Infancy

Adequate vitamin D status during the rapid period of growth and development that occurs during the first 12 months of life is crucial for the healthy development of the skeletal system.

Rickets, once thought to be eradicated, is beginning to reappear.  Over the last 4 to 5 years, there have been reports of up to 20 cases of rickets, among infants and toddlers attending paediatric hospitals in Dublin (Kennedy, 2006). In addition, rickets represents the extreme end of the spectrum of vitamin D deficiency, indicating that sub-optimal vitamin D status is prevalent amongst infants. This is a a matter of concern as the potential long-term effects of vitamin D insufficiency at the crucial stages of development between birth and 6 months are unknown.

Whilst infant formula is fortified with vitamin D (1.3µg/100ml), exclusively breastfed infants have a very limited intake, due to the low content of vitamin D in breast milk.  In addition, weaning diets of infants are usually low in vitamin D, as vitamin D is mainly found in oily fish, offal and eggs, as well as some fortified margarines, milk and cereals.  Therefore, regardless of whether babies are breastfed, partially breastfed or fed on infant formula during the first year of life, infants are at risk of having inadequate vitamin D intake.

In  the UK (Department of Health, 1998), Sweden (Axelsson et al. 1999), Finland (National Nutrition Council, 1999 ), Germany ( Deutsche Gesellschaft fur Ernahrung et al. 2000 ) and the Netherlands ( Health Council of the Netherlands, 2000 ) infants are recommended to take a daily supplement of 10μg vitamin D for prevention of rickets.  The Food Safety Authority of Ireland (FSAI) now believes there is a need for a vitamin D supplementation policy for infants (0-12 months) in Ireland (FSAI, Mar 2007) .  An interim measure until a new vitamin D3 supplement is made available is now in place.  This consists of supplementing all exclusively breastfed infants (particularly those who are dark-skinned) with 0.3ml of Abidec/day (provides 5µg of vitamin D), from birth until 12 months of age.  Partially breastfed infants should also be supplemented with 0.3ml Abidec/day from birth to 12 months of age, providing that they do not receive in excess of 500ml of infant formula per day.