The AAP policy statement on Vitamin D and the prevention of rickets is
appears to be finished but embargoed pending final AAP Board approval.  Larry
Gartner, MD, one of the primary authors of the statement had been struggling
with how to present a generic recommendation to supplement all breastfed
infants with 200 international unitsof Vitamin D per day and not imply that
breastmilk is somehow deficient or inadequate for normal full term babies.

The Academy of Breastfeeding Medicine, of which I am the current secretary,
was asked to comment on the draft AAP policy document.  Our response was
basically that all infants and children require Vitamin D for appropriate
growth and development.  Routes of obtaining adequate Vitamin D include
endogenous production from adequate sun exposure or dietary sources.  As our
lifestyles have changed much more rapidly than the content of human
breastmilk, endogenous production of Vitamin D has been sharply curtailed.
The use of sunscreens, avoidance of sun exposure, especially in dark skinned
and inner city populations has produced a recent increase in Vitamin D
dependant rickets. We were very concerned that the AAP statement be clear
that Vitamin D is designed to be produced endogenously, and that the emphasis
not be placed on suggesting this is a deficiency of breastmilk.

As predicted, the artificial baby milk companies are jumping at the bit with
ads at the ready suggesting that formula is a preferred food because it has
adequate amounts of Vitamin D. It is clear that Vitamins A & C are not
needed, and the AAP is urging industry (hopefully someone other than the
formula companies) to produce an inexpensive, single ingredient 200 IU dose
of Vitamin D.

Instead of targeting vulnerable populations such as dark skinned, inner city
populations, and religious groups who have very little exposure to sunlight,
the American Academy of Pediatrics appears to have chosen the politically
correct, but economically much more costly approach of recommending Vitamin D
supplementation for all breastfed infants.  Many of us would have rather seen
the previous recommendationsfor sunlight exposure as described in the
Nutrition Handbook, 4thEd. be utilized.  Much more research needs to be done
regarding maternal supplementation, necessary amounts of sun exposure in
various skin pigmentation populations and production of Vitamin D with the
use of certain sunscreens or light filtered through windows.

The Academy of Breastfeeding Medicine is also an international organization
and is  concerned with the possible effects of the AAP recommendation on
international populations where the supplemental vitamin may not be available
for financial reasons. We are very concerned about a recommendation that
infers that one needs to purchase something additional to make breastfeeding
nutritionally complete.

Nancy E. Wight MD, FAAP, IBCLC
Neonatologist, Children's Hospital and Sharp Mary Birch Hospital for Women
Medical Director, Lactation Services, Sharp HealthCare

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