Vitamin D is a fat soluble vitamin that regulates the level of calcium and phosphorus in the body. Vitamin D is needed in bone metabolism to maintain and build strong bones and teeth. Vitamin D is also thought to play a role in reducing the the susceptibility to infection.

Low levels of vitamin D can cause weak bones, aches and pains, slow growth, muscle weakness, delayed walking, seizures, problems with the heart and depression.

In its severest form vitamin D deficiency causes a disease called rickets, where bones are so soft they change shape.


Vitamin D in Pregnancy


It is essential that maternal vitamin D deficiency is prevented and/or corrected during pregnancy in order to prevent babies being born with depleted stores. Current guidelines recommend that pregnant and breastfeeding women take a vitamin D supplement of 10 micrograms (400 units)

In some cases pregnant woman may require a higher dose of vitamin D. This should be always discussed with a health care professional before increasing the dose.

Sources of Vitamin D


The best source of natural vitamin D is sun exposure. Vitamin D is found in smaller amounts in the diet. Sources of dietary Vitamin D include: oily fish – such as salmon, sardines, herring and mackerel,red meat,liver,egg yolks.


Which Mothers are at risk of Vitamin D deficiency

Most of us are able to synthesise vitamin D through normal exposure of the skin to summer sunlight . The risk of deficiency increases where a mother lives in the Northern hemisphere, especially when at a higher latitude.

This risk is further increased where:


  • The Mother has darker skin pigmentation,

  • The mother breastfeeds

  • Where the Mother wears concealing clothing, preventing skin exposure to

sunlight

  • Mothers who spend a lot of time indoors or use sun creams, reducing skin exposure to sunlight

  • Mothers with a BMI >30

  • Mothers with gestational diabetes.

Which babies are at risk of vitamin D deficiency?


The amount of Vitamin D a baby receives from breast feeding depends on the mother’s Vitamin D status. Babies who have an increased risk of vitamin D deficiency are:

  • babies from multiple pregnancies (such as twins) as the mother’s vitamin D has to be shared between the babies

  • • babies born in the winter months (September to April)

  • • babies of mothers who have a body mass index of more than 30

  • babies of mothers who have gestational diabetes or type 2 diabetes.

  • Babies with darker skin types: these include babies with African, Afro-Caribbean, Middle Eastern or Indian ethnic backgrounds

Breast Fed Babies and Vitamin D supplements in the newborn.


It is advised that where a baby is breastfed that they should be given Vitamin D supplements. The recommended dose from UNICEF is 8.5 to 10 micrograms of vitamin D per day for the first year of life. Formula fed babies will only need supplementation if they are having less than 500mls of formula per day, as Infant formula is already fortified with vitamin D.

Vitamin D and Fluoride

Fluoride is not transferred through the breastmilk therefore in areas where fluoride is not added to drinking water it is recommend to give vitamin D with fluoride. There are differing opinions to whether babies under 6 months actually need fluoride supplementations , with much literature suggesting they do not need this until 6 months of age. Introducing a fluoride supplement to a newborn infant can cause indigestion and gas issues in the baby.

How To Give Vitamin D


Vitamin D comes in tablet form or drops. With the tablets, crush between two spoons and mix with a little milk or cooled boiled tap water. For the drop put onto a spoon or into the bottle







Summer suddenly arrived in Munich and in our classes this week we have been talking about how to keep the babies cool.

Research shows that babies have an increased risk of Sudden Infant Death (SIDS) if they get too hot. So what can you do to keep your little one cool?


At Home

Where possible keep the blinds down during the day in baby’s bedroom. At night have the window and bedroom door open. Using a fan is recommended though do not put the fan directly on baby.

The ideal room temperature for the baby is 16-20C ; although some days this can be hard to achieve. If using a sleeping bag for your baby make sure that it is a tog that is recommended for summer, and that they wear thinner nightwear underneath.

Making sure your baby has enough fluids.

On those warmer days we get thirsty, so it follows that our babies do too. If you are fully breastfeeding make sure you increase your fluid intake for yourself, whilst also taking into consideration the extra breast feeding you will be doing. Fully breastfed babies do not need any extra water until solids are introduced, but they will need more milk from you. If you are bottle feeding then you can give your baby a little cooled boiled water to quench his or her thirst in addition to their usual formula intake. On those warmer days and nights you may also find that your baby wakes more often as they are thirsty.

When you are out and about.


On these lovely summer days you want to be outside with your little one. Not only do you want to protect your baby from the sun you also want to make sure they do not over heat. Where possible avoid going outside in the midday sun, or if you are out try and find some shade. When protecting your baby from the sun use a a clip on parasol or sunshade for your pram; not only does this protect your baby from the sun but also keeps your baby cooler. Do not cover the pram with a blanket to protect them from the sun , as this can lead to over heating and increases the chance of SIDS.

Travelling by car


When travelling by car try and keep the car as cool as possible on hot days. Use sunshields on the windows, dress baby in cool clothing and use the AC unit to keep the car cool. If you are on a long journey make sure you take regular breaks so that your baby can be removed for the car seat and have a little time to kick around.

Sun Safety Tips

It is so nice to be out in the sun, it is a real mood booster and a natural source of vitamin D. But it can also be an enemy to us and our little ones.

