New Concerns Emerge About Nutritional Deficiencies in Infants and Toddlers
Children's Healthcare of Atlanta Study
Prompts CDC and Georgia Health Department to Investigate
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 SUPPLEMENTATION 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 supplementation. 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 exposure. 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 www.fda.gov/medwatch/how.htm . 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 adults. 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
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