by Amy Spangler
October 16, 2008

The recent decision by the American Academy of Pediatrics (AAP) to double the recommended daily intake for vitamin D in infants, children, and adolescents is one that all parents and health workers need to be aware of given the clinical significance of vitamin D.

In a clinical report, “Prevention of Rickets and Vitamin D Deficiency in Infants, Children, and Adolescents,” the AAP recommends, “that all infants and children, including adolescents, have a minimum daily intake of 400 IU of vitamin D beginning soon after birth.” This is twice the previously recommended amount of “200 IU beginning in the first two months after birth and continuing through adolescence.”

To ensure adequate vitamin D levels, the AAP recommends that exclusively and partially breastfed babies receive 400 IU of vitamin D each day starting in the first few days of life and continuing up until babies are weaned to at least 1 liter or 1 quart of vitamin D fortified formula or milk a day. Daily supplements (400 IU) are also recommended for those adolescents who do not drink adequate amounts of vitamin D fortified milk (100 IU per 8 ounce serving) or eat vitamin D rich foods (fortified cereals, egg yolks).

The importance of vitamin D cannot be overstated. Besides keeping bones strong, research suggests that vitamin D may also reduce the risk for autoimmune diseases (multiple sclerosis, rheumatoid arthritis), some cancers (breast, ovarian, colorectal, prostate), and type 1 and type 2 diabetes.

Rickets on the rise
Concern over vitamin D deficiency was prompted by a resurgence of rickets (poor bone growth in infants and children). For centuries, the primary source of vitamin D for adults and older children has been the UVB rays of the sun. Unborn and newborn babies have relied upon their mothers to meet their vitamin D needs—initially via the placenta and later through breast milk.

Until recently, the sun satisfied mothers’ vitamin D needs. But alterations in lifestyle and changes in environmental conditions have converted a previously safe source into an unsafe one. Moreover, changes in the environment have occurred so quickly, humans haven’t had time to adapt. The result is that a growing number of adults and children are now vitamin D deficient. Until researchers find a way to make adequate exposure to sunlight safe (assuming that’s possible), other sources of vitamin D must be identified.

Vitamin D (which isn’t a vitamin at all, it’s a sterol) occurs naturally in few foods, so any attempt to meet vitamin D needs through the diet requires that foods be fortified. It’s easy to fortify infant formula and cow milk, but fortifying human milk means fortifying breastfeeding mothers. Researchers are currently investigating this option, but there isn’t enough data at this time for researchers to make specific recommendations. Until then, the best option is to supplement exclusively and partially breastfed babies.

It’s not the milk, it’s the moms
Vitamin D supplementation was the subject of a recent post on baby gooroo, that was written in response to a New York Times article in which the mother of a child diagnosed with rickets was quoted as saying, “Breast milk is supposed to be an entire meal, dessert and drinks included.”

The fact is that human milk is an entire meal. What this mother (and many others) fail to understand, is the complementary role human milk plays in meeting breastfed babies’ vitamin D needs.

Human milk is not deficient in vitamin D as long as the mother has adequate vitamin D levels. If a mother is vitamin D deficient, then her ability to meet her baby’s vitamin D needs during pregnancy and while breastfeeding is affected.

It’s not the milk, it’s the moms.

The efforts of Drs. Wagner and Greer, authors of the AAP clinical report, in formulating the new recommendation are to be applauded.