Breast-fed babies should get vitamins to avoid rickets

CHICAGO -- The American Academy of Pediatrics says all exclusively breast-fed infants should receive vitamin D supplements to prevent rickets, a bone-weakening disease doctors fear may be becoming more common.

Breast-fed infants should receive vitamin supplements beginning at 2 months of age and until they begin taking at least 17 ounces daily of vitamin D-fortified milk, the academy says in a new policy statement, being published today in Pediatrics magazine.

The academy recommends multivitamin supplements containing 200 international units of vitamin D, available as over-the-counter liquid drops or tablets. Supplements containing only vitamin D generally are too concentrated to be safe for routine use, it says.

The new recommendation also applies to:

Infants who aren't breast-fed but who don't drink at least 17 ounces of fortified formula or milk daily.

Children and adolescents who don't drink that much fortified milk, who don't get regular sunlight exposure or who don't already take multiple vitamins with at least 200 international units of vitamin D.

Breast milk contains small quantities of vitamin D and doctors used to think babies could get enough if they also spent time in sunlight, which stimulates the body to produce vitamin D.

However, concerns about skin cancer and recommendations that youngsters wear sunscreen and avoid excessive sun exposure may be putting some children at risk for vitamin D deficiency and rickets, said Dr. Nancy Krebs, head of the academy's nutrition committee.

The new recommendation, being published today in April's Pediatrics, was prompted by reports of dozens of cases of rickets nationwide in recent years.

"We really hope that this is a way to optimize the health of breast-fed infants and not in any way to discourage breast-feeding," Krebs said.

The federal Centers for Disease Control and Prevention highlighted concerns about rickets in a 2001 report about several Georgia youngsters hospitalized with the disease. They included breast-fed infants who did not receive vitamin D supplements.

Although reports are rising, it's not clear if the actual incidence of rickets has risen since there are no national statistics on the ailment, said CDC epidemiologist Kelley Scanlon.

Most recent cases of rickets have affected black children, whose skin does not absorb as much sunlight. Youngsters who spend a lot of time indoors, perhaps because of parents' long work hours or safety concerns, also are at increased risk.

Symptoms include high fever and seizures in infants, and bone pain, delayed walking, small stature and bowed legs in toddlers. Youngsters can be deficient in vitamin D months before symptoms are obvious. Blood tests can diagnose the disease.

Rickets can be treated with adequate vitamin D and sometimes braces or surgery, but short stature and bone deformities may be permanent if not corrected while children are still growing.

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On the Net:

Pediatrics: http://www.pediatrics.org

CDC: http://www.cdc.gov