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Lactation Information and Discussion <[log in to unmask]>
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Mon, 31 Mar 2003 14:50:02 +0100
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Current guidance on vitamin supplementation in the UK is that babies
breastfed after 6 mths require vit supps of D and A. However, I would
make a guess that most don't use them - they would be free, so it's
not cost, but HPs have on the whole not really understood the policy,
and anyway, most will see very few babies still bf after six months.

The concern is mainly to do with Vit D and rickets - (see, for
example,  BMJ 1999; 318, 39-40; Mughal et al 'Florid rickets
associated with prolonged bf without Vit D supplementation').  This
paper describes just 6 cases, and the babies were all Asian (in UK
terms this means from ethic groups who originate in the Indian
sub-continent).  It's not a good paper - the definition of breastfed
is poor, as we don't know when  these babies had other foods, and
also there's no info on whether the babies got outside at all.

Four of the mothers wore concealing clothes, according to the paper.
It may be that the mothers and babies stayed indoors all the time -
who knows, because this paper doesn't ask them, and only looks at the
bf.

Other papers referenced by an article in Community Practitioner April
2002 make it clear that much of the UK concern refers to African and
Asian babies, in non-African and non-Asian settings. They may need
more exposure to the outdoors than white babies.

I can't find any good evidence for Vit A supplementation.  It's
probably linked with Vit D because it is another fat-soluble vitamin
- maybe it's easier to extract Vit A and D rather than D alone, I
don't know.

I think it's pretty certain that physiologically,  babies need to be
breastfed ad lib, *and* to have a 'normal' exposure to outdoors, in
order to synthesise enough Vit D. This should be simpler, and
cheaper, than dosing everyone with supps. Advice to *all* mothers
should be to get outside with your baby on most days, including the
winter, because it's our lifestyles that have changed, not
breastmilk! Like comments here say, this doesn't have to mean outside
for hours at a time.

Black and brown skinned babies here in the UK, especially the North
and especially in the winter, may be more vulnerable to vitamin
deficiency, but that too could be addressed by *asking* the mothers
do they want supps, or are they happy that they both (mother and
baby) get out of doors on most days of the year?

I tell mothers who ask about this that formula has the supplements
*added to it* - emphasises that formula is not magically endowed with
Vit D and A, and that their breastmilk is just fine, but a baby over
6 mths will get positive benefit from being outside on most days.

Heather Welford Neil
NCT bfc Newcastle upon Tyne UK

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