Vitamin D Supplements & Breastfeeding
Today, Carole Arsenault of Newborn Nurses shares information on vitamin D supplements for breastfed babies:
A lot of breastfeeding moms ask me whether their baby needs a vitamin D supplement. The answer is yes; the American Academy of Pediatrics (AAP) recommends that all children receive 400 IU a day of vitamin D, beginning within the first few days of life. This is double the previous 2003 recommendation of 200 IU per day. The change follows data from new clinical trials, and the historical precedence of safely giving 400 IU per day to the pediatric population.
Importantly, clinical data show that 400 IU of vitamin D a day will prevent and treat rickets. (Adequate vitamin D through childhood also may help reduce the risk of osteoporosis, and in adults vitamin D may help prevent infections, autoimmune diseases, cancer, and diabetes.) Rickets continues to be reported in the United States in infants and adolescents and is preventable with adequate vitamin D, but dietary sources of vitamin D are limited and it is difficult to determine a safe amount of sunlight exposure to synthesize vitamin D per individual.
The greatest risk for rickets is in exclusively breastfed infants who do not receive vitamin D supplements.
The AAP report recommends:
"Breastfeeding is the best source of nutrition for infants. However, because of vitamin D deficiencies in the maternal diet, which affect the vitamin D in mother’s milk, it is important that breastfed infants receive supplements of vitamin D…Until it is determined what the vitamin D requirements of the lactating mother-infant dyad are, we must ensure that the breastfeeding infant receives an adequate supply of vitamin D through a supplement of 400 IU per day." - Carol Wagner, MD, member of the AAP section on Breastfeeding Executive Committee
Specifically, the new recommendations suggest that:
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Comments
I did not have any problem giving my baby vitamin D supplements, and I am not sure why someone would refuse to give it to their babies because they "think" the child was exposed to sun enough in the previous months. It is ridiculous.
The only problem I have with this post is that this recommendation was all over the news 7 months ago, and just now this nurse is sharing this info.
Posted by: Talita Feuerstein | May 12, 2009 7:26 PM | Reply to this comment
Hi Talita,
Thanks for commenting in. Yes, I agree that this isn't exactly breaking news, but through her work, Carole has encountered many new moms for whom this is unfamiliar territory. Given that, it seemed appropriate to share the information.
I also know that some parents are against vitamin D supplements and I encourage them to share their viewpoints here.
Posted by: Christine Koh (Editor) | May 12, 2009 8:24 PM | Reply to this comment
Your post does a good job of presenting the AAP party line, but no discussion is complete without the other side. The main concern for me is the idea that breast milk has "deficiencies." This is absolutely untrue and a very damaging attitude to pass on to new moms. It completely undermines the ongoing effort to get more moms to breast-feed. Most babies CAN get all the vitamin D they need from nursing and sunlight.
Here's my blog post that I wrote after researching the issue:
http://mamajoan.livejournal.com/747286.html
And here's an excellent article detailing the argument against vitamin D supplements:
http://tinyurl.com/2jmykz
If your baby actually tests deficient in vitamin D, or has underlying health issues, by all means give him/her a supplement. But recommending it across the board for all breastfed babies is not the answer.
Posted by: Joan L. | May 13, 2009 9:45 AM | Reply to this comment
Hi Joan,
Thanks so much for sharing your valuable links and perspective. I will say that when my daughter was nursing (3 years ago) this issue wasn't really even on the table (our pediatrician did recommend vitamin drops later on but honestly we were kind of lax about it) - I've always been a proponent of good natural nutrients through food, and Laurel seems to have turned out fine. :-)
Also, I just wanted to underscore that Carole is indeed pro-breastfeeding; she is a certified lactation consultant.
I do think your last point is an excellent one -- and perhaps I could have done better by adding an editorial caveat to that effect at the end of the post. Thanks for contributing!
Posted by: Christine Koh (Editor) | May 13, 2009 9:55 AM | Reply to this comment
Thanks for this post. I heard a bit about this before, but never got details. Our pediatrician doesn't prescribe the Vitamin D drops for the reasons mentioned by Joan. I'm glad to know more about the reasons behind the recommendation, though, so that I can make an informed decision.
Posted by: halloweenlover | May 13, 2009 10:29 PM | Reply to this comment
In response to some of the comments above:
Yes - the vitamin D recommendation was officially endorsed by the AAP 7 months ago but it has only been in the last one or two months that new moms have been calling and asking about it. Sometimes it take years for new data to become mainstream. My goal is simply to inform and educate new moms and dads about this recommendation.
This information in no way undermines breastfeeding. Over the last few years the incidence of rickets has increased significantly in newborns and as a lactation nurse in the hospital I have seen this. With increasing research vitamin D has been found to have many health benefits in addition it prevents the disease rickets. This recommendation is backed by much research and data. The AAP website has much more information regarding this topic including sources and information about the research.
The AAP recommends vitamin D supplements across the board. Pediatric experts recommend vitamin D based on the many health benefits for babies. Most of us do not get enough vitamin D from the sun. Whether or not to use this supplement is just one of many choices that parents make.
Posted by: Carole @ Newborn Nurses | May 17, 2009 4:12 PM | Reply to this comment