New Concerns Emerge About Nutritional Deficiencies in Infants and Toddlers

Children's Healthcare of Atlanta Study

Prompts CDC and Georgia Health Department to Investigate

Mar 29, 2001, 00:00 ET from Children's Healthcare of Atlanta

    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.
     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.
     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