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Vitamin D Supplementation in Breast-Fed Infants

Physician recommendation was significantly associated with parents' decision to supplement.

Breast-fed infants are at risk for rickets. In 2008, the American Academy of Pediatrics increased the recommendation for vitamin D supplementation from 200 to 400 IU/day for infants who are predominantly breast-fed. To examine vitamin D supplementation in breast-fed infants, investigators in Seattle surveyed 44 pediatricians in a practice-based network and 1140 parents of breast-fed infants (age range, 6–24 months) in 2006–2008. All infants were predominantly breast-fed for at least 6 months.

Among pediatricians, only 36% recommended vitamin D supplementation for all breast-fed infants, 32% recommended it for high-risk infants, 14% discussed the pros and cons of supplementation with parents, and 18% did not recommend it. Two factors were significantly associated with vitamin D supplementation: parental agreement that vitamins are important for overall health (odds ratio, 1.98) and recommendation by the child's doctor (OR, 7.76). Factors significantly associated with no supplementation included parental belief that supplementation is unnecessary (OR, 0.12) and that administration of vitamins is inconvenient (OR, 0.45). Only 44% of parents whose pediatricians recommended vitamin D supplementation actually gave it to their infants.

Comment: These results indicate that vitamin D supplementation in breast-fed infants is linked to physician recommendation. Parents trust their child's doctor. However, a number of issues remain: Some low-risk breast-fed infants (e.g., those with light skin who are exposed to adequate sunlight) might not need supplementation, and some parents do not adhere to their physician's recommendation to supplement.

— Howard Bauchner, MD

Published in Journal Watch Pediatrics and Adolescent Medicine February 3, 2010

Citation(s):

Taylor JA et al. Use of supplemental vitamin D among infants breastfed for prolonged periods. Pediatrics 2010 Jan; 125:105.

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Reader Remarks:

Review and add to remarks on this article

• Vitamin D
  Janice L Hinson, midwife, 12 Feb 2010 3:47 PM EST
  If this was true then why does not every breastfed baby get rickets. History of the human race does not... [more]
• Vitamin D
  Ronald M Hofman, Alger Pediatrics, Grand Rapids, MI, 1 Mar 2010 2:41 PM EST
  For 25 years, I never recommended supplemental vitamin D. The data on subclinical rickets applies to a small number of... [more]
• Vit D in pregnancy/lactation
  LE N, OH, 1 Mar 2010 2:41 PM EST
  We really need to start thinking beyond the box when it comes to manifestations of Vit D deficiency. Deficiency does... [more]

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