Vitamins & breastmilk
Do babies need vitamin D?
Thursday, September 15, 2005
The extra vitamin D is needed to prevent rickets, a once common disease marked by soft or deformed bones. Vitamin D helps the body absorb calcium, which strengthens bones.
This comes at the same time the American Academy of Pediatrics is reiterating its support of breastfeeding. A policy statement issued in mid-March says: "Breastfeeding ensures the best possible health as well as the best developmental and psychosocial outcomes for the infant."
Still, most experts agree breastfed babies need extra vitamin D—especially African-American babies, whose darker skin makes it harder to absorb the vitamin from the sun. But vitamin D supplements are not profitable in the United States, so companies manufacture a one-size-fits-all multivitamin drop, says Dr. Lawrence Gartner, chairman of the section on breastfeeding for the American Academy of Pediatrics and professor of pediatrics and obstetrics and gynecology at the University of Chicago.
Therefore, most babies are being given vitamins they don’t need, such as A and C.
It’s not harmful, but it’s not necessary, either, says Ruth Lawrence, a pediatrics professor at the University of Rochester School of Medicine in New York.
"Vitamin supplements are not recommended for a breastfed baby," says Katy Lebbing, a certified lactation consultant at La Leche League. "The exception might be vitamin D. Vitamin D is not meant to be in breast milk. The way babies are supposed to get vitamin D is sunlight. In this area, we don’t usually see a problem unless the baby has very dark skin or never ever gets outside."
Most doctors agree breastfed babies should get the drops, but hospital policies differ on when and how.
In the confusion, advocates worry mothers will get the wrong message and decide against breastfeeding.
And doctors have yet to address how to get babies to swallow these bitter drops.
It’s confusing. I should know.
When I gave birth to my daughter in mid-December at Loyola University Medical Center, I was determined to breastfeed.
I was shocked when a hospital employee brought my daughter back from the nursery with a bottle of vitamin drops she was supposed to receive once a day.
"Some babies don’t like the taste, so what we do in the nursery is just mix them in a little formula and put it in the nipple of a bottle," she said.
Formula? Bottles? I couldn’t believe it—but I was in no condition to protest.
The next day I asked the lactation consultant about the vitamins. She told me most babies don’t get enough vitamin D from the sun. For formula-fed babies, it’s not a concern, since vitamin D is added to formula. But breastfed babies need the drops.
She said I could give the vitamins straight from a dropper, but I should put them in the side of my baby’s mouth so she wouldn’t choke and get them in her lungs, causing pneumonia.
When I tried to give her the drops, she gagged and choked, wheezed and sputtered. I got them down, but then she spit up the drops, along with her last feeding.
My husband and I tried different ways to get her to take the orange-colored drops. Once he stuck the dropper in her mouth as I nursed her, but I was afraid she would think my milk tasted bad and refuse the breast.
Our pediatrician agreed that she should have the drops. But after a few more days of watching her spit up orange goo, I gave up. When we pressed our pediatrician, she said since my daughter is so fair-skinned, holding her in the light a few minutes a day would be enough.
Whom was I to believe?
The American Academy of Pediatrics began advising in April 2003 that babies receive vitamin D supplements "beginning within the first two months."
Some hospitals—such as Loyola—begin at birth.
At Edward Hospital in Naperville, preemies get vitamins in the nursery. Full-term babies are sent home with vitamins but don’t get them at the hospital, says Nicole Tracy, a pediatric dietician.
Other hospitals, such as Northwestern Memorial Hospital, Advocate Christ Medical Center and Hope Children's Hospital, feel it’s too much to ask a mother to worry about the drops right away and give them at the follow-up visit.
Oak Lawn pediatrician Zoe Alikakos says most parents give the vitamins from the dropper without difficulty. She is especially vigilant during the winter, when babies are less likely to be in the sun.
Supplements in the real world
During a 2001 conference at the Centers for Disease Control and Prevention in Atlanta, doctors and researchers discussed racial differences in babies’ need for vitamin D supplements. Everyone acknowledged rickets strike more African-American babies, yet the American Academy of Pediatrics recommends the same thing for all babies.
Breastfeeding advocates at La Leche League disagree with this recommendation. They say treating each mother and baby as a "unique pair" lessens the need for supplements.
Lebbing also takes issue with hospitals giving the drops in a bottle nipple. "Putting it in a nipple can set you up for a nipple confusion situation," she says.
Babies also receive supplements in other countries. In Germany, vitamin D is put on the mother’s nipple once a day before nursing.
In Canada, a vitamin D-only drop is available, says Gartner, which tastes better than the multivitamin drops here. Gartner says doctors should prescribe drops without the bitter-tasting B vitamin.
But Dr. James Raettig, medical director of the Newborn Nursery at Loyola, says it doesn’t matter which solution is given, and that there is no evidence to suggest drops interfere with breastfeeding. He says it is not hospital procedure to administer the drops in formula.
Gartner says the academy’s advisory on vitamin D supplements is open: "The way the wording is—within the first two months—allows leeway. For many mothers having to start the baby out the first few days when they’re just getting into the breastfeeding, giving the drops was just one more burden."
Gartner says a healthy mother taking prenatal vitamins during pregnancy gives her baby enough vitamin D through the placenta to last two months. Unfortunately, he says, many women don’t take prenatal vitamins.
Although my doctor suggested sunlight as an alternative, many pediatricians say sunlight cannot be relied upon. Because sunlight is difficult to measure, its effect on vitamin D absorption is hard to study. And there is the racial difference. Some doctors estimate African-Americans need 10 times the two-hour-per-week recommendation of sunlight.
Complicating matters, some studies show childhood sun exposure can be a risk factor for skin cancer.
"People say, ‘Why don’t you recommend 15 minutes of sun a day? That won’t cause skin cancer,’ " Gartner says. "Well, we don’t know that. We do know that giving vitamin D drops is perfectly safe."
The formula frenzy
Since formula is fortified with vitamin D, breastfed babies are at greater risk for rickets. Some health professionals fear women will hear the wrong message: Their breastmilk is deficient.
Others worry that formula makers—already feeling the financial crunch as more women breastfeed—will push formula as a solution.
In fact, a leading manufacturer of baby vitamin supplements is Mead-Johnson, the maker of Enfamil. Poly-Vi-Sol, a liquid supplement with vitamin D, comes with the Enfamil logo displayed on the box. In Canada, Mead-Johnson manufactures vitamin D-only drops in packaging that implies human milk is deficient, Gartner says.
Manufacturers can’t make big money from vitamin D since it can’t be patented, Gartner adds, leaving formula companies looking to exploit the issue.
"The only ones interested in making [vitamin D] would do so to market a product that has a big profit margin, like formula," says Gartner, who notes that formula companies give large contributions to the academy.
Gartner, a breastfeeding advocate, worries if the drops are not given, rickets could make a comeback and create negative publicity for breastfeeding.
Although the recommendation had its intended effect in my case—educating me about rickets and vitamin D—the message may not be getting to those who need it most.
Chinita Williams, an African-American mother from Chicago’s West Side, breastfed her daughter, Kourtney. Despite Kourtney’s increased risk of rickets because of her skin color, Williams says she was told nothing about the disease or vitamin D last August when Kourtney was born at Gottleib Memorial Hospital in Melrose Park. Her doctor never mentioned them, either.
"If it’s something that can affect her health, then, yes, I wish I’d known," Williams says.
Writer Alice Hohl was shocked to learn she'd have to give her newborn daughter vitamin D drops because she was breastfeeding.