Keep your little one out of direct sunlight. Make sure they are wearing a sun hat ( a 50SPF hat is ideal and there are many on the market). These are essential if your bay is in the carrier. Make sure any exposed area of skin has suncream applied, (and don't forget the bottoms of the feet). Re apply sun cream every two hours.

If your baby is old enough to go swimming make sure that if you are outside they have a sun hat, and a 50SPF all in one bathing suit.

When at the beach consider purchasing or renting an umbrella or sun protection tent for you baby to lie under.

Mosquitos and Ticks


In Munich there are many mosquitos in the evening. Like us some babies seem to be attracted to mosquitos and some not. Consider purchasing a mosquito net to cover the kinderwagon. Many mosquito repellents are not safe for little people -read the instructions; also be aware that some are not advised to use whilst breastfeeding. Other options are mosquito patches that you can insert into the kinderwagon or attach to your clothes. Also consider a mosquito net on the bedroom window to prevent you and your baby being bitten over night.

Ticks are carried by the deer, and have the ability to give humans Lyme's Disease. After a day outside check you and your baby for ticks. If you find one carefully remove, it is advised not to use tweezers. Put some antiseptic cream or tea tree oil over the site. Take note of the day you removed the tick. Signs of Lyme's Disease can appear between 10-21 days after the tick was found, though often difficult to recognise in babies. Always check with your kinderarzt if concerned.

FINALLY - DON’T GET DISTRACTED

A summer safety tip that can apply year-round. Don’t get distracted when you are out- phones being our biggest distraction! You need to be all eyes on these little people, especially when they start to move.

ENJOY YOUR SUMMER




Sudden infant death syndrome (SIDS) – sometimes known as "cot death" – is the sudden, unexpected and unexplained death of an apparently healthy baby. SIDS is rare and the risk of your baby dying from it is low. Data from the Lullaby Trust shows that 88% of SIDS deaths occur within the first six months. Although the cause of most SIDS is unknown, it is known that babies who are at higher risk are those born prematurely or with a low birthweight, and the risk is slightly higher in baby boys. SIDS usually occurs when a baby is asleep, although it can occasionally happen while they're awake. Although the risk of your baby dying from SIDS is low research has shown that parents can significantly reduce the chance of SIDS occurring by following safer sleep practices.



SAFER SLEEP PRACTICES

  • Put baby on their back for all sleeps – day and night – as this can reduce the risk of SIDS by six times compared to sleeping them on their front.

  • Share a room with your baby for the first six months – this can halve the risk of SIDS.

  • Keep your baby smoke-free during pregnancy and after birth – this is one of the most protective things you can do for your baby. Around 60% of sudden infant deaths could be avoided if no baby was exposed to smoke during pregnancy or around the home.

  • Never sleep on a sofa or armchair with your baby - this can increase the risk of SIDS by 50 times.

  • Do not co-sleep with your baby if: you or your partner has been drinking, is a smoker, has been taking drugs or is extremely tired; these factors can put babies at an extremely high risk of SIDS when co-sleeping. One study found that the risk of SIDS when co-sleeping is six times higher in smokers than in non-smokers.

OTHER POINTS TO CONSIDER.

Swaddling It is fine to swaddle your baby. However, make sure that the baby is always on his or her back when swaddled. The swaddle should not be too tight or make it hard for the baby to breathe or move his or her hips. When your baby looks like he or she is trying to roll over, you should stop swaddling. Pacifiers/Dummies Research has shown that using a pacifier/dummy helps reduce the risk of SIDS. If you are breastfeeding it is advised to wait until breastfeeding is well established, ie. 2-3 weeks before commencing the use of a pacifier. Not all babies are receptive to a pacifier, some babies just do not like them; if so do not worry. Bed-sharing Bed sharing is for the most part not recommended. But bed sharing is shown to be riskier when:

  • Your baby is younger than 4 months old.

  • Your baby was born prematurely or with low birth weight.

  • You or any other person in the bed is a smoker (even if you do not smoke in bed).

  • The mother of the baby smoked during pregnancy.

  • You have taken any medicines or drugs that might make it harder for you to wake up. You or your partner drank any alcohol.

  • You are not the baby's parent.

  • The surface is soft, such as a waterbed, old mattress, sofa, couch, or armchair.

  • There is soft bedding like pillows or blankets on the bed.

Baby’s Crib

  • Keep soft objects, loose bedding, or any objects that could increase the risk of entrapment, suffocation, or strangulation out of the baby's sleep area. This includes: pillows, quilts, comforters, sheepskins, blankets, toys, bumper pads or similar products that attach to crib slats or sides.

  • To keep your baby warm consider a “sleep sack” that is the appropriate size for his/her age; and thickness for the season.

  • Do not let your child fall asleep on nursing pillows or pillow-like lounging pads.

Use Caution When Buying Products There are many products on the market, claiming to make your baby sleep better, reduce the risk of SIDS, reduce the risk of a misshapen head etc. Before purchasing it is always worth to do a little product research. Resources such as The Lullaby Trust have good guidance on products.

Further Reading and Other Resources https://www.unicef.org.uk/babyfriendly/wp-content/uploads/sites/2/2018/08/Caring-for-your-baby-at- night-web.pdf https://www.healthychildren.org/English/ages-stages/baby/sleep/Pages/A-Parents-Guide-to-Safe- Sleep.aspx https://www.lullabytrust.org.uk/safer-sleep-advice/



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