Breast-fed Babies May Need Extra Vitamin D

USA TODAY
Marilyn Elias

October 21, 2002

Babies who are breast-fed exclusively should get a supplement of 200 units of vitamin D a day, U.S. pediatricians are likely to advise in the next few months.

Increasing reports of rickets in babies and toddlers prompted nutrition experts at the American Academy of Pediatrics (AAP) to suggest the recommendation. The AAP executive board is expected to approve the change by early next year, says Ronald Kleinman of Massachusetts General Hospital, a key nutrition adviser to the group.

Infant formula is fortified with vitamin D, which deposits calcium salts in the bones and prevents the skeletal disease. But babies exclusively nursed get very little of the vitamin from breast milk. Direct sunlight is the other major source, but parents have been told to use sunscreen or keep babies in the shade to prevent burns and skin cancer.

Black babies who are breast-fed are especially vulnerable because their skin blocks absorption of the vitamin from sunlight, says pediatrician Frank Greer of the University of Wisconsin Medical School. He spoke on a weekend panel at the AAP meeting in Boston.

There's no national monitoring system for rickets cases, so an upswing in the disease can't be verified. ''But more cases are coming to our attention,'' says William Dietz , director of nutrition and physical activity at the Centers for Disease Control and Prevention. A study of levels of vitamin D in children is being started by the CDC and should reveal the extent of vitamin deficiency in the next couple of years.

Black babies absorb the least vitamin D in-utero and from nursing because their mothers have lower stores of the vitamin than white women, says Marsha Davenport of the University of North Carolina Medical School. About 42% of black women of childbearing age had insufficient levels of vitamin D in a national study, compared with 4% of whites, Davenport says.

Babies need 200 to 400 units of vitamin D a day, she says. Two cups of fortified milk contain 200 units. Doctors used to advise a supplement, but that has fallen out of favor. The younger the pediatrician, the less likely it was that he or she told parents that nursing babies needed extra vitamin D, a recent North Carolina survey shows.

Young rickets patients become bow-legged, their bones and muscles weaken and, in later stages, they suffer retarded growth and delayed motor development, Davenport says. Vitamin D can reverse the effects, but toddlers sometimes need corrective surgery.

''We don't want to discourage breast-feeding. We just want to make sure the babies get their vitamins,'' Davenport says.

La Leche League International, a pro-nursing group, won't oppose the anticipated AAP policy, spokeswoman Carol Huotari says.

More research is needed to confirm a link between the rickets cases and breast-feeding, says Katherine Barber, executive director of the African-American Breastfeeding Alliance, a pro-nursing education and support group for black mothers. ''We would support the policy, though,'' Barber says, ''because it's better to err on the side of safety.''

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