Birth, pregnancy & breastfeeding related articles of interest

A little girl sits on the floor playing with her new birthday present: a baby doll and a toy bottle. This child’s mother believes strongly in the importance of breastfeeding. What difference does it make if the little girl plays with baby bottles?

Some argue that playing with bottles is harmless - it’s just a toy, after all. Some argue that allowing such play shows children all the options, so that they can make an “informed choice” when they have their own babies someday. Some argue that they as parents will make sure their children are taught the importance of breastfeeding. So what’s the harm?

Realistically? How many children in the world are not aware of what bottles are for? Use of formula milk is so widespread that an awful lot of people think of formula as normal and breastfeeding as the earth-mother, crunchy-granola, “poor person’s” option. If we constantly present the two “options” of breastfeeding and formula-feeding side by side, and follow each message about breastfeeding with “but you know … some women can’t breastfeed and then formula is just fine,” then we undermine the normalcy of breastfeeding. Truthfully, breastfeeding is not yet regarded as the normal thing. Ours is a bottle feeding culture, whether we live in North America, Asia, or almost anywhere on earth.

Removing bottles from the toy chest doesn’t “shelter” children. Playing with bottles goes beyond teaching children informed choice. Having bottles around to play with sends a subtle message that bottles are normal. Anything that’s around every day - especially something that children grow up with - becomes part of the normal scenery. Bottles should be something unusual. Do we keep empty syringes (without needles) around in case our children become diabetic later in life? Empty pill bottles so they know that drugs are always an option to treat whatever ails them? Pictures of cesarean births framed on our walls alongside the art prints of waterbirths so that kids won’t feel bad if they end up with a cesarean - they’ll just think it’s a normal alternative?

Can’t we just tell our own children that breastfeeding is the best choice?

Children are influenced by so many things in our culture - bottle feeding messages come through each day by the thousands, on TV and in the movies, in magazines and books, in health classes at school, on the signs and brochures at the doctor’s office, at your kid’s friend’s house where the mother bottle feeds, and on and on. How many commercial birth announcements or congratulations cards do you see that have a baby bottle on them? Check out the standard clip art on your computer - how many items can you find that have a baby bottle in the picture? And how many have breastfeeding images?

We can have all the serious conversations in the world with our kids about supporting breastfeeding, but those words may still not be able to compete with the physical presence of bottles - that old saw about a picture being worth a thousand words is all too true!

Will girls who don’t play with bottles feel guilty if they decide to formula feed?

Some women say they tried everything to make breastfeeding work, but could not, and then they were made to feel guilty. They say this is a double blow - first the failure to breastfeed, then feeling like a failure. But if a woman has tried everything she can to breastfeed and cannot, why should she feel guilty? What more could she have done?

Guilt comes from within - no one can make us feel an emotion. If we are comfortable with our decisions, other people’s opinions have nothing to do with it.

If we give our girls and boys bottles to play with so they will “know their options,” isn’t this about trying to make sure they won’t feel guilty if they choose that option? Bending over backward to make formula feeding a “normal” option doesn’t help women to escape guilt. That only comes from within. What normalizing formula does is take away from the normalcy of breastfeeding. Far more women suffer from the effects of being told “oh, just use a bottle, dear - you’re putting yourself through too much!”

We should be concentrating on building a culture where breastfeeding is truly the norm. That culture would give proper support to women as they learn to breastfeed. It would also marginalize formula feeding to where it belongs - available to the few who truly need it. If it’s truly needed, there’s absolutely no reason to feel badly about using it.

In recent years, women have been taking a much more active role in their pregnancies than ever before. As times have changed, people have noticed in our country that pregnancy is often viewed as a nine-month illness requiring doctor and hospital visits, drug therapies, episiotomies, cesarean sections and more. Parents are realizing more and more that pregnancy is a natural process that is, for the most part, under their control. They are taking prenatal classes, consulting midwives, reading, researching, preparing birth plans and becoming more conservative. Expectant parents are more educated than ever before regarding birth issues for themselves and their unborn children. At the Healing Hands Chiropractic and Wellness Centre, we believe that all parents have the right to inform themselves about any health issue pertaining to themselves and their children. We endeavour to provide you with as much information as possible so that you are able to make informed choices.

