The question of whether and what vitamins to give children is one that parents encounter early, receive inconsistent advice about, and often find confusing. The gap between what the NHS recommends and what parents are actually doing is significant: vitamin D deficiency in particular is endemic in the UK, yet supplementation rates remain low. This guide cuts through the confusion to provide clear guidance based on current NHS and NICE recommendations.
Healthbooq (healthbooq.com/apps/healthbooq-kids) covers infant nutrition and child health recommendations across the early years.
Vitamin D: The Most Important Supplement
Vitamin D is produced by the skin when exposed to UVB sunlight. In the UK's latitude, sufficient UVB for vitamin D synthesis is only available for approximately 4-5 months per year (typically April to September), and even then, cloud cover, time of day, skin pigmentation, and clothing coverage reduce effectiveness. Research by Susan Lanham-New at the University of Surrey, who has led major UK studies on vitamin D deficiency, and surveillance data from Public Health England consistently document that vitamin D deficiency is widespread across the UK population, with particularly high rates in exclusively breastfed infants and in people with darker skin tones.
Recommendation for infants: The NHS recommends vitamin D supplementation (8.5-10 micrograms per day) for all breastfed babies from birth to 1 year. Formula-fed babies who are taking at least 500ml of formula per day are covered by the vitamin D added to formula and do not need additional supplementation; those taking less than 500ml per day should supplement.
From 1-4 years, the recommendation is 10 micrograms (400 IU) per day.
Severe vitamin D deficiency causes rickets (softening and weakening of bones leading to deformity); less severe deficiency is associated with immune function, muscle weakness, and general wellbeing. The return of rickets in the UK has been documented in recent years and is attributed primarily to vitamin D deficiency.
Vitamins A, C, and D: The Healthy Start Combination
The Department of Health's "Healthy Start" vitamins programme provides free vitamins to qualifying families (those receiving certain benefits) containing vitamins A (233 micrograms), C (20mg), and D (10 micrograms) – the nutrients most likely to be deficient in UK children. These are recommended for all children from 6 months to 5 years, but free for qualifying families.
Healthy Start vitamins are also available to purchase from pharmacies. Generic children's multivitamin drops providing A, C, and D are a reasonable alternative where Healthy Start is not available or not preferred.
Vitamin K at Birth
Vitamin K supplementation at birth is a separate consideration. Vitamin K is essential for blood clotting; newborns have very low levels because it does not cross the placenta efficiently and breast milk contains only small amounts. Vitamin K deficiency in the newborn causes haemorrhagic disease of the newborn, which can involve serious bleeding including intracranial haemorrhage.
The NHS recommends vitamin K for all newborns: by intramuscular injection (single dose, most reliable) or orally (three oral doses: at birth, 1 week, and 4-6 weeks, or monthly if breastfed). This is offered to all newborns and is not optional from a safety perspective; parents who decline should be counselled on the risk.
Iron
Iron is not routinely supplemented for healthy term breastfed babies in the UK (iron stores at birth from maternal transfer are sufficient for approximately 6 months, after which complementary feeding begins). Premature babies and those born to iron-deficient mothers may need supplementation from approximately 4 weeks; this should be discussed with the neonatal or community team.
Formula milk is iron-fortified; formula-fed babies do not typically need additional iron.
When solid foods are introduced, including iron-rich foods (fortified infant cereals, meat, lentils, beans, dark green vegetables) is important, particularly for breastfed babies who rely on food sources from 6 months.
Fluoride
The NHS recommends that children in non-fluoridated water areas (most of England) use fluoride toothpaste from when the first teeth appear (1000ppm for children under 3, smear amount; 1000-1350ppm from 3 years, pea-sized amount). Fluoride supplements in tablet or drop form are not routinely recommended in the UK as they are in some other countries.
Key Takeaways
The NHS recommends vitamin D supplementation for all breastfed babies from birth, and for formula-fed babies who consume less than 500ml of formula per day. Vitamin D deficiency is common in the UK population due to limited sunlight exposure. The Department of Health recommends vitamins A, C, and D for all children aged 6 months to 5 years. Iron supplementation is not routinely recommended for healthy term babies in the UK but is important in premature babies and those with specific dietary restrictions. Multivitamin supplements designed for children (such as Healthy Start vitamins) provide an appropriate combination.
