg/day during the same period. If the child urinates or vomits within one hour of administration, a repeat administration of the recommended dose is required.

Iron

Due to the rather rare occurrence of iron deficiency anaemia in Poland, according to expert recommendations there is no need for widespread iron supplementation in healthy, term-born infants and young children.

Prophylactic iron supplementation may be important for infants in risk groups including infants growing up in low socioeconomic families, living in an area with a high risk of iron deficiency anaemia, as well as children consuming insufficient iron-containing complementary foods.

Infants who are artificially fed should be given iron-fortified breast milk replacement products (4-8 mg/l). Follow-on feeding products should be enriched with this element, but due to a lack of sufficient data, experts have not determined the optimal iron concentration in such preparations.

All infants from 6 months of age onwards, should receive iron-containing complementary foods, such as meat and/or iron-fortified products.

The daily iron requirement for infants and young children is at least 10 mg.

Fluoride

Fluoride is essential for the normal mineralisation processes of bones and teeth. Symptoms of insufficient fluoride supply mainly include reduced enamel hardness, tooth decay and lower fracture toughness of bones.

According to the guidelines, fluoride preparations should not be given to infants during the first six months of life. Fluoride supplementation can be started between 6 and 36 months of age. The age at which fluoride supplementation should begin depends on the content of fluoride in the water consumed by the child and in other drinks and foods. Usually, supplementation is recommended when the fluoride concentration in the drinking water is less than 0.3 mg/l (0.3 ppm).

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Summary

Current dietary guidelines assume greater freedom regarding the order, how new foods are added to an infant's diet, that the child decides on the size of the meal and that strict portion sizes are not set. Parents must remember that they are the ones who have the greatest influence on shaping their children's eating habits, which is why it is so important to know the recommendations and apply them in everyday life. The freedom to introduce complementary foods must be dictated by the parents' common sense, which takes into account the child's need for all nutrients and thus ensures proper development.

The first part of the article can be found at this link.