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nutritional requirements for infants and toddlers
Calcium, Phosphorus, and Vitamin D
Formula fed infants generally consume more than the recommended daily allowance of calcium, phosphorus and vitamin D; breast fed infants consume less total calcium from breast milk but retain similar amounts to formula fed infants because of better absorption of calcium from breast milk.
The RDA for calcium is met by about 22 ounces of milk for children 1-3 years old. Vitamin D intake is not a problem for formula fed infants or those toddlers on vitamin-D fortified whole milk (400 iU/liter). Breast fed infants receive only about 22 IU/liter of vitamin D, and for this reason a supplement of 300-400 IU per day is often recommended for these children.
Breast fed infants are at risk for iron deficiency because while the iron in breast milk is very well absorbed, iron levels in breast milk are inadequate. About one fifth of unsupplemented breast fed infants develop evidence of iron deficiency by 9 months of age. Iron fortified cereal starting around 4 to 6 months greatly reduces the risk of iron deficiency. The American Academy of Pediatrics recommends supplementation of exclusively breast fed infants older than 6 months with 1 mg/kg/day (1/2 mg per pound per day).
Breast milk is low in vitamin K. Before mandated use of vitamin K in the newborn, the devastating hemorrhagic disease of the newborn stuck about 1 in 100 babies. This condition has been almost eliminated by vitamin K use at birth.
While adequate dietary fluoride helps prevent tooth decay, an unsightly mottling and structural weakening of the permanent teeth known as fluorosis has become more prevalent in the United States in recent years due to the widespread adoption of fluoride supplementation in public water supplies and fluoride toothpastes. Younger children get a significant amount of dietary fluoride simply by swallowing their toothpaste. For this reason, the current recommendation is to not supplement infants under 6 months, and to supplement only those children from 1 to 3 years old whose water supply contains less than 0.3 ppm of fluoride. Your health department or municipal water supply office can confirm the level of fluoride in your municipal water.