The debate around supplementing breastfeeding babies with vitamin D continues. Not all experts agree this is necessary. However, there are newly recognized disease risks associated with vitamin D deficiency as documented in a report published in December 2008 Breastfeeding Medicine.
In a paper entitled, "Does Vitamin D Make the World Go ‘Round'?" the authors state that "vitamin D is now viewed not simply as a vitamin with a role in promoting bone health, but as a complex hormone that helps to regulate immune system function. Long-term vitamin D deficiency has been linked to immune disorders such as multiple sclerosis, rheumatoid arthritis, type I diabetes, and cancer."
According to Ruth A. Lawrence, MD, Editor-in-Chief of Breastfeeding Medicine, from the Department of Pediatrics, University of Rochester School of Medicine and Dentistry, "Vitamin D is a hormone not a vitamin and it is not just for kids anymore. Perhaps the most startling information is that adults are commonly deficit in modern society. Vitamin D is now recognized as a pivotal hormone in the human immune system, a role far beyond the prevention of rickets."
Adequate vitamin D in childhood may reduce the risk of developing osteoporosis (weakened bone disease) in later life. Vitamin D is also important for the immune system and the prevention of a range of autoimmune diseases, diabetes and cancer.
Dr Carol Wagner, member of the American Academy of Pediatrics (AAP) Section on Breastfeeding Executive Committee and who co-authored the report "Prevention of Rickets and Vitamin D Deficiency in Infants, Children, and Adolescents" Pediatrics, November 2008; vol 122, with Frank R. Greer said:
"Breastfeeding is the best source of nutrition for infants," but "because of vitamin D deficiencies in the maternal diet, which affect the vitamin D in a mother's milk, it is important that breastfed infants receive supplements of vitamin D".
This new recommendation follows a review of recent clinical trials on vitamin D that show 400 units of vitamin D a day not only prevents but also treats rickets, the bone-softening disease.
A sufficient amount of vitamin D stops children from developing rickets. Exposure to sunshine (our skin makes vitamin D from sunshine) is the best way to receive vitamin D, but there are problems with determining what is a safe amount of exposure to the sun. According to Anne Meerwood, director of the Breastfeeding Center of Boston Medical Center, "While a sunburn should be avoided, even a small amount of time spent outdoors was protective against deficiency [in the women]."
The peak incidence of rickets is in babies aged between 3 and 18 months, but there are also reports of the disease in older children and adolescents. Rickets continues to occur in the US and other western countries.
Current AAP recommendations:
- Babies who are fully or partly breastfed should start having a daily supplement of 400 IU of vitamin D within a few days of birth.
- Babies who are not breastfed, and older children, who consume less than one quart (about 2 pints or 1 litre) of vitamin D-fortified formula or milk a day should also be taking a daily supplement of 400 IU of vitamin D.
- Adolescents should also be taking a daily supplement of 400 IU of vitamin D if their diet does not give them this amount every day.
- Some children may need higher doses, for instance if they are taking certain medications that put them at higher risk of vitamin D deficiency.
- Healthcare providers caring for women during their pregnancy should consider monitoring their vitamin D levels, given the growing body of evidence that vitamin D is important for fetal development.
I'd love to hear what the Pediatricians and Family Practice doctors in your area are recommending. When you leave your comment be sure to tell us where you live since hours of sunlight vary around the world.