Vitamin D Association

The Vitamin D Association has identified what we believe is a serious error in the guidelines on vitamin D supplementation of breastfed infants in the UK, and other serious gaps in the avoidance of vitamin D deficiency in the South Asian and African community.  Put simply, the problem is that the UK guidlines do not recommend vitamin D supplementation of breastfed infants during the first six months of life as standard.  This early supplementation  is needed, and is standard practice in most other comparable countries.  For more background information about this, see our FAQ for parents.

Advice for Parents:

What does this mean to you and what should you do about it?:

If you are a white mother anywhere in the UK breastfeeding in Winter or Spring:

The risk: if you follow all of the current guidelines, our analysis is that your baby is at significant risk of vitamin D deficiency or serious vitamin D deficiency during the first six months of life. The main health consequences to be concerned about are a risk of impaired bone development, and impaired ability to avoid or manage infections.

Recommended actions if you want to avoid vitamin D deficiency in your child during the first six months of life:

1. First of all take all of the supplements recommended in the current NHS guidelines, for you as a preganant of breastfeeding mother - if you do not know what these are then ask your health professional or your chemist.

2. Speak to your GP and raise your concerns with them. Most likely they will be unaware of the issue. This is not their fault. Point them to this website. What you are asking them to do, is to support the decision, that the right thing is to give your baby direct supplementation with vitamin D3, beginning from the first few days of life, until you change to giving your baby the official recommended "healthy start" type drops at six months. You would be requesting that they follow the guidelines of other countries, e.g. USA, Canada, Germany, France, Ireland, Holland, Sweden, Norway, Finland etc

Links for your GP, to the USA and to the Canadian guidelines are here:

American Pediatric Guidelines 2008

Canadian Paediatric Society (CPS)

GPs in the UK are not able themselves to prescribe pure vitamin D3 preparations for infants without exposing themselves to legal risk ! So until this is changed, what you are after, is their advice on whether or not it is OK for you to buy the drops or other melt-in-the-mouth preparations yourself - they are available from many chemists, and you can order them online through Amazon. However, check with your GP that you are ordering is correct. You must consult with your GP, as there are rare conditions which might mean that your baby should not receive these supplements, and because all medication you give to a young infant should only be given with the support of your main health professional.  

Your GP may not be aware of this, but if you as a mother have not been following taking vitamin D supplements exactly as per the current official guidlines, the current guidline is that your GP or other health professional should be advising or prescribing that your breastfed baby receives a vitamin D supplemtn from the age of one month.  There is no medical basis that we know of for this additional delay. The exact wording of the current NHS guidline for health professionals is "If there is any doubt about the mother's use of vitamin D supplements during pregnancy and/or breastfeeding, the breastfed infants will benefit from vitamin D supplements from 1 month"

3. From the age of six months, follow the official NHS guidlines diligently.  This means giving your child a supplement of 7 micrograms of vitamin D per day until their sixth birthday.  This may be in the form of a multivitamin preparation - ask your health professional of chemist for advice.  The supplement should be of viatmin D3, not vitamin D2. Vitamin D3 is the natural form of vitamin D produced in our bodies, and it has not been established that vitamin D2 (the plant form of vitamin D) is equivalent to vitamin D3 in all cellular pathways.

4. If you are a white mother who is pregnant or breastfeeding in Scotland or Northern Ireland in winter or spring, the risks are much higher. We would in addition advise that, you have your own vitamin D level checked  (this is the standard of care in the USA and in Australia and New Zealand), and that if you are found to be deficient of 'insufficint', you request your GP to instruct you on how to correct the deficiency or 'insufficiency'. In vitamin D medical parlance 'Insufficiency' means deficient, but as deficient as 'deficient'!

5. If you think the current situation is highly unsatisfactory, or if your GP does not feel able to help, you may want to email the Chief Medical Officer of the region in which you live, detailing your experiences. Email addresses for all of the Chief Medical Officers in the UK are given at the bottom of this section.

If you are a South Asian or African in England or Wales and are pregnant or breastfeeding:

The risk: if you follow all of the current guidelines, your baby is at serious risk of acute vitamin D deficiency during the first six months of life. The health consequences to be concerned about are a serious risk of rickets, seizures, heart problems, and even death.

Recommended actions:

1. First of all take all of the supplements recommended in the current guidelines - if you do not know what these are then ask your health professional.

2. Our analysis is that if all you do is to follow current guidelines to the letter your baby will be at considerable and totally unacceptable risk of illness resulting from vitamin D deficiency.

3. Speak to your GP and point them to this website, including the links to the papers by Ahmed et al. 2011, and Sharma et al 2009 at the end of this section. You must insist on the following:

a. Having your own vitamin D status checked and corrected

b. Either having pure vitamin D drops for your infant prescribed, beginning in the first few days of life until 6 months old, or have instruction from your GP on what to buy and administer. Point out to your GP that the source document for the current guidelines (SACN 2007) includes the provision that, quote

"The UK RNI for vitamin D for all pregnant and breastfeeding women is 10μg of vitamin D daily, and for breastfed babies is 7-8.5μg daily from the age of six months or earlier if there is increased risk of deficiency by virtue of low maternal status. The UK RNI for vitamin D for all pregnant and breastfeeding women is 10μg of vitamin D daily, and for breastfed babies is 7-8.5μg daily from the age of six months or earlier if there is increased risk of deficiency by virtue of low maternal status. paragraph 109 page 35"

Point out that as a South Asian or African mother you clearly fall into the category of " low maternal status" . If there is any disagreement about this, ask to have your vitamin D level measured ASAP. If you have not been exactly following the guidelines on taking absolutely every vitamin D supplement every day yourself, you can tell your GP that your status is questionable, and on the current guidelines they have issued to them, (see here) they should start giving your baby a pure vitamin D3 supplement from 1 month. Hopefully your GP will co-operate, even though the Health Service may have made this difficult for them. In the worst case, if your GP refuses to cooperate, they are exposing themselves or their health service to the risk of a claim for negligence.

c. If you have difficulty getting the support we have advised, or if you think that the current position in terms of guidelines for the South Asian and African community is unacceptable, email the Chief Medical Officer of your region, and have this issue raised with your MP.

d. Follow the current guidelines diligently from age six months to 4 and a half years.

Information you might like to take to your GP:

American Pediatric Guidelines 2008

Canadian Paediatric Society (CPS)

If you would like to contact your Chief Medical Officer, below are their email addresses.

England: Professor Dame Sally Davies, CMOweb@dh.gsi.gov.uk

Wales: Dr Tony Jewell, tony.jewell@wales.gsi.gov.uk

Scotland: Sir Harry Burns, cmo@scotland.gsi.gov.uk

Northern Ireland: Dr Michael McBride, michael.mcbride@dhsspsni.gov.uk

Ahmed et al. 2011 and Sharma et al 2009

Link to SACN 2007: 

Link to NHS - Important information for health professionals

For more information, see our FAQ.