Vitamin D Supplementation of Breast-Fed Infants
Regarding the new American Academy of Pediatrics (AAP) recommendation for vitamin D supplementation of exclusively breast-fed infants: Does living in a high-altitude, sunny climate alter the need for this supplementation?
David Pacini, MD
The AAP recently published new guidelines regarding the supplementation of vitamin D in all infants, including those who are exclusively breast-fed, with 200 IU/day of vitamin D. This recommendation is consistent with nutritional requirements for infancy promulgated by the National Academy of Sciences.
Rickets, a disease of vitamin D deficiency, is rarely encountered but still is reported by the practicing pediatrician in the United States today. It is clear that sunlight is important, but it is not the only factor necessary for prevention of rickets.
The adequacy of sunlight exposure is often difficult to interpret because there are covariates that affect its efficacy: pigmentation of the individual, geographic zones, exposure times, and body surface area exposure secondary to lifestyle or cultural factors. Furthermore, the relationship between what constitutes an appropriate amount of sunlight exposure for vitamin D formation is not readily available for study. In addition, the recommendation to limit sunlight exposure in infancy because of the increasing evidence that initial and prolonged exposure to sunlight and ultraviolet radiation increases skin cancer risk makes it more important to consider the AAP recommendations.
A recent case report of congenital rickets from the Mediterranean island of Crete, where there is an abundance of sunlight throughout the year, justifiably makes one anxious if it is assumed that sunlight is sufficient for the prevention of rickets in infancy. A full-term male infant presented with clinical and biochemical findings consistent with the diagnosis of congenital rickets: weak muscle tone, craniotabes, episodes of tremor, hypocalcaemia, elevated serum alkaline phosphatase, secondary hyperparathyroidism, decreased 25-hydroxyvitamin D, and normal 1,25-dihydroxyvitamin D serum levels. Treatment with calcium and vitamin D resulted in the disappearance of clinical findings of rickets and normalization of the infant's biochemical profile.
Both the National Academy of Sciences and the American Academy of Pediatrics recommend that supplementation with 200 IU per day of vitamin D is necessary for the prophylaxis of rickets in all infants. It seems prudent to follow these guidelines, regardless of the environmental region in which the infant lives.
Regarding the new American Academy of Pediatrics (AAP) recommendation for vitamin D supplementation of exclusively breast-fed infants: Does living in a high-altitude, sunny climate alter the need for this supplementation?
David Pacini, MD
The AAP recently published new guidelines regarding the supplementation of vitamin D in all infants, including those who are exclusively breast-fed, with 200 IU/day of vitamin D. This recommendation is consistent with nutritional requirements for infancy promulgated by the National Academy of Sciences.
Rickets, a disease of vitamin D deficiency, is rarely encountered but still is reported by the practicing pediatrician in the United States today. It is clear that sunlight is important, but it is not the only factor necessary for prevention of rickets.
The adequacy of sunlight exposure is often difficult to interpret because there are covariates that affect its efficacy: pigmentation of the individual, geographic zones, exposure times, and body surface area exposure secondary to lifestyle or cultural factors. Furthermore, the relationship between what constitutes an appropriate amount of sunlight exposure for vitamin D formation is not readily available for study. In addition, the recommendation to limit sunlight exposure in infancy because of the increasing evidence that initial and prolonged exposure to sunlight and ultraviolet radiation increases skin cancer risk makes it more important to consider the AAP recommendations.
A recent case report of congenital rickets from the Mediterranean island of Crete, where there is an abundance of sunlight throughout the year, justifiably makes one anxious if it is assumed that sunlight is sufficient for the prevention of rickets in infancy. A full-term male infant presented with clinical and biochemical findings consistent with the diagnosis of congenital rickets: weak muscle tone, craniotabes, episodes of tremor, hypocalcaemia, elevated serum alkaline phosphatase, secondary hyperparathyroidism, decreased 25-hydroxyvitamin D, and normal 1,25-dihydroxyvitamin D serum levels. Treatment with calcium and vitamin D resulted in the disappearance of clinical findings of rickets and normalization of the infant's biochemical profile.
Both the National Academy of Sciences and the American Academy of Pediatrics recommend that supplementation with 200 IU per day of vitamin D is necessary for the prophylaxis of rickets in all infants. It seems prudent to follow these guidelines, regardless of the environmental region in which the infant lives.