Dear all:

In addition to changes in the recommendations for iron supplementation (which it turns out was disputed by the Breastfeeding Section of the American Academy of Pediatrics), the American Academy of Pediatrics Nutrition Committee has also reduced the age of introduction of vitamin D supplements to as early as three days.  I distinctly remember commentary in the original report of the expert panel convened by the Centers for Disease Control and Prevention when parents complained to them about their infants developing rickets.  In this original report, they mentioned risk of aspiration for cod's liver oil.  In thinking about this, and knowing what happens when some parents use the push method of syringe feeding and choke their babies (I've seen this plenty of times) I cannot imagine that using a syringe to push a supplement into a three day old would be any safer.  Furthermore, I've seen enough babies who become orally defensive with this method when not instructed properly.  AND I've seen plenty of parents who complain because their pediatrician told them to start the vitamin D supplements at three days.  I will go back to the report and read it again, but I did not see ANY EVIDENCE to support pushing the recommendation from two months down to three days.  What was in the report was a lot of speculative leaps to health problems far later in life.  In order to push back the recommendation into the range where babies might choke or become orally defensive from a sugary liquid, I would want to see clear research that shows that there is a distinct difference in health outcomes between  those infants who are started at two months and those that are started at three days.  It is a far stretch to extrapolate from no research to claims of health outcomes that are essentially associational later in life.  

If anyone else has found a study that clearly shows a benefit from starting vitamin D supplements at 3 days and two months, I would really like to see it.  Especially given that there is potential new evidence that very high doses of vitamin D may be harmful.  I already know this because of an incident when a small dairy that used glass bottles for their milk (and the glass was clear which means the riboflavin is destroyed) thought if some vitamin D is good, more would be better.  There were very severe outcomes from the overdose of vitamin D in the population of children who were drinking that milk.  I know that vitamin D is the hot new vitamin (when it really is actually a hormone) and that we have neglected to look at the health outcomes, but we should always be careful to ensure we are also studying potential side effects very carefully when we introduce new treatments.  And, ingesting unnatural sources of vitamin D should be considered a "treatment" for an environmental problem.

Best regards,

Susan Burger

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