"Research shows that exclusively breastfed Caucasian infants six months of age and younger living in a latitude comparable to the Midwestern United States can make adequate vitamin D with exposure to sunlight for 30 minutes per week (diaper only) or two hours per week (fully clothed without a hat) (Specker et al. 1985).
Since the most significant risks of sun exposure are based on sunburn and prolonged exposure to UV rays, mothers should always be prepared with protective clothing and to keep their nursling out of the sun after a brief period of exposure (Shaikh & Alpert 2004). Since the needed duration of exposure is highly individual based on the family's geographic location, skin pigmentation, lifestyle, and other factors, an informed decision about whether or not to supplement with vitamin D drops can be aided by both consulting a health care provider and by learning more about sunlight deficiency. Breastfeeding mothers, professionals, and advocates should educate themselves with the facts on vitamin D, nutritional rickets, and safe levels of sunlight exposure.
In order to balance the AAP's recommendation with practices that encourage exclusive breastfeeding, in her recent editorial published in the Journal of Human Lactation, M. Jane Heinig, PhD, IBCLC, recommended that lactation consultants "remind and reassure families that breastfeeding is the optimal method of infant feeding" and "advocate for international research on safe UVB exposure levels for infants and children" (Heinig 2003).
Are you and your baby at risk for vitamin D deficiency?
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. 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
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.
Adapted from the April 2003 LLLI media release, "Sunlight Deficiency, 'Vitamin D,' and Breastfeeding." More information is available online at www.lalecheleague.org/FAQ/vitamin.html.
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Heaney, R.P. et al. Human serum 25-hydroxycholecalciferol response to extended oral dosing with cholecalciferol. Am J Clin Nutr 2003; 77(1):204-10.
Heinig, M.J. Vitamin D and the breastfed infant: Controversies and concerns. J Hum Lact 2003; 19(3).
Nesby-O'Dell, S. et al. Hypovitaminosis D prevalence and determinants among African American and white women of reproductive age. Am J Clin Nutr 2002 Jul; 76(1):3-4.
Shaikh, U. and Alpert, P. Practices of vitamin D recommendation in Las Vegas, Nevada. J Hum Lact 2004; 20(1).
Specker, B. et al. Sunshine exposure and serum 25-hydroxyvitamin D concentrations in exclusively breastfed infants. J Pediatr 1985; 107:372-76."
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