All dark-skinned infants and children who are breast-fed should be given 400 IU of vitamin D per day to prevent rickets, researchers recommend in the August issue of The Journal of Pediatrics.
As recently as the 1960s, rickets had become so rare in North America, but now reports of the illness have been on the rise, particularly in dark-skinned infants who are breast-fed without vitamin D supplementation.
To determine the characteristics of infants with rickets, the researchers tracked cases seen at two medical centers from 1990 to June of 1999. During that time, there were 30 cases of rickets. All children were African-American and had been breast-fed for an average of 12.5 months. The growth of most children, who ranged in age from 5 to 25 months, was below average. Sixty-five percent of the children were in the fifth percentile or below for length, and 43% were in the fifth percentile or below for weight.
Human breast milk contains 15 to 50 IU/L of vitamin D, which is inufficient to meet the recommended intake of 400 IU per day. The researchers also noted that a decline in the number of children receiving vitamin D supplementation and decreased exposure to sunlight might account for some of the increase in rickets cases.
Breast milk is still the "ideal nutrition" for infants and is not deficient in any way. But due to low levels of vitamin D in breast milk and the fact that melanin (the pigment that makes skin dark) filters sunlight, African-American infants who are breast-fed have a higher risk of developing rickets.
Most experts recommend that mothers give vitamin D supplements beginning at two months of age for all infants who are exclusively breast-fed, regardless of race. Children who are breast-fed but who also receive formula each day most likely receive enough vitamin D.
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