April 7, 2003 -- Babies, children, and teens should be taking vitamin D supplements -- either as drops or in pill form -- for good bone health. It's especially important for infants who are breastfed, since breast milk contains only small amounts of vitamin D, and a lack of this vital vitamin could seriously affect baby development.
That's the word from the nation's leading pediatricians, outlined in a new policy statement issued by the American Academy of Pediatrics. The statement appears in the April 2003 issue of Pediatrics.
"There's evidence that many children are vitamin D-deficient long before they show signs of rickets," says Frank R. Greer, MD, a member of the AAP's Committee on Nutrition, and professor of pediatrics at the University of Wisconsin at Madison. His committee helped write the new policy regarding baby development.
Rickets is a bone-softening disease linked with inadequate vitamin D intake, Greer tells WebMD. Weakened bones in small children result in bowed legs, soft skulls, and delays in crawling and walking. Doctors are seeing increasing numbers of children with rickets, he says.
Sunlight can be a major source of vitamin D, since skin can produce the vitamin. However, sun exposure is difficult to measure -- and is dangerous for young infants. In fact, parents are urged to keep babies younger than six months out of direct sunlight. Very early exposure to sunlight seems to greatly impact risk of skin cancer.
Most bottle-fed babies get enough vitamin D, since formula is fortified for optimal baby development, says Greer. However, doctors are encouraging new mothers to breastfeed their infants to boost immunity. With this comes a concern -- that baby development will be impaired if infants get too little vitamin D.
Signs of weakening bones are subtle, so damage may occur before there are any outward signs of a baby development problem, he adds.
Over-the-counter multivitamins are available in drop form for infants. Beginning in the first two months of life, a minimum of 200 IU of vitamin D per day promotes optimal baby development, Greer tells WebMD. "This should continue throughout childhood and adolescence. In fact, throughout our lives, we should all take at least 200 units a day. After age 65, we may need to take a little more."
The recommendation is "very reasonable," says Kumaravel Rajakumar, MD, pediatrician at Children's Hospital of Pittsburgh. "We've come to realize that rickets is indeed a problem for babies who are exclusively breastfed -- especially if they are dark-skinned in color. Those babies seem to be most at risk."
"I suppose it's possible," says Rajakumar. "I think if you measured the vitamin D in breast milk in any two women you would find the amount excreted would be variable. But 200 units a day is not a lot. And the current thinking is that the amount in breast milk is miniscule. Together, the amount would not be high enough to harm the baby."
Rajakumar concurs that infant formula contains levels of vitamin D sufficient for optimal baby development.