Some Common Questions

Some of the questions you may have regarding chiropractic care are “Is chiropractic safe during pregnancy?, “Will my pain go away?, and “Will this affect my labour in any way?”. Chiropractors look to the function of the nervous system for answers. The nervous system is a delicate system housed in the bony structure of the spine; it dictates all functions of the body through messages to the brain. Interference in this system results in what is termed a Vertebral Subluxation Complex (or simply, subluxations), which alters the normal function of the body. Through careful analysis including orthopaedic and neurologic testing, chiropractors locate and gently correct any areas of subluxations in your spine. It is considered one of the safest, most conservative forms of therapy.

Decreases Labour Pain

Approximately fifty per cent of all pregnant women complain of low back pain. This pain is usually caused by a combination of ligament laxity and changes in posture to accommodate the growing baby. In short, the pain is usually biomechanical. By correcting the biomechanical problems, women are amazed at how much better they feel, how much more they are able to function in their normal activities, and how much more they can enjoy their pregnancies. The many advantages to chiropractic are not limited to pregnancy, but are especially beneficial during delivery. Clinical research, as well as patient reports, indicate that deliveries are faster and less painful when the mother has been under chiropractic care. According to De. Per Freitag, an American medical researcher, chiropractic patients’ need for pain medication during delivery was reduced by half.

About the author:
Dr. Shawna Hord graduated from the Canadian Memorial Chiropractic College. She earned a Fellowship in the International Chiropractic Pediatric Association and enjoys a family chiropractic practice with a special emphasis on pregnancy and pediatric care. She operates Healing Hands, a multidisciplinary clinic offering chiropractic, massage therapy, homeopathy, therapy, naturopathic medicine, psychotherapy and nutritional counseling. Dr. Hord is a member of the Ontario Chiropractic Association, the Canadian Chiropractic Association, the International Chiropractic Pediatric Association (member and Fellow) and the Aurora Chamber of Commerce.

To contact Dr. Shawna Hord:
Healing Hands Chiropractic and Wellness Centre,
73 Wellington Street East,
Aurora, Ontario L4G 1H7
(905)841-0400

A Safe and Gentle Way of Turning Breech or Posterior Babies...
The Webster^TM Turning Technique

Many women are shocked and disappointed to find out their baby is either breech or posterior. To turn a breech baby, medical doctors will sometimes use a technique called “external version”. This technique involves forcing the baby to turn by pushing on the tummy, and it can be very uncomfortable. If the baby is in a breech position because of an anatomical reason such as a short cord or the cord is wrapped around the baby’s neck, this technique can put the baby into distress.

Fortunately, there is a better way. The Webster^TM technique is a unique chiropractic approach to turning babies in a position of in-utero constraint, such as breech or posterior. Babies usually take a breech position because the joints of the pelvis and low back are not moving sufficiently, not because there is an anatomical problem. The Webster^TM technique uses a very gentle pelvic adjustment together with muscular trigger point therapy to open up the pelvis and allow the baby to turn herself. That is the beauty of this approach - we do not force the baby to do anything she should not be doing naturally. If there is an anatomical reason for the baby to be breech, the baby simply will not turn.

Who should I see for the Webster^TM technique?

You should see a chiropractor qualified to use this technique. Ask your chiropractor about her credentials. Has she completed a fellowship in Pregnancy and Pediatric Care with either the International Chiropractic Association (ICA) or the International Chiropractic Pediatric Association (ICPA)? Are they specifically certified in performing the Webster^TM technique? You can log onto www.icpa4kids.com to find the nearest chiropractor certified in this amazing technique.

About the author:
Dr. Shawna Hord graduated from the Canadian Memorial Chiropractic College. She earned a Fellowship in the International Chiropractic Pediatric Association and enjoys a family chiropractic practice with a special emphasis on pregnancy and pediatric care. She operates Healing Hands, a multidisciplinary clinic offering chiropractic, massage therapy, homeopathy, therapy, naturopathic medicine, psychotherapy and nutritional counseling. Dr. Hord is a member of the Ontario Chiropractic Association, the Canadian Chiropractic Association, the International Chiropractic Pediatric Association (member and Fellow) and the Aurora Chamber of Commerce.

To contact Dr. Shawna Hord:
Healing Hands Chiropractic and Wellness Centre,
73 Wellington Street East,
Aurora, Ontario L4G 1H7
(905)841-0400
Web site: http://healinghandsaurora.com

© Cynthia Good Mojab 2003. All rights reserved. This article may be printed once for personal use. Any other form of transmission, duplication, or translation is prohibited without permission from the author.

