The AAP's recommendations for vit D supplementation of breastfed infants
includes the inaccurate statement:
Exclusively breastfed infants are at increased risk of vitamin D deficiency
and rickets. This is because human milk typically contains only small amounts
of vitamin D, insufficient to prevent rickets.
Human milk contains adequate amounts of Vit D to nourish infants if mothers
receive adequate sunlight to produce their own required levels. Admittedly
in the US some mothers are inside buildings both in summer and winter. And
if they are outside they are covered with sun screen which blocks their
skin from the beneficial rays.
So, given the current patterns of some American women, their breastmilk
will not contain adequate vit D for their infants. It is, of course,
difficult for a Ped to ascertain a given mother's healthful environmental
patterns, therefore the blanket recommendation for universal vit D
supplementation for breastfed infants.
Formula-fed infants, on the other hand, are adequately covered, as is made
clear by this AAP statement.
The statement also says:
"Vitamin D supplements, in drop or tablet form, are available over-the-counter
as part of multivitamin preparations."
Breastfed infants whose mothers are deficient in vit D, do *not* need vit
A, vit C, and iron. But there has been no call in the US for the pharm
companies to make a Vit D (along) supplement for such infants. I believe
that such Vit D supplements are available in other countries.
My clients are being told to give their infants Tri Vi Sol with iron "
because breastmilk is deficient in those vitamins" and that this
recommendation is from the AAP. A few are being told to give the Tri Vi Sol
with iron because "breastmilk doesn't have all of the vitamins that formula
has." When asked about the iron, the reply is "just to be safe."
Now, everyone on this list knows what message this sends to the masses in
our country.
If an infant needs vit D she should be prescribed vit D, not an aray of
synthetic supplements that will supplant the natural nutrients in her
mother's milk.
Dr Wight, do you know why the AAP has not asked the pharm companies to make
vit D supplements readily available?
Also, the initial reports of rickets were in infants of African American
motherswith limited sun exposure. Are there documentated increases in cases
of rickets in Caucasian mothers?
I find it disappointing to see how instantly the Peds embraced this AAP
recommendation while they are still giving orders for beginning solid foods
at 4 months, ignoring the 6-month recommendation that was stated 6 years
ago. I know that rickets is scarier than obesity but I suspect an
eagerness to find human milk deficient rather than sufficient for 6 months
of nutrition.
I understand that the ABM worked hard on this issue and if this is all that
can be done, I can live with it, but I do not accept the recommendation to
prescribe multi vitamin supplements instead of vitamin D.
I am recommending that my clients ask for a vit D supplement if it is
suggested that the need is there.
Pat Gima, IBCLC
Milwaukee, Wisconsin
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