As I look at the AAP's recommendation to supplement all breastfed babies with
vitamin D, I am wondering how closely the infants were looked at who
developed rickets in the few studies that have been used to justify this new
practice. Were the babies' lead levels checked? Can't high lead levels impair
vitamin D metabolism? What about genetic predisposition to rickets? Is some
of this genetic in nature? Most of the reports of rickets are case studies
and anecdotal reports. Where are the population based studies that confirm
who is at risk and who is not? Since when did limited exposure of young
babies to sunlight cause skin cancer? We aren't talking about the
leather-faced old ladies who bake on the beaches for hours every day. Where
is the evidence from the American Cancer Society that babies cannot be taken
out in the sun for a few minutes a day? What are mothers supposed to do? Keep
them inside for 6 months and then slather them with chemicals? Will mothers
also be informed that high levels of vitamin D can be toxic? What happens if
mothers secretly sneak their babies out into the sun for a walk?

Mead Johnson has anticipated this news by making sure all of its discharge
bags have a coupon for its vitamin D preparation. Mead Johnson is the only
maker of commercial vitamin D for infants in the US and was quick to make
sure that mothers knew they had "deficient" breast milk. One wonders how much
lobbying they did behind the scenes to cash in on this windfall of new
customers. What about other sources of supplementation? Who will be
conducting safety studies on the side effects of this supplementation? I
think it will take more than a letter from breastfeeding advocates to change
this policy. I think we need a whole lot better research on this topic and
that this recommendation has been rendered in haste.

Marsha Walker, RN, IBCLC
Weston, MA

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