by Anne Eglash MD, IBCLC, FABM
What are the pediatric health problems associated with a low vitamin D level?
The main source of vitamin D is sunlight. Living in a northern latitude, insufficient sunlight exposure, dark skin, and exclusive breastfeeding are all associated with low vitamin D levels.
Infants who are not breastfed receive vitamin D supplementation via formula, but breastfeeding infants need to rely on either a vitamin D supplement, or adequate vitamin D levels in mother’s milk. Mothers in the USA are assumed to have low vitamin D levels in their breastmilk, which is why the American Academy of Pediatrics recommends 400 units of vitamin D as a supplement for all breastfeeding infants starting at birth.
The Institute of Medicine recommends 600units of vitamin D for healthy children ages 1-18.
Many families do not give vitamin D supplements routinely to their breastfeeding infants because of the inconvenience, cost, belief that breastmilk is a complete food, and their infant’s refusal to take it.
A 2017 article published in Global Public Health reviewed the health implications of a low vitamin D level during infancy.
What did the authors cite as pediatric health problems associated with a low vitamin D level? (choose 1 or more):
- A. Possible increased risk of autism, if maternal levels are low during pregnancy
- B. Low calcium absorption from food in the intestines
- C. Increased susceptibility to severe infections
- D. Rickets (lack of mineralization of the bones causing stunted growth)
- E. Under-developed dental enamel
- F. Delayed motor milestones
- G. Failure to Thrive
- H. Increased risk for type 1 diabetes mellitus
See the Answer
The answer is all of the above
Milk Mob Comment by Anne Eglash MD, IBCLC, FABM
I find that my breastfeeding families tend to be pretty laid back when it comes to supplementing their breastfeeding infants with vitamin D. After all, in the late 20th century, many physicians were not aware that breastfeeding infants needed extra vitamin D, and there were only sporadic reports of rickets in dark skinned infants in the USA. Now we are learning that low vitamin D levels in pregnancy and infancy may have long term health effects for the child.
Based on my experience, I believe that we can increase vitamin D supplementation in pregnant mothers and nursing infants by increasing education for families. My guess is that many families believe vitamin D is just for bones, and since they don’t see any bone problems in their infants, they may not feel compelled to supplement their infants. Some families might assume that their infants have enough sunlight exposure to provide sufficient vitamin D, but this is hard to determine, since the amount of sunlight needed depends on time of year and latitude, among other factors.
In addition, some of the typical vitamin D options at stores tend to be artificially flavored supplements that necessitate relatively large volumes (1ml), enough for babies to spit out in disgust. There are several products out there that provide 400 units of vitamin D3 in one simple tasteless drop. While these would likely increase compliance, they can might be hard to find in some communities.
Evidence indicates that mothers can take extra vitamin D while nursing to provide enough vitamin D in their breastmilk. A 2015 study published in the journal Pediatrics found that breastfeeding mothers who took 6400 units of vitamin D3 each day supplied an appropriate amount of vitamin D to their infants via breastmilk. Given that there is no firm recommendation on this yet, it would be reasonable to check an infant’s vitamin D level if relying on mother’s vitamin D supplement. Maternal absorption of vitamin D from supplements depends on the quality of the supplement, her health characteristics, and her body weight.