Hi Niki and all:
I'm Suzanne, a La Leche League Leader and hospital based LC in Cincinnati.
I won't be at ILCA because I will be speaking about vitamin and mineral
supplements and breastfeeding at a Leaders only seminar in Dayton, Ohio.
Here's my interpretation of the available literature but what the exam will
say I have no idea, of course.   The AAP recommends universal
supplementation of all infants beginning in the first two months of life
with 200 IU of Vitamin D, following the guidelines determined by the
National Academy of Sciences.  This is the minimum to prevent a deficiency
which can, long-term, lead to rickets.
Supplements are recommended, but not mandated, for the following and I quote
from Gartner, LM and Frank R Greer, Pediatrics Vol. 111 No. 4 April 2003,
pp. 908-910:
1. All breastfed infants unless they are weaned to at least 500mL per day of
vitamin D-fortified formula or milk.
2. All nonbreastfed infants who are ingesting less than 500mL per day of
vitamin D-fortified formula or milk.
3. Children and adolescents who do not get regular sunlight exposure, do not
ingest at 500 mL per day of vitamin D-fortified milk, or do not take a daily
multivitamin supplement containing at least 200 IU of Vitamin D.
The reasoning is that even in sun-rich nations, children and their mothers
avoid sunlight exposure due to skin cancer risks and cultural traditions.
Using sunscreen and having darkly pigmented skin prevent Vitamin D formation
by the skin.  If you are really interested, Cynthia Good Mojab has done an
exhaustive study of this topic, published in Mothering magazine no 117
March/April 2003.
A different question is how much to supplement.  A recent review article in
the American Journal of Clinical Nutrition (Vol 79, No. 5, 717-726, May
2004) by Bruce Hollis and Carol Wagner suggests that the recommendations are
basically shots in the dark and maybe the concentration should be on
lactating mothers and a daily intake of 2000 to 4000 IU.  Quite a bit
different from the recommended 400 IU at present!
Sunlight and cod liver oil are the best natural sources, in a nutshell, to
get enough Vitamin D into mother's milk.
Probably more than you wanted to know, sorry.  But it should be helpful to
know that infants and their mothers throughout the world struggle with the
same dilemma, it is not just an American phenomenon.
Good luck, stay relaxed!
Suzanne

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