ATLANTA, March 29 /PRNewswire/ -- Articles published in the April edition
of "Pediatrics" and this week's Centers for Disease Control and Prevention's
"Morbidity and Mortality Weekly Report" (MMWR) report cases of severe
malnutrition in toddlers and African-American breast-feeding infants. The
deficiencies stem from two very different factors: the increase of alternative
milk products consumed by toddlers and a lack of vitamin-D supplementation in
some breast-feeding infants. Vitamin-D is needed for the body to absorb
calcium, which is a critical mineral in building healthy bones.
PARENTS AND PHYSICIANS OFTEN UNAWARE OF THE IMPORTANCE OF VITAMIN-D
The "Pediatrics" article, authored by Norman Carvalho, M.D., of Children's
Healthcare of Atlanta, outlines two different cases of malnutrition caused by
young children consuming health-food beverages. In one instance the beverage
was not fortified with vitamin-D, and the child developed rickets, a bone
weakening and deforming disease. The other child developed kwashiorkor, a
potentially fatal protein deficiency, as the rice drink that he consumed
contained very little protein. In both cases, the parents were well educated
and health-conscious, providing regular medical care for their child. The
beverages were labeled "not intended for infant use," but did not specify
warnings for toddler consumption.
"Soy and rice beverages may look like cow's milk, but they often do not
contain the vitamin-D or protein that is needed for proper growth and
development for toddlers," Dr. Carvalho said. "These products should be
labeled with a caution regarding their consumption by toddlers and infants."
Nutritional rickets was once a major pediatric health scourge in the
United States. To combat rickets, commercially prepared milk has been
fortified with vitamin-D since the late 1920s. National rates for rickets and
protein energy malnutrition (PEM) are unavailable because neither condition is
now a reportable health disease. Rickets and other forms of malnutrition
mostly are found in developing countries.
"Because malnutrition is relatively uncommon in the United States,
physicians may be unfamiliar with its clinical features. We believe that
there are many more cases of malnutrition going unrecognized because of the
growing popularity of 'health foods' and changing social and environmental
factors in our society," stated Dr. Carvalho.
CDC AND GEORGIA HEALTH DEPARTMENT INVESTIGATE CASES -- BREAST-FED DARK-
SKINNED INFANTS ARE AT GREATEST RISK
In 1999 Dr. Carvalho reported his findings to the Georgia Health
Department and the CDC, which in turn reviewed hospitalized cases of rickets
and protein energy malnutrition (PEM) in Georgia. The additional research
uncovered a handful of other cases with rickets mostly stemming from breast-
fed African-American infants who did not receive vitamin-D supplementation.
"Breast milk is universally recognized as superior to infant formula
because it protects against childhood illness and is nutritionally
appropriate. However, some breast-fed infants may need a supplemental source
of vitamin-D, so parents should consult with their physician on whether or not
they should provide vitamin-D drops for their infants," said Dr. William
Dietz, director division of nutrition and physical activity at the CDC.
Although the vitamin-D content of human milk is low, many pediatricians
consider the combination of breast milk and sunlight exposure to provide
sufficient vitamin-D in most instances.
"Parents' lifestyle changes, concerns about skin cancers, poor air quality
and childhood allergies -- all of these factors keep babies indoors out of the
sunlight, and parents may be unwittingly depriving their child of the
essential vitamin-D that is needed for healthy bones," Dr. Carvalho said. He
suspects health care providers do not discuss the importance of vitamin-D with
new breast-feeding mothers.
A previous study published in "Pediatrics" in August 2000 uncovered
30 cases of African-American breast-fed babies and toddlers with nutritional
rickets. In each case there was a history of breast-feeding without vitamin-D
The American Academy of Pediatrics (AAP) is examining the issue of
vitamin-D supplementation. Currently it recommends vitamin-D supplementation
at 400 IU/d for breast-fed infants whose mothers are vitamin-D deficient or
for those not exposed to adequate sunlight. However, adequate sunlight
exposure may be complicated by skin pigmentation, environmental conditions and
the use of sunscreen. Furthermore, because sun exposure increases the risk of
developing skin cancer, there is concern about recommending increased
Because health officials are concerned that these cases represent a more
far-reaching problem, the Food and Drug Administration (FDA) recommends that
clinicians and health officials report cases of malnutrition associated with
the misuse of milk alternatives through the MedWatch system at
With 400 beds in two hospitals, Children's Healthcare of Atlanta is one of
the nation's largest pediatric health systems. Dedicated to enhancing the
lives of children through excellence in patient care, research, and education,
Children's addresses the unique needs of sick and injured children and their
families with specially trained physicians and staff, equipment designed for
young, growing bodies and a child-friendly environment. Children's has been
recognized for excellence across a broad spectrum of clinical specialties, and
has gained particular preeminence in the areas of hematology/oncology,
cardiology and transplant.
The journal "Pediatrics" is published by The American Academy of
Pediatrics, an organization of 55,000 primary care pediatricians, pediatric
medical sub-specialists, and pediatric surgical specialists dedicated to the
health, safety, and well-being of infants, children, adolescents, and young
To receive a copy of the "Pediatrics" report, contact the American Academy
of Pediatrics Office of Public Relations at 847-434-7877.
SOURCE Children's Healthcare of Atlanta