Sunlight Deficiency, "Vitamin D," and Breastfeeding
From: LEAVEN, Vol. 39 No. 3, June-July 2003, p. 70.
The following Press Release was issued by LLLI in April 2003 in response to a clinical report from the AAP, which was published in Pediatrics.
Exclusively breastfed healthy, full-term infants from birth to six months who have adequate exposure to sunlight are not at risk for developing vitamin D deficiency or rickets. Rickets occurs because of a deficiency in sunlight exposure, not because of a deficiency in human milk.
"Vitamin D" is a steroid hormone—misclassified as a vitamin in 1922—that is produced in the body upon exposure of the skin to ultraviolet B (UVB) radiation in sunlight. Rickets is the bone-softening disease of childhood caused by inadequate exposure to UVB radiation.
Very few foods naturally contain significant amounts of vitamin D. The biologically normal and most common means of obtaining adequate levels of vitamin D for human beings, including infants, is through casual exposure of the skin to sunlight. Because the skin has a large capacity to produce vitamin D, adequate levels can be developed from partial exposure of the body to small amounts of sunlight well before sunburn occurs. According to the World Health Organization and United Nations Children’s Fund, small amounts of UVB radiation are beneficial for people and essential in the production of vitamin D. However, excessive sunlight exposure can cause sunburn and increase the risk of skin cancer.
Concerns about sunlight deficiency, vitamin D, and breastfeeding have been raised by a new American Academy of Pediatrics (AAP) clinical report. The AAP now recommends that all infants have a minimum intake of 200 IU of vitamin D per day beginning during the first two months of life.
Risk factors for developing vitamin D deficiency and rickets include low maternal levels of vitamin D, indoor confinement during the day, living at higher latitudes, living in urban areas with tall buildings and pollution that block sunlight, darker skin pigmentation, use of sunscreen, seasonal variations in UVB radiation, and covering much or all of the body when outside.
"No known risks of ‘vitamin D’ supplementation exist at the level recommended by the AAP. However, no research has actually investigated whether ‘vitamin D’ supplementation during the first six months has any negative consequences for infant health, such as vomiting and aspiration when supplementation is not tolerated, harmful alterations of the infant gut, or increased risk of infection," said Cynthia Good Mojab, MS, IBCLC, RLC, Research Associate in the Publications Department of La Leche League International. Therefore, parents may wish to talk with their healthcare providers about their infant’s risk of vitamin D deficiency and decide whether or not supplementation with this hormone is warranted for their infant.
For more information on vitamin D supplementation, go to www.laleche league.org or look for an article in an upcoming issue of LEAVEN.