I’m a nursing student at the University of North
Dakota and am currently in the second semester of my
junior year in the program.  I've been reading a lot
about the increasing incidence of rickets and vitamin
D deficiencies in the U.S. in the archives and the
topic was very interesting to me.  Previously when
this problem arose, a variety of foods were fortified
with vitamin D to curb it (Massachusetts Medical
Society, 1999).  Since then, it seems that the problem
has recurred.
        What I have gathered from the postings is that the
main question is whether or not vitamin D
supplementation is necessary for breastfeeding mothers
to help prevent deficiencies.  Gartner and Greer
(2003) state that human breast milk does not meet the
recommended guidelines of 200 IU per day; it usually
contains only about 10% of that.  Sun exposure may be
able to compensate for the lack of vitamin D, but
there are a lot of discrepancies regarding how much
sunlight without sunscreen is safe. The amount of
sunlight needed for infants with darker skin is more
than the amount of sunlight needed for infants with
lighter skin as well, which poses a larger problem for
those children.  The AAP guidelines recommend that
children under six months of age be kept out of direct
sunlight, and that children should wear sunscreen and
participate in activities that minimize their amount
of sun exposure (Gartner and Greer, 2003).
        Serwint and Spence (2004) have made the suggestion
that primary prevention is necessary to prevent
vitamin D deficiencies in children.  They argue that
the minimum recommended amount of vitamin D necessary
with supplements (200 IU per day) is not enough; that
just because an infant does not have any signs of a
deficiency, it does not mean that they do not have
one.  Because of this, supplementation of vitamin D
should be increased.  Many women breastfeed for the
first six months or so after their child is born and
then start them on formula.  Formulas in the U.S. have
more than adequate amounts of vitamin D in them (400
IU/L or more) so why is this deficiency still such a
problem?

REFERENCES:
Gartner, L.M., & Greer, F.R. (2003, April).
Prevention of Rickets and Vitamin D     Deficiency: New
Guidelines for Vitamin D Intake.  American Academy of
Pediatrics Clinical Report, 111, 908-910.
Massachusetts Medical Society.  (1999).  Safer and
Healthier Foods.  Morbidity and Mortality       Weekly
Report, 48, 905-913.
Serwint, J.R. & Spence, J.T. (2004, January).
Secondary Prevention of Vitamin D-      Deficiency Rickets.
 Pediatrics, 113, 70-72.




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