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Monday, January 30, 2006The Boston Herald ran an article over the weekend that talks about the resurgence in rickets and blames that resurgence partly on the increased rates of breastfeeding in the last few years. The article claims that mother's milk doesn't contain adequate amounts of Vitamin D and that many breastfeeding mothers refuse to supplement with Vitamin D drops, thus leaving their babies vulnerable to rickets.
From the article:
The boon in breastfeeding -- mother’s milk doesn't have sufficient vitamin D -- is partly to blame. Investigators at Boston Medical Center did a one-year study that found 81 percent of mothers giving birth -- predominantly black and Hispanic women -- and 76 percent of their infants were vitamin D deficient at the time of birth, Holick said. The study has been submitted for publication in a pediatrics journal.
While an increasing number of mothers breastfeed, breast milk doesn’t have an adequate amount of vitamin D, which enables the body to absorb bone- fortifying calcium, doctors said. Some pediatricians don’t tell mothers they need to give their babies vitamin D for fear that they won’t breastfeed -- which has many benefits.
I also found a statement from the La Leche League on the issue:
"Research suggests that people of color, especially religious or cultural groups who wear enveloping clothing should expose their babies' uncovered cheeks to sunlight for just 20 minutes a day to get the needed vitamin D. In cases where this is not possible or the mother is not getting adequate vitamin D, doctors may prescribe a vitamin D supplement for the baby. According to La Leche League International, the world's recognized authority on breastfeeding, rickets has rarely been found in fully breastfed infants. This is true even in northern climates where there is less exposure to sunlight, which activates the formation of vitamin D. Research has shown that human milk contains adequate vitamin D for at least the first 6 months of life."
Couldn't find any reference to their research though...I've heard that cited in a few places, but haven't read the studies.
What's interesting is that the Boston Herald article also mentions the obvious fact that sunlight is one of the primary sources of Vitamin D and that children are spending less time outside. It would seem to me that it's a little more likely that the lack of sunlight exposure may be playing a larger role here than breastfeeding.
Although Nora was exclusively breastfed for 6 months and drank breastmilk until she was about 13 months, we never supplemented with Vitamin D drops. When I spoke with my pediatrician, he said that as long as she had about 10-30 minutes of exposure to sunlight each day, she'd get all the Vitamin D she needed.
It makes me wonder if part of the issue here is not so much the lack of vitamins, but a city verses a country thing. Not sure how much time babies and children in cities like Boston and NYC, but out here in the midwest, there doesn't seem to be much trouble getting plenty of sun exposure for our kids. If anything, there's a movement to keep them lathered up with high SPF lotion and proper clothing to keep them from getting too much sun.
Nevertheless, the American Academy of Pediatrics changed their recommendations two years ago to suggest that infants receive a minimum of 200 international units of vitamin D per day. I looked up a few studies and most tended to focus on an increased risk of rickets in breastfed African-American babies, leading me to wonder if this is more of a genetic issue than a breastfeeding issue.