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In northern climates during the winter months when maternal and infant sunlight exposure is minimal, the level of vitamin D in breast milk may not be sufficient to maintain optimum skeletal growth. Infants from such regions fed only breast milk without supplemental vitamin D have lower bone mineral content, compared with those given a 10-ug daily supplement of the vitamin.5 Therefore, most experts recommend that breast-fed infants who do not get regular sunlight exposure should receive a supplement. Vitamin D supplementation should be at the level of 5-10 ug/day. Toxicity can occur if infants are given higher doses of vitamin D.

Newborn infants have low body stores of vitamin E and needs for the vitamin are high. The requirement for vitamin E increases as dietary intake of polyunsaturated fatty acids (PUFAs) increases, and human milk is rich in PUFAs. Also, because of reduced absorption of fat-so luble compounds, it is difficult for many infants to absorb sufficient vitamin E. During the 1960s and 1970s, infants were often fed formulas high in PUFAs, but with low vitamin E : PUFA ratios. These formulas caused vitamin E deficiency and anemia. Current formulas have been modified and now contain less PUFAs and more vitamin E. To compensate for poor intestinal absorption, infants may benefit from daily supplementation with 5-10 mg of vitamin E.

Vitamin K is important during the newborn period for normal blood clotting. However, the infant requirement for vitamin K cannot be met by usual levels in breast milk. Poor vitamin K status can lead to hemorrhagic disease of the newborn. Therefore, to prevent bleeding problems and provide adequate body stores, newborns often receive a single dose of 0.5-1 mg of vitamin K soon after birth.

Ample vitamin B6 is important for infant growth. Infants with low vitamin B6 intakes (less than 0.1 mg/day) may show signs of deficiency - irritability, digestive problems, and, if deficiency is severe, seizures.

Body stores of folate at birth are small and can be quickly depleted by the high requirements of growth. Although human milk contains ample folate, cow's milk has little. Moreover, if the cow's milk is boiled, folate levels will fall even further. Therefore, infants receiving boiled cow's milk or boiled evaporated milk need supplemental folate.

Because vitamin B12 is only found in animal foods, infants of vegetarians (vegans) who are exclusively breast-fed may develop anemia and neurological problems due to vitamin B12 deficiency.11 Lactating women who are vegetarians should consider taking a vitamin-B12 supplement - the vitamin will then be passed to their infant in their milk.

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