No. This point of view is a cultural artifact. Just the phrase "vitamin D deficiency" illustrates how much we have missed the point, as "vitamin D" was misclassified as a vitamin and subsequently found to be a hormone produced via exposure of the skin to sunlight and not contained in most foods. What we are really talking about is sunlight deficiency.

2. Are the statements "Exclusively breastfed infants are at increased risk of vitamin D deficiency and rickets. This is because human milk contains only small amounts of vitamin D, insufficient to prevent rickets."* accurate?

No. It is as inaccurate as saying something like: "breathing increases the risk of lung cancer." While statistically true (people who don't breathe are not going to die of lung cancer), it fails to acknowledge that certain things are happening while breathing that increase the incidence of lung cancer: the inhalation of cigarette smoke to be specific. Breathing is biologically normal. Intentionally and repeatedly breathing cigarette smoke is not. Breastfeeding is biologically normal. Inadequate sun exposure is not. Exclusively breastfed infants who are inadequately exposed to sunlight are at increased risk of vitamin D deficiency and rickets. Exclusively breastfed infants who are adequately exposed to sunlight are not at increased risk of vitamin D deficiency and rickets. Sunlight deficiency, a biologically abnormal situation, is the problem.

The amount of sunlight exposure needed to prevent vitamin D deficiency depends on such factors as skin pigmentation, latitude, degree of skin exposure, season, time of day, amount of pollution, degree of use of sunscreen, altitude, weather, the vitamin D status of the lactating mother, and the current status of vitamin D stores in the infant's body. Recommendations do and should, therefore, vary around the world, taking into account local conditions and practices.

"The skin has a large capacity to produce vitamin D. Exposure of the entire adult body to the smallest amount of UVB radiation that produces transient, just perceptible skin reddening is comparable to taking an oral dose of 10,000 to 25,000 IU of vitamin D. ^8,9 Therefore, sufficient levels of vitamin D can be developed from partial exposure of the body to sunlight well before sunburn occurs." (Good Mojab 2003)

"Exclusively breastfed Caucasian infants under six months of age (39 N; Cincinnati, Ohio) are expect to achieve adequate vitamin D status when exposed to sunlight for 30 minutes per week (diaper only) or two hours per week (fully clothed without a hat). ³⁴ The sunlight exposure of darkly pigmented infants is poorly understood. ³⁵ Studies of the influence of skin pigmentation on the cutaneous production of vitamin D in adults have shown conflicting results. ^{36, 37} However, a study by Brazerol and colleagues showed that darkly and lightly pigmented adults were equally capable of producing vitamin D when episodes of UVB exposure occurred periodically over time (biweekly for six weeks in their study).³⁸" (Good Mojab 2003)

"There is no global consensus on whether or how to screen infants, children, or pregnant women for vitamin D deficiency or on how to best prevent vitamin D deficiency in breastfed infants and children. Recommendations for preventing vitamin D deficiency in breastfed infants include universal supplementation, supplementation of at-risk breastfed infants, and habitual small doses of sunshine; some regions with plentiful sunshine have not yet developed recommendations.^{28,
29, 30, 31, 32}…The determination of the exact amount of regular, brief, and nonerythemal sunlight exposure needed just to produce sufficient vitamin D in specific infants and children depends on many factors." (Good Mojab 2002)

4. What is the prevalence of rickets among breastfed infants?

"There are currently no national data on the prevalence of rickets in the US,⁷⁷ though case reports and descriptive studies clearly indicate that rickets is not a disease of the past…. Rickets in breastfed infants has been documented among at-risk populations in northern Europe, North America, and former Soviet countries since the 1970s.⁷⁸ In some developing countries it remains a serious health problem.^79-82 Overt rickets is more common in children 6 to 36 months of age than in infants under 6 months of age.^83-86 Findings of bone deformities suggestive of rickets are very rare in full-term or premature neonates.⁸⁷" (Good Mojab 2003)

No, the water soluble form of vitamin D has not been shown to have antirachitic activity. It certainly has some other biochemical role, but it does not prevent vitamin D deficiency or rickets.

6. How long do a newborn's prenatal stores of vitamin D last without exposure to sunlight?

7. Can vitamin D be made with exposure of the skin to sunlight from a window?

The answer is that it depends on whether the glass of the window is open or closed. Exposure of the skin to sunlight that has passed through plexiglas (Dupont Chemical Company, Memphis, TN, USA), most other plastics, or window pane glass (e.g., in buildings, motorized vehicles, covered strollers or prams, etc.) does not allow the endogenous production of vitamin D because these materials efficiently absorb ultraviolet B radiation (Holick 1994). Without UVB radiation, the skin cannot initiate the body's process of making vitamin D. Holick, M. F. McCollum Award Lecture: Vitamin D: New horizons for the 21st century. Am J Clin Nutr 60: 619-30, 1994.

Let me be clear that 1) prophylactic vitamin D supplementation is demonstrably useful for infants who are at risk of vitamin D deficiency and 2) no known risks of supplementation exist with 200 to 400 IU per day. Still, I believe that there is a great potential for harm from a recommendation that all US breastfed infants be supplemented with vitamin D when only some are at risk, not the least is via the marketing of vitamin supplements produced by formula companies who violate the WHO/UNICEF International Code of Marketing of Breast-milk Substitutes. In addition…

Good Mojab, C. Sunlight deficiency and breastfeeding. Breastfeeding Abstracts. 2002; 22(1):3-4.

References cited in the excepts above that come from this reference:

28. American Academy of Pediatrics Committee on Nutrition. Pediatric Nutrition Handbook. 4th ed. Elk Grove Village, IL: American Academy of Pediatrics, 1998, 275-76.
29. American Academy of Pediatrics. Breastfeeding and the use of human milk. Pediatrics 1997; 100(6):1035-39.
30. Standing Committee on the Scientific Evaluation of Dietary Reference Intakes. Dietary Reference Intakes for Calcium, Phosphorous, Magnesium, Vitamin D, and Fluoride. Washington, DC: National academy Press, 1997, 264-66.
31. Vitamin D Expert Panel Meeting. October 11-12, 2001. Atlanta, Georgia. Final Report. url: http://www.cdc.gov/nccdphp/dnpa/nutrition/pdf/Vitamin_D_Expert_Panel_Meeting.pdf
32. UNICEF. Vitamin D: Rickets in children and osteomalacia in pregnant women. The Prescriber: Guidelines on the Rational Use of Drugs in Basic Health Services. December 1993; 8:11.

Good Mojab, C. Sunlight deficiency: A review of the literature. Mothering. March-April 2003; 117:52-55; 57-63.

Notes cited in the excerpts above that come from this reference:

7. M. Holick, “Evolution, Biological Functions, and Recommended Dietary Allowance for Vitamin D,” in Vitamin D: Physiology, Molecular Biology, and Clinical Applications, M. Holick, ed. (Totawa, NJ: Humana Press, 1999), 1–16.
8. M. Holick, “Environmental Factors that Influence the Cutaneous Production of Vitamin D,” Am J Clin Nutr 61 (suppl.) (1995): 638S–645S.
9. W. Brazerol et al., "Serial Ultraviolet B Exposure and Serum 25 Hydroxyvitamin D Response in Young Adult American Blacks and Whites: No Racial Difference," J Am Coll Nutr 7, no. 2 (1988): 111–118.
15. H. Makin et al., “Vitamin D and Its Metabolites in Human Breast Milk,” Arch Dis Child 58 (1983): 750–753.
16. M. Ala-Houhala, “25-Hydroxyvitain D Levels during Breast-Feeding with or without Maternal or Infantile Supplementation of Vitamin D,” J Pediatr Gastroent Nutr 4, no. 2 (1985): 220–226.
17. B. Specker et al., “Effect of Race and Normal Maternal Diet on Breast Milk Vitamin D Concentrations,” Pediatr Res 18 (1984): 213A.
18. B. Hollis et al., “Vitamin D and Its Metabolites in Human and Bovine Milk,” J Nutr 111, no. 7 (1981): 1240–1248.
19. N. Butte et al., Nutrient Adequacy of Exclusive Breastfeeding for the Term Infant during the First Six Months of Life (Geneva: World Health Organization, 2002), 27.
20. M. Holick, “Evolution, Biological Functions, and Recommended Dietary Allowance for Vitamin D,” in Vitamin D: Physiology, Molecular Biology, and Clinical Applications, M. Holick, ed. (Totawa, NJ: Humana Press, 1999), 1–16.
21. M. Holick, “Evolution, Biological Functions, and Recommended Dietary Allowance for Vitamin D,” in Vitamin D: Physiology, Molecular Biology, and Clinical Applications, M. Holick, ed. (Totawa, NJ: Humana Press, 1999), 1–16.
22. H. Makin et al., “Vitamin D and Its Metabolites in Human Breast Milk,” Arch Dis Child 58 (1983): 750–753.
23. M. Ala-Houhala, “25-Hydroxyvitain D Levels during Breast-Feeding with or without Maternal or Infantile Supplementation of Vitamin D,” J Pediatr Gastroent Nutr 4, no. 2 (1985): 220–226.
24. B. Pal and N. Shaw, “Rickets Resurgence in the United Kingdom: Improving Antenatal Management in Asians,” J Pediatr 139, no. 2 (2001): 337–338.
25. J. Daaboul et al., “Vitamin D Deficiency in Pregnant and Breast-Feeding Women and Their Infants,” J Perinatol 1997; 17: 10–14.
26. M. Ala-Houhala, “25-Hydroxyvitain D Levels during Breast-Feeding with or without Maternal or Infantile Supplementation of Vitamin D,” J Pediatr Gastroent Nutr 4, no. 2 (1985): 220–226.
33. B. Specker et al., “Sunshine Exposure and Serum 25-Hydroxyvitamin D Concentrations in Exclusively Breastfed Infants,” J Pediatr 107 (1985): 372–376.
34. B. Specker et al., “Sunshine Exposure and Serum 25-Hydroxyvitamin D Concentrations in Exclusively Breastfed Infants,” J Pediatr 107 (1985): 372–376.
35. B. Specker et al., “Sunshine Exposure and Serum 25-Hydroxyvitamin D Concentrations in Exclusively Breastfed Infants,” J Pediatr 107 (1985): 372–376.
36. C. Lo et al., "Indian and Pakistani Immigrants Have the Same Capacity as Caucasians to Produce Vitamin D in Response to Ultraviolet Radiation," Am J Clin Nutr 44 (1986): 683–685.
37. T. Clemens et al., "Increased Skin Pigment Reduces the Capacity of the Skin to Synthesize Vitamin D," Lancet 1 (1982): 74–76.
38. W. Brazerol et al., "Serial Ultraviolet B Exposure and Serum 25 Hydroxyvitamin D Response in Young Adult American Blacks and Whites: No Racial Difference," J Am Coll Nutr 7, no. 2 (1988): 111–118.
39. B. Specker et al., “Sunshine Exposure and Serum 25-Hydroxyvitamin D Concentrations in Exclusively Breastfed Infants,” J Pediatr 107 (1985): 372–376.
40. M. Holick, “Environmental Factors that Influence the Cutaneous Production of Vitamin D,” Am J Clin Nutr 61 (suppl.) (1995): 638S–645S.
41. A. Webb et al., “Influence of Season and Latitude on the Cutaneous Synthesis of Vitamin D3: Exposure to Winter Sunlight in Boston and Edmonton Will Not Promote Vitamin D3 Synthesis in Human Skin,” J. Clin Endocrinol Metab 67 (1988): 373-–378.
42. S. Grover and R. Morley, “Vitamin D Deficiency in Veiled or Dark-Skinned Pregnant Women,” MJA 175 (2001): 251–252.
43. K. Feldman et al., “Nutritional Rickets,” Am Fam Physician 42 (1990): 1311–1318.
44. I. Sills et al., “Vitamin D Deficiency Rickets: Reports of Its Demise Are Exaggerated,” Clin Pediatr 33 (1994): 491–493.
45. M. Pugliese et al., “Nutritional Rickets in Suburbia,” J Amer College Nutr 17, no. 6 (1998): 637–641.
46. 8. M. Holick, “Environmental Factors that Influence the Cutaneous Production of Vitamin D,” Am J Clin Nutr 61 (suppl.) (1995): 638S–645S.
47. K. Feldman et al., “Nutritional Rickets,” Am Fam Physician 42 (1990): 1311–1318.
48. I. Sills et al., “Vitamin D Deficiency Rickets: Reports of Its Demise Are Exaggerated,” Clin Pediatr 33 (1994): 491–493.
49. M. Holick, “Evolution, Biological Functions, and Recommended Dietary Allowance for Vitamin D,” in Vitamin D: Physiology, Molecular Biology, and Clinical Applications, M. Holick, ed. (Totawa, NJ: Humana Press, 1999), 1–16.
50. L. Matsuoka et al., “Sunscreens Suppress Cutaneous Vitamin D3 Synthesis,” J Clin Endocrinol Metab 64, no. 6 (1987): 1165–1168.
51. L. Matsuoka et al., “Chronic Sunscreen Use Decreases Circulating Concentrations of 25-Hydroxyvitamin D,” Arch Dermatol 124, no. 12 (1988): 1802–1804.
52. B. Hollis et al., “The Effects of Oral Vitamin D Supplementation and Ultraviolet Phototherapy on the Antirachitic Sterol Content of Human Milk,” Calcif Tissue Int 34 (suppl.) (1982): 582.
53. A. Webb et al., “Influence of Season and Latitude on the Cutaneous Synthesis of Vitamin D3: Exposure to Winter Sunlight in Boston and Edmonton Will Not Promote Vitamin D3 Synthesis in Human Skin,” J. Clin Endocrinol Metab 67 (1988): 373-–378.
54. Grover and R. Morley, “Vitamin D Deficiency in Veiled or Dark-Skinned Pregnant Women,” MJA 175 (2001): 251–252.
55. K. Feldman et al., “Nutritional Rickets,” Am Fam Physician 42 (1990): 1311–1318.
56. I. Sills et al., “Vitamin D Deficiency Rickets: Reports of Its Demise Are Exaggerated,” Clin Pediatr 33 (1994): 491–493.
57. M. Pugliese et al., “Nutritional Rickets in Suburbia,” J Amer College Nutr 17, no. 6 (1998): 637–641.
58. M. Pugliese et al., “Nutritional Rickets in Suburbia,” J Amer College Nutr 17, no. 6 (1998): 637–641.
59. L. Muhe et al., “Case-Control Study of the Role of Nutritional Rickets in the Risk of Developing Pneumonia in Ethiopian Children,” Lancet 349 (1997): 1801–1804.
60. K. Feldman et al., “Nutritional Rickets,” Am Fam Physician 42 (1990): 1311–1318.
61. I. Sills et al., “Vitamin D Deficiency Rickets: Reports of Its Demise Are Exaggerated,” Clin Pediatr 33 (1994): 491–493.
62. L. Muhe et al., “Case-Control Study of the Role of Nutritional Rickets in the Risk of Developing Pneumonia in Ethiopian Children,” Lancet 349 (1997): 1801–1804.
63. T. Thacher et al., “A Comparison of Calcium, Vitamin D, or Both for Nutritional Rickets in Nigerian Children,” New Engl J Med 341, no. 8 (1999): 563–568.
64. N. Carvalho et al., “Severe Nutritional Deficiencies in Toddlers Resulting from Health Food Milk Alternatives,” Pediatrics 107, no. 4 (2001): E46.
65. T. Thacher et al., “A Comparison of Calcium, Vitamin D, or Both for Nutritional Rickets in Nigerian Children,” New Engl J Med 341, no. 8 (1999): 563–568.
66. I. Robertson et al., “The Role of Cereals in the Etiology of Nutritional Rickets: The Lesson of the Irish National Nutrition Survey 1943–8,” Br J Nutr 48 (1981): 17–22.
67. S. Özgür et al., “Rickets and Soil Strontium,” Arch Dis Child 75 (1996): 524–526.
68. Why Barns Are Red: Health Risks from Lead and Their Prevention (Toronto, Ontario: Metropolitan Toronto Teach Health Units and the South Riverdale Community Health Center, 1995).
69. M. Berglund et al., “Metal-Bone Interactions,” Toxicol Lett 112–113 (2000): 219–225.
77. K. Scanlon, ed., Final Report, Vitamin D Expert Panel Meeting, Atlanta, GA, Oct. 11–12, 2001; see www.cdc.gov/nccdphp/dnpa/nutrition/pdf/Vitamin_D_Expert_Panel_Meeting.pdf
78. M. Garabédian and H. Ben-Mekhbi, “Rickets and Vitamin D Deficiency,” in Vitamin D: Physiology, Molecular Biology, and Clinical Applications, M. Holick, ed. (Totawa, NJ: Humana Press, 1999), 273–286.
79. T. Thacher et al., “A Comparison of Calcium, Vitamin D, or Both for Nutritional Rickets in Nigerian Children,” New Engl J Med 341, no. 8 (1999): 563–568.
80. S. Özgür et al., “Rickets and Soil Strontium,” Arch Dis Child 75 (1996): 524–526.
81. X. Ma, “Epidemiology of Rickets in China,” J Pract Pediatr 1 (1986): 323.
82. M. Rafii, “Rickets in Breast-Fed Infants below Six Months of Age without Vitamin D Supplementation,” Arch Irn Med 4, no. 2 (2001): 93–95.
83. M. Garabédian and H. Ben-Mekhbi, “Rickets and Vitamin D Deficiency,” in Vitamin D: Physiology, Molecular Biology, and Clinical Applications, M. Holick, ed. (Totawa, NJ: Humana Press, 1999), 273–286.
84. K. Feldman et al., “Nutritional Rickets,” Am Fam Physician 42 (1990): 1311–1318.
85. I. Sills et al., “Vitamin D Deficiency Rickets: Reports of Its Demise Are Exaggerated,” Clin Pediatr 33 (1994): 491–493.
86. M. Pugliese et al., “Nutritional Rickets in Suburbia,” J Amer College Nutr 17, no. 6 (1998): 637–641.
87. M. Garabédian and H. Ben-Mekhbi, “Rickets and Vitamin D Deficiency,” in Vitamin D: Physiology, Molecular Biology, and Clinical Applications, M. Holick, ed. (Totawa, NJ: Humana Press, 1999), 273–286.
99. K. Scanlon, ed., Final Report, Vitamin D Expert Panel Meeting, Atlanta, GA, Oct. 11–12, 2001; see www.cdc.gov/nccdphp/dnpa/nutrition/pdf/Vitamin_D_Expert_Panel_Meeting.pdf

Cynthia Good Mojab, MS (clinical psychology), IBCLC, RLC, is Research Associate in the Publications Department of La Leche League International and Senior Editor at Platypus Media. She is the coauthor of Breastfeeding at a Glance: Facts, Figures, and Trivia About Lactation (Platypus Media 2001). Her publications can be accessed from her website, Ammawell (http://home.comcast.net/~ammawell), which provides breastfeeding and parenting information.

Citation: Good Mojab, C. Frequently Asked Questions About Vitamin D, Sunlight, and Breastfeeding. Ammawell website 2003.

Information You Need to Know About Hypoglycemia In a Newborn

The following is a basic overview of the topic. It is meant as a tool to encourage further exploration on this topic. We were surprised to find that many of the creditable research recommendations are not implemented as practice with caregivers. Please use the resources listed at the bottom of the page to start your own research in this area.

Those at risk are:

	infant of diabetic mother
	premature infants
	small for gestational age babies
	growth restricted babies
	infant who suffers perinatal asphyxia
	cold ‘stressed’ baby
	any baby showing symptoms of low blood sugar
	sick baby
	Macrosomic babies (may have hyperinsulinism) - contraversial

At-risk babies:

	Breastfeed within 1 hour
	Breastfeed when hungry
	Not longer than 3 hours between feeds
	Maintain normal body temperature

Testing Procedures:

	Only babies at risk should be tested
	Testing can be stressful
	Testing is unreliable
	Unreliable testing leads to unnecessary treatments
	Unnecessary treatments leads to breastfeeding difficulties
	Testing should be done 4-6 hours after birth
	Hospitals test 1-2 hours after birth when the blood sugar levels reach a natural low as babies adjust to life outside the womb.
	Testing should be done before a feeding.
	Testing should be done by reliable lab testing.
	Glucose-oxidase strips have poor sensitivity & specificity and should not be relied upon.
	Procedure used to test must be accurate.

Different levels & Suggested Treatment:

	Normal at or above 2.6mmol-l(47mg/100ml) evidenced based research unable to clearly define
	Below Normal -Breastfeeding should be encouraged -Repeat testing after 1 hour -If it remains low, baby should receive IV glucose -IV not available then glucose supplementary feed should be given by cup or tube -Breastfeeding should always continue

Warning signs/symptoms of severe low blood sugar:

Minor:

	vomiting
	pallor
	lethargy
	high pitched cry
	hypotonia
	poor feeding
	respiratory distress
	irregular respirations

Major:

	apnoea
	cyanosis
	jitteriness
	convulsions

If symptomatic:

	glucose measured urgently
	below 2.6mmol-l baby should be given 10% glucose immediately
	monitor & adjust accordingly
	continue breastfeeding
	if reliable testing unavailable -IV reserved for major complications (e.g. convulsions) or when enteral feeds contra-indicated.

Resources

Christensson, K., Siles, C. Moreno, L. Belaustequi, A., De La Fuente, P., Lagercrantz, H., Puyol, P. and Winberg, J. (1992). