From the Guidelines
The most appropriate recommendation for this 2-month-old boy is continuing vitamin D supplementation (option C). This healthy, exclusively breastfed infant is growing well with all parameters (length, weight, and head circumference) within normal percentiles, and he is meeting developmental milestones appropriately. While breast milk provides excellent nutrition for infants, it contains inadequate amounts of vitamin D. The American Academy of Pediatrics recommends that all breastfed infants receive 400 IU of vitamin D daily starting shortly after birth to prevent vitamin D deficiency and rickets, as stated in the study by 1. This recommendation is supported by more recent guidelines, such as those from 1, which suggest that term infants up to 12 months of age should receive 400 IU/day of vitamin D.
Some key points to consider:
- The importance of vitamin D supplementation in breastfed infants is highlighted by the potential risks of vitamin D deficiency, including rickets and other health problems.
- The recommended dose of vitamin D supplementation is 400 IU/day, as stated in the studies by 1 and 1.
- Other options, such as stomach sleeping, babyproofing, introducing solid foods, and formula supplementation, are not appropriate at this time due to increased risks of SIDS, lack of mobility, and unnecessary supplementation for a thriving breastfed infant.
Overall, continuing vitamin D supplementation is the most appropriate recommendation for this 2-month-old boy, based on the evidence from 1 and 1.
From the FDA Drug Label
Pediatric doses must be individualized (see DOSAGE AND ADMINISTRATION). Caution should be exercised when Ergocalciferol Capsules, USP are administered to a nursing woman. In a mother given large doses of vitamin D, 25-hydroxycholecalciferol appeared in the milk and caused hypercalcemia in her child Monitoring of the infant's serum calcium concentration is required in that case (Goldberg, 1972).
The most appropriate recommendation at this time is C) Continuing vitamin D supplementation, as the patient is already receiving oral vitamin D supplementation daily and there is no indication to stop it 2.
From the Research
Recommendations for the Infant
- The patient is a 2-month-old boy who is exclusively breast-fed and has met all developmental milestones appropriately.
- He has no history of serious illness and receives oral vitamin D supplementation daily.
- Based on the studies, the most appropriate recommendation at this time is to continue vitamin D supplementation, as it may increase 25-OH vitamin D levels and reduce the incidence of vitamin D insufficiency 3, 4.
- The American Academy of Pediatrics recommends a daily intake of 400 IU of vitamin D for infants, children, and adolescents 4.
- Breastfeeding is protective against SIDS, and this effect is stronger when breastfeeding is exclusive 5.
Rationale for the Recommendation
- Vitamin D deficiency is common worldwide and can have adverse health consequences, such as growth failure and rickets 3, 4, 6.
- Exclusively breastfed infants are at risk of vitamin D insufficiency or deficiency, and vitamin D supplementation may reduce this risk 3, 4.
- The evidence suggests that vitamin D supplementation given to infants may increase 25-OH vitamin D levels and reduce the incidence of vitamin D insufficiency 3.
- However, there is insufficient evidence to determine the effect of vitamin D supplementation on bone health and the risk of vitamin D deficiency 3.