Knew this one was coming.
Here's a reference to two good articles if you need them:
Good Mojab, C. Sunlight deficiency: A review of the literature. Mothering.
March-April 2003; 117:52-55; 57-63.
Good Mojab, C. Sunlight deficiency and breastfeeding. Breastfeeding
Abstracts. 2002; 22(1):3-4.
Generally, if the mother has sufficient vitamin D, her breast milk will have the normal amount of vitamin D and her baby will have stores of vitamin D that last until about the 2nd month. The reason this concern has surfaced is b/c of a *supposed* increase in rickets in bf babies, however, I have seen no study to document that, it is only anecdotal as far as I know.
The concern is b/c of fear of exposure to sunlight, mothers and babies will not get enough vitamin D. Vitamin D (which is not actually a vitamin but rather a hormone produced in the skin) is synthesized in the skin with exposure to the sun. There is concern b/c the use of sunscreen lessens the impact of the sun to produce vitamin D in the exposed person, as does smog. Also, it is known that dark skinned people are more vulnerable and need more sun and that women who wear clothing that covers the entire body may be at a higher risk.
According to Mojab 2003," sufficient levels of vitamin D can be developed from partial exposure of the body to sunlight well before sunburn occurs." (Good Mojab 2003)
She also says that caucasian babies under 6 months only need about 30 minutes per week in the sun in a diaper only or 2 hours per week fully clothed without a hat to obtain enough vitamin D.
It isn't completely understood, according to Mojab, how dark skin affects the process of producing vitamin D but studies have shown conflicting results. However, one study showed that dark skinned adults were able to produce enough vit D with sun exposure over time. No specific amount was mentioned, just biweekly over 6 weeks.
Further it seems as though sunlight is the "natural" way that humans are expected to obtain vitamin D b/c it is not naturally found in many foods in sufficient enough quanities to be significant.
Mojab explains it in this way, "Breastfeeding is biologically normal. Inadequate sun exposure is not. Exclusively breastfed infants who are inadequately exposed to sunlight
are at increased risk of vitamin D deficiency and rickets. Exclusively breastfed infants who are adequately exposed to sunlight are not at increased risk of vitamin D deficiency and rickets. Sunlight deficiency, a biologically abnormal situation, is the problem.
Breast milk is not "low" or "deficient" in vitamin D since vitamin D is not supposed to be obtain primarily through food sources.
The risk factors for low sunlight exposure include: Dark skin, indoor confinment (this is seen as a result, some feel, of inside day care and/or unsafe neighborhoods), living in more northern areas of the world, use of sunscreen, and covering the entire body when outdoors due to cultural expectations, and exposure to lead.
It *may* be helpful for some "at risk" infants to have the vitamin D supplements but it is not necessary IMO for "all" babies to be supplemented. I think we need to develop a research based criteria to determine who needs the supplementation and who does not. We also need to determine what else we can do to favorably impact the vitamin D level in the child through less invasive methods such as increasing safe sun exposure.
In the meantime the AAP feels perfectly comfortable recommending vitamin D supplements for all babies without any studies to demonstrate the safety of vitamin D supplementation. Might vitamin D supplementation negatively alter the baby's delicate balance in the gut, might it increase the risk for infection like iron supplements, might it make more mothers feel breast milk is inferior to formula?
All of those questions need to be addressed IMO before making a blanket recommendation for all bf babies.
I hope this helps to clear up this issue a bit.
Warmly
Kathy
