The American Academy of Pediatrics says "the normal breast-fed infant of the well-nourished mother has not been shown conclusively to need any specific vitamin and mineral supplement. Similarly, there is no evidence that supplementation is necessary for the full-term, formula-fed infant and for the properly nourished normal child."

Many physicians recommend supplements, nevertheless--especially for breast-fed infants.

The controversy on supplements usually revolves around the following:

* Iron--Although the amount of iron in breast milk is very low (0.3 milligrams of iron per liter), the infant absorbs almost half. In contrast, while iron-fortified formulas contain 10 to 12 mg per liter, babies absorb only about 4 percent, amounting to about 0.4 mg per liter to 0.5 mg per liter. In either case, those amounts of iron are adequate for the first 4 to 6 months, according to the American Academy of Pediatrics.

In the past, there was concern that iron-fortified formulas could cause gastrointestinal problems such as colic, constipation, diarrhea, or vomiting. But, based on several studies over the last 10 years, the American Academy of Pediatrics does not believe there is any evidence connecting these problems to iron and recommends that iron-fortified formula be used for all formula-fed infants.

* Vitamin D--Insufficient vitamin D can cause rickets, a disease that results in softening and bending of the bones. Although the amounts of vitamin D in breast milk are small, rickets is uncommon in the breast-fed term infant. This may be because, like the iron in breast milk, the vitamin D in breast milk is easily absorbed by the baby.

Sunlight is important for the formation of vitamin D, but probably as little as a few minutes exposure a day is all the baby needs, says Schanler, and exposure to the whole body isn't necessary--just the arms and face are enough.

* Fluoride--No one knows for sure if giving fluoride during the first six months of life will result in fewer cavities. Reflecting the uncertainty surrounding fluoride supplements, the American Academy of Pediatrics recommends starting fluoride supplements shortly after birth in breast-fed infants, but also says that waiting up to six months is acceptable. Because there is no fluoride in infant formula, that twofold recommendation also applies when ready-to-feed formula is used or when the water used for powdered or concentrated formula has less than 0.3 parts per million of fluoride.

FDA CONSUMER A REPRINT FROM FDA CONSUMER MAGAZINE (with permission) REPRINTED AND UPDATED FROM SEPTEMBER 1990 DHHS PUBLICATION NO.(FDA) 91-2236 Updated 2002

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Vitamin Supplements for Infants - Yes or No?