Thursday, April 23, 2015

Vitamin D requirement for BreastFeed infants

Concerns:
  • Vitamin D requirements cannot ordinarily be met by human milk alone which provides <25 IU/L to 78 IU/Lwhich provides <25 IU/L to 78 IU/L
  • breast milk alone does not provide infants with an adequate intake of vitamin D
  • The vitamin D content of human milk is related to the mother's vitamin D status, so mothers who supplement with high doses of vitamin D may have correspondingly high levels of this nutrient in their milk
  • Most breastfed infants are able to synthesize additional vitamin D through routine sunlight exposure
  • While the sun is a potential source of vitamin D, the AAP advises keeping infants out of direct sunlight and having them wear protective clothing and sunscreen

High Risk Groups:
  • Babies of mothers with darker skin types, particularly when living in high latitude areas such as the UK where the winter sun provides little or no access to vitamin D;
  • Babies and mothers who wear concealing clothing, preventing skin exposure to sunlight;
  • Babies and mothers who spend a lot of time indoors or use sun creams critically reducing exposure to sunlight;
  • Babies of obese mothers (BMI >30).
  • Rickets is also more prevalent among immigrants from Asia, Africa, and the Middle East, possibly because of genetic differences in vitamin D metabolism and behavioral differences that lead to less sun exposure

Need for Vitamin D Supplementation
  • It is essential that vitamin D deficiency is prevented and / or corrected during pregnancy in order to prevent babies being born with depleted stores. A baby born deficient in vitamin D will not restore their levels from breastmilk alone.
  • Healthy breastfed babies born to mothers (who have been taking 400mcg Vit D daily) should receive a vitamin D supplement from six months of age (as part of a multivitamin supplement)
  • if the mother’s vitamin D status in pregnancy is uncertain, or if she falls into one of the risk groups, vitamin D supplements for mother and baby should be started soon after birth
  • AAP recommends that exclusively and partially breastfed infants be supplemented with 400 IU of vitamin D per day [23], the RDA for this nutrient during infancy

Available Products
Adequate amounts of vitamin D can be achieved by currently available multivitamin products (Appeton, syrup multivitamins etc) containing 400 IU of vitamin D per mL
Prescription preparations of vitamin D have very high vitamin D concentration and are not for routine home use.
If an infant is weaned to vitamin-D fortified infant formula (consuming at least 1000 mL per day) or a child one year of age or older is weaned to vitamin-D fortified milk, then further supplementation is not necessary


References:
  1. www.uptodate.com
  2. http://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/
  3. http://www.cdc.gov/breastfeeding/recommendations/vitamin_d.htm
  4. http://www.unicef.org.uk/BabyFriendly/News-and-Research/News/UNICEF-UK-Baby-Friendly-Initiative-Statement-on-vitamin-D-supplementation-for-breastfed-babies/


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