Adherence to Vitamin D Supplementation Recommendations for Breastfed Infants and Young Children: An Analysis of Canadian Community Health Survey Data Cycles From 2015 to 2018

In Canada, nutrition policy as outlined in the Nutrition for Healthy Term Infants recommendations, includes a daily vitamin D supplement of 10 μg (400 IU) for breastfed infants and young children to support adequate vitamin D status. To report on adherence to vitamin D supplementation recommendations for breastfed infants (≤12 months); and for children breastfed >12 months. Canadian Community Health Survey (paired-cycles 2015/2016 and 2017/2018) maternal experiences data for infants born 2012-2018 who received any breastmilk formed the sample (n=7079). Whether the infant was given a vitamin D supplement (yes/no), and the frequency (daily/almost everyday, 1-2/week, or <1/week) were surveyed. Weighted data (95%CI) were summarized according to breastfeeding history (exclusive to 6 months and continuing; partial to 6 months and continuing; stopped ≤6 months). Correlates of supplement adherence were explored using logistic regression. Overall, 87.1% (95%CI: 85.9, 88.3) of participants reported giving their infant (≤12 months) a vitamin D supplement, and of these 83.3% (95%CI: 81.9, 84.7) did so daily/almost everyday, 12.4% (95%CI: 11.1, 13.7) did so 1-2/week, and 4.3% (95%CI: 3.6, 5.0) did so <1/week. Lower adjusted odds of adherence were observed among participants reporting: stopped breastfeeding ≤6 months, lower education or income, recent immigration, and overweight pre-pregnancy body mass index; higher odds of adherence were observed in the western provinces. Mothers of children >12 months and breastfed (n=2312), 58.0% (95%CI: 54.9, 61.1) gave a vitamin D supplement daily/almost everyday. Adherence to providing a vitamin D supplement to breastfed infants is high in Canada. Nonetheless, we estimate that ∼27% of mothers are non-adherent to daily/almost everyday administration of a vitamin D supplement; and that adherence declines in children breastfed >12 months. Further promotion to support uptake of the current guidance may be necessary, particularly for parents of recent immigration or lower socioeconomic status.