Recently, the topic of whether or not babies need calcium supplements has caused heated discussion. In fact, there is already an authoritative view on calcium supplementation for infants and young children. Let''s use this article to review these often overlooked suggestions.

Before discussion, it is necessary to distinguish between vitamin D supplementation and calcium supplementation, although the effects of the two are somewhat consistent. Vitamin D''s main role is to promote the use of calcium, mainly by skin synthesis, vitamin D in milk or other foods are very few, so it is a nutrient generally lacking in babies. Calcium is very rich in milk, but its absorption rate is limited (ranging from 30% to 60%). The relationship between vitamin D and calcium is a bit like a gun and bullets, indispensable.

　　 Vitamin D supplementation is required by almost every baby; while calcium supplementation is not needed by most babies, with a few exceptions.

　　Recommendations on vitamin D supplementation:

　　 1. The American Academy of Pediatrics 2008 Guidelines for the Prevention and Treatment of Rickets and Vitamin D Deficiency recommends that all infants and young children ( Regardless of whether breastfeeding or not) at least 400 IU of vitamin D is added daily shortly after birth.

　　 2. The Chinese Dietetic Association''s "Dietary Guidelines for Chinese Residents 2007" recommends that breast-feeding infants should be supplemented with vitamin D 400-800 IU (North) or 400-600 IU (South) from 2 weeks after birth.

　　Interpretation:

　　 The American Academy of Pediatrics’ Guidelines for the Prevention and Treatment of Rickets and Vitamin D Deficiency (2003 edition) also advocates that breastfeeding infants should At least supplement vitamin D200IU. For infants fed with formula milk, when supplementing vitamin D, the vitamin D added to the formula milk should be deducted, and then the insufficient part should be supplemented to 400IU. But the new version (2008 version) has changed a lot, 400IU, no longer treat breastfeeding and formula feeding differently.

　　Dietary Guidelines for Chinese Residents 2007" recommends that breastfeeding should be supplemented with vitamin D400~600 or 400~800IU. There is no mention of formula milk feeding. According to the national standard GB10765-2010 of formula milk powder, the VD content in formula milk powder is (per 100 kilocalories) 42~100IU, which is roughly equivalent to 25~60IU per 100ml (different brands have different contents). To achieve 400IU, about 667~1600ml of formula milk is needed. Obviously, babies, especially babies under 6 months old, cannot meet all vitamin D needs with formula milk. Therefore, infants fed formula milk also need to supplement vitamin D.

　　Combining the above two guidelines, I think it is very necessary for babies to supplement vitamin D400IU every day. On the basis of breast milk and formula, after supplementing this dose, the baby no longer needs to be in the sun to meet all vitamin D needs. Of course, even if you are basking in the sun at the same time, you don''t have to worry about too much vitamin D.

　　 Individual infants may still have rickets (although less likely) after vitamin D supplementation. In this case, the vitamin supplement dosage should be increased or changed to vitamin D injection. The doctor decides according to the child''s condition.

　　About calcium supplements

　　American Academy of Pediatrics Guidelines for Prevention and Treatment of Rickets and Vitamin D Deficiency 2008 and Chinese Nutrition Society’s Dietary Guidelines for Chinese Residents 2007 Almost nothing mentions that babies should take calcium regularly.

　　 In fact, when breast milk or formula is sufficient, calcium intake is sufficient for babies. Adding vitamin D supplements to increase the absorption rate of calcium in milk is enough to prevent rickets, without the need for regular calcium. The so-called "adequate breast milk or formula milk" refers to pure breastfeeding or formula milk feeding under 6 months, and more than 6 months, taking 600 ml of breast milk per day or 600~800 ml of formula milk.

Of course, if the baby is found to have early symptoms of rickets, calcium supplementation is still required. The so-called early symptoms of rickets mainly include irritability, night terrors, night crying, sweating, and occipital alopecia, and the related laboratory indicators are positive. These manifestations lack specificity. For example, sweating and occipital baldness may also be caused by hot weather, so you should take calcium after being confirmed by a pediatrician.

　　Once a child''s rickets occurs, it is necessary to increase the dose of vitamin D and take calcium. This gives an illusion to many people that it seems that vitamin D should always be taken with calcium. This improper understanding has even been written into regulations or guidelines for the prevention and treatment of children''s rickets in certain areas (such as Shanghai), which has caused great misleading. In fact, as far as the prevention of rickets is concerned, the baby’s intake of calcium is sufficient when the amount of milk is sufficient. At this time, it is only necessary to supplement vitamin D to promote calcium absorption.

　　On the other hand, taking calcium for babies who do not need calcium supplementation is unnecessary and may pose a health risk, but there is no evidence that it is taken daily (unnecessarily) 100 to 200 mg of calcium will cause actual harm to the baby. This is not to encourage the misuse of calcium, but to eliminate unnecessary worry.