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Rickets, a bone disorder caused by vitamin D deficiency,
appears to be on the rise in infants and toddlers who are exclusively
breastfed, particularly African Americans.
Because of this, the American Academy of Pediatrics
(AAP), will likely issue new recommendations that all
breast fed infants receive vitamin D supplements, in
the near future.
Although breastfed infants are more at risk for
a vitamin D deficiency, experts caution that breast
milk is still the best food source for infants.
Thirty cases of severe rickets have been seen in
the past 10 years in North Carolina, but 60% of those cases occurred in
the last 18 months, according to one report. All the
cases occurred in African-American babies who were exclusively breast
fed, and the cases were so severe the infants sometimes had
obvious bone abnormalities or even seizures.
In Georgia, the CDC found six cases of severe rickets
occurred in youngsters 7-21 months of age between January 1997 and June
1999. The children were breast-fed for at least 7 to 19 months and in
one instance, a child drank an unfortified milk substitute after being
weaned.
Although most diagnosed cases are especially severe,
doctors suspect there may be many more mild cases of
the illness that go undiagnosed.
"Any time there's a case report of a clinically
apparent deficiency disease it's likely there were more children that
were deficient that we weren't able to pick up," said Dr. Susan Baker,
chair of the AAP's Committee on Nutrition.
The vitamin D deficiency in rickets is a "failure
of the bony matrix to mineralize," Dr. Baker said. Bones become soft
and weak, and typically the legs bow outwards due to the weight of the
body. The condition can lead to skeletal abnormalities, and in severe
cases, seizures. While 50% of children under the age of five had the condition
in the late 1800s, the condition was thought to be relatively rare now
in the US.
One reason for the recent increase
may be the trend towards protecting babies from sunshine, the
primary source of vitamin D. The risk is especially great for darker skinned
infants, who have higher levels of skin pigment, which limits the amount
of vitamin D production triggered by the sun.
"Human milk unfortunately has very little vitamin
D," Dr. Baker said. According to the AAP, the answer may be to provide
breast-fed infants, regardless of race, vitamin D supplements.
In addition, adequate vitamin D levels are important
for older children and adults as well. Dr. Baker states that if fortified
milk is not a part of someone's diet, they should not rely on alternative
products such as soy milk or rice beverages, which are not always fortified
with vitamin D.
All commercially available infant formulas are fortified
with vitamin D, and formula-fed infants should not be given vitamin D
supplements, according to the experts, since too much vitamin D can be
toxic.
Meeting of the
American Academy of Pediatrics October, 2000 Chicago, Illinois
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