By Guest Commentary By Elaine Robertson Lactation consultant
QUESTION: I am breast feeding and I heard recently that breast-fed babies should be given vitamin D supplements to help prevent rickets. Is this true?
ANSWER: Although most people consider rickets to be a disease of the past in the United States, the American Academy of Pediatrics (AAP) recently issued a new recommendation that all infants, including those who are breast-fed, should receive vitamin D supplements to help prevent the bone-weakening disease. Under the new AAP guidelines, all infants should receive 200 IUs of vitamin D per day during the first two months of age and continuing throughout childhood and adolescence.
Before you make a decision about giving your baby any vitamin supplements, however, you should be aware that the incidence of rickets is still extremely rare in this country. The new recommendation by the academy was prompted by reports of only dozens of cases nationwide, out of the millions of breast-fed infants each year.
In addition, natural sunlight helps to produce vitamin D through the skin, and those of us living here in Southern California typically receive enough sun exposure throughout the year to create sufficient amounts of vitamin D to prevent rickets. The second source of vitamin D is food, and infants past 1 years old also will get vitamin D from a number of dietary sources, such as fortified cereals and eggs.
Vitamin D is needed for the metabolism of calcium and phosphorus in the body, which affects the amount of calcium that is deposited in the bones. Vitamin-D deficiency rickets weakens the bones in small children, resulting in bowed legs, soft skulls and delays in crawling and walking. In severe cases of malnutrition, infants can suffer sudden seizures and convulsions.
Experts attribute the slight rise in rickets in this country due to the fact that more Americans are limiting their sun exposure — and that of their children — because of growing skin cancer concerns. By limiting our sun exposure, we become more dependent on dietary sources for vitamin D. The risk for rickets is higher for darkskinned children because dark pigmentation is a natural filter for the sun, preventing them from absorbing as much sunshine as those with fair skin.
If you feel your infant is at risk for vitamin D deficiency, you should discuss the need for supplementation with your pediatrician first. Do not exceed the recommended daily allowance of 200 IUs of vitamin D. Too much vitamin D can be harmful, with overdoses causing nausea and vomiting, weight loss and possible kidney problems.
For more information about the AAP’s new guidelines on vitamin D intake, visit the their Web site at www.aappolicy.org. A complete copy of the AAP’s clinical report in the April 2003 issue of pediatrics can be located on this site by typing in “rickets” in the search function and then clicking on “Prevention of Rickets and Vitamin D Deficiency.” (Elaine Robertson, I.B.C.L.C., is an international board certified lactation consultant for Saint John’s Health Center in Santa Monica. Robertson teaches childbirth classes and prenatal breastfeeding classes to expectant parents. Call (310) 829-8944 for further information or visit Saint John’s Web site at www.stjohns.org.)
Originally published in the Santa Monica Daily Press print edition on April 29, 2003. Read the original PDF.