Infants with liver or kidney disease may need special attention to vitamin D intake and status. Although vitamin D toxicity is very uncommon, caution should be used to avoid extremely concentrated high doses found in some commercially available drops. Infant formula contains vitamin D, and most infants will reach an intake from formula of about 400 IU daily within the first 2 months of life if they are consuming routine cow milk-based formula.

These include the use of drops placed on the mother’s breast, dissolvable doses, and high maternal doses (approximately 6,400 IU daily).

Vitamin D is commonly provided to infants via drops for breastfed babies or via infant formula, although alternative dosing approaches exist for breastfed infants, which some families may prefer.

There are no strong data to support either routine testing of serum 25-hydroxyvitamin D or targeting high serum 25-hydroxyvitamin D levels (e.g., 30 ng/mL) in healthy preterm or full-term infants. Higher doses have not been consistently shown to have specific clinical benefits for healthy infants. Available research, as well as most guidelines, recommend an intake of 400 IU daily of vitamin D as adequate for bone health in preterm and full-term infants. However, the primary cause of rickets in premature infants is a deficiency of calcium and phosphorus, not vitamin D. Rickets is uncommon in full-term infants with a much higher risk in very premature infants.

Inadequate vitamin D in infants leads to increased risks of poor bone mineralization and ultimately rickets. Vitamin D is necessary for the active (transcellular) absorption of calcium and for skeletal health.

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