In response to Pearl Shifer's request for information on routine vitamin
administration to breastfed infants:

        The American Academy of Pediatrics does not recommend routine
vitamin D administration to all breastfed infants, but suggests that there
are some infants who need vitamin D supplementation because of infant
condition, maternal condition or lack of exposure of infant and mother to
sunlight.  Premature infants need vitamin D supplementation and probably
should continue to receive vitamin D after discharge from the hospital.
Some infants, particularly in climates with long winters and prolonged
periods of little sun and those with life styles which preclude exposure of
mother and infant skin to sunlight, require vitamin D supplementation.
Normal, well nourished mothers with some daylight exposure have adequate
amounts of vitamin D in their breastmilk.  Infants exposed to daylight for
several minutes each day produce adequate amounts of vitamin D.
        A few breastfed infants with rickets are reported in every urban
area every year.  Identifying those infants who require vitamin D
supplementation is not always easy and some physicians have opted to
recommend vitamin supplementation for all infants.  It is clear that this
is not necessary, however, if some judgement is used based on history.
        More research is needed in this area to more clearly define the
mechanisms that result in rickets in those few breastfed infants who
develop it.  In addition to dietary and sunlight deficiency, it has been
suggested that those infants who develop rickets may require a higher than
normal intake of vitamin D, an intake which is not met by the approximately
50 units of vitamin D supplied per day by breastmilk.  Formula and bottled
whole milk contain 400 units of vitamin D per quart, which is more than
adequate to prevent rickets and well above the amount that most infants
require.  Experience from years back demonstrated that excess vitamin D
(800 or 1,000 units per day) can produce renal injury.  400 units per day
is a safe level, even if higher than the minimal requirement.
                                Larry Gartner


PLEASE NOTE NEW AREA CODE FOR PHONE & FAX

Lawrence M. Gartner, M.D.
Professor of Pediatrics and Obstetrics/Gynecology
The University of Chicago
MC6060
5841 S. Maryland Avenue
Chicago, IL 60637
Phone: (773) 702-0389
FAX: (773) 702-0764
E-Mail: [log in to unmask]