Chapter 4 – Vitamins and Minerals

Breast milk provides all the necessary nutrients to support a baby’s nutritional needs in the first months of life. However, in recent times, two specific vitamin deficiencies have been identified as potential health risks for infants. By supplementing them, these risks can be prevented.

The first is vitamin K, produced by the bacteria in the intestinal flora and essential for blood clotting. During pregnancy, the fetus receives vitamin K from the mother in small amounts, as the placenta is only slightly permeable to this molecule. Moreover, in the first few weeks of life, the baby’s body produces little vitamin K because the intestinal flora is still immature.

A deficiency in vitamin K can lead to minor hemorrhages in the intestines, urinary tract, or—more seriously—the brain. This condition is called hemorrhagic disease of the newborn, and it may appear in an early form (within the first 2–3 days of life) or in a late form (between the 2nd and 12th week). Although rare, it cannot be ruled out. To prevent early-onset hemorrhagic disease and significantly reduce the risk of the late form, in Italy, every newborn is given 1 mg of vitamin K by injection immediately after birth. Other countries may use different dosages and administration methods (e.g., an oral supplement over the first 14 weeks of life).

The second recommended supplement for all infants is vitamin D. Found in small amounts in certain foods, vitamin D is mainly synthesized by the skin when exposed to sunlight. Its multiple roles in the body are still under study, but it is known to: Support immune system development, Be essential for calcium absorption and bone formation.

Although severe vitamin D deficiency is rare in Italy due to abundant sunlight, increased indoor lifestyles and sun-avoidance recommendations have led to mild deficiency in about 50% of children in recent years.

Therefore, a daily oral dose of 400 IU of vitamin D in drop form is recommended from birth until the end of the first year of life—unless the baby is already consuming vitamin D-fortified foods. In that case, parents should consult their pediatrician to avoid harmful overdosing.

Depending on specific needs, pediatricians may prescribe additional supplements: Formula-fed infants may benefit from: Probiotics, to support a healthy gut flora, DHA (docosahexaenoic acid), an omega-3 fatty acid important for nervous system development, found abundantly in breast milk. Breastfed infants may sometimes receive an iron supplement.

Starting from the appearance of the first baby tooth (around 6 months), the World Health Organization (WHO) recommends fluoride prophylaxis—a preventive measure against cavities that strengthens tooth enamel. WHO advises: Using fluoride toothpaste appropriate for the child’s age, Brushing twice a day from the eruption of the first tooth, Applying only a pea-sized amount each time, Toothpaste is significantly more effective than fluoride drops, as it acts directly on the teeth.