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 *********************************************** The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(TM) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html