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Friday, May 15, 2009

vitamin D deficiency AAP statement

Vitamin D Deficiency Clinical Report

Patient FAQs

Here are some commonly asked questions and answers on the recommendations in the AAP Clinical Report, "Prevention of Rickets and Vitamin D Deficiency in Infants, Children and Adolescents."

1. Q. Why do babies and older children need vitamin D?

A. Vitamin D is needed to help your body develop strong bones.

2. Q: Why is it necessary to give vitamin D supplements to my breastfeeding baby?  Doesn't human milk have all the essential nutrients for babies?

A. The AAP recommends breastfeeding of infants for at least 12 months and for as long thereafter as the mother and infant desire. However, human milk does not contain enough vitamin D to prevent rickets. Sunlight is the usual source of vitamin D production in the skin.

3. Q: If my baby goes out in the sunlight every day or every other day for an hour or so, isn't that enough?

A: It may be enough sunlight exposure in some parts of the country throughout the year, but sunlight exposure is difficult to measure. Factors such as the amount of pigment in your baby's skin and skin exposure affect how much vitamin D is produced by your body from sunlight. In the more northern parts of the country during the winter, the amount of sunlight is not enough for any baby. Exposing infants and children's skin to sunlight has been shown to increase the risk for skin cancer later in life. We now recommend that infants and young children not be in direct sunlight when they are outside, particularly infants younger than 6 months of age. Sunscreens should be used on all children when in sunlight but it prevents vitamin D formation in the skin.

4. Q: Do I need to give vitamin D supplements to infants who are fed infant formula?

A. No. All formulas sold in the United States have a sufficient amount of vitamin D that infants need as long as they are given 27 to 32 ounces of infant formula per day.

5. Q: When I take my baby outside, I always cover all of his skin with sunscreen, just as the AAP recommends. Isn't that enough to protect him from cancer and yet give him vitamin D?

A: No, the sunscreen prevents the skin from making vitamin D.

6. Q: How do I give vitamin D to my infant?

A: Liquid multivitamin drops with vitamin D are available. If you give your baby the recommended amount from the dropper in the vitamin drops bottle, the baby will get all the vitamin D needed to prevent rickets.

7. Q: When should I start giving the vitamin D drops?

A: You should start during the first few days of life.

8. Q: How often do I give the vitamin D drops?

A: You should give the drops once a day, every day. But, if you forget one day, it is all right. The vitamin D is stored in the baby and there will be enough in the baby's body to prevent rickets.

9. Q: If I give the vitamin drops to the baby, will the baby not want to breastfeed?

A: No, the drops will not interfere with breastfeeding. The amount is very small and giving a few drops from the dropper in to the corner of the baby's mouth toward the cheek will not give the baby any problem with breastfeeding.

10. Q: Don't the vitamin drops taste bad?

A: Some vitamin drops do have a strong taste, especially the ones that contain vitamin B, but the triple vitamin drops that contain only vitamins A, C, and D taste all right.

11. Q: Do babies need vitamins A and C also?

A: Breastfed babies do not need vitamins A and C, but giving them these additional vitamins in this dosage is not harmful. In some parts of Africa, there is deficiency in vitamin A and those babies may also need the vitamin A.

12. Q: How long do I keep giving the vitamin D drops?

A: You should keep giving it until your child has weaned from breastfeeding and is receiving 27 to 32 ounces of infant formula every day. The AAP recommends that "infants weaned before 12 months of age should not receive cow's milk feedings but should receive iron-fortified infant formula". Once your child begins drinking at least a quart of vitamin D-fortified milk after 12 months of age, he/she does not need additional vitamin D drops or a tablet. If, however, your child drinks less than one quart of regular milk, you should give him/her vitamin D drops or a tablet. This recommendation applies to children of all ages and even to adults.

13. Q: How will I know if my baby or child has rickets from vitamin D deficiency?

A: Rickets is a disease of the bones and is difficult to diagnose clinically without an X-ray before your infant begins to walk, at which time there will be excessive bowing of the legs.  There may also be swelling of the wrists and ankles.  Many infants with vitamin D deficiency will have slow growth.  Some may have breathing and heart problems.

14. Q: My older children do not drink any milk. How can they get extra vitamin D?

A: There are the same concerns for protecting the skin of these children from direct sunlight exposure to prevent skin cancer later in life. Vitamin D-fortified milk is the  sole dietary source of vitamin D. Any child who is not consuming at least 32 ounces of vitamin D-fortified milk should receive vitamin D as part of a vitamin drop or pill to ensure adequate vitamin D intake. It is now recommended that even adults consume vitamin D in milk or vitamin pills.

February 2009

John C Kim MD

847-346-0846 FAX
773-321-8183 (best number)

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Personal Web site for John C Kim: KIDDOC.ORG

I am a pediatrician specializing in General Pediatrics, International Adoption Medicine, and in the diagnosis and coaching of families pursuing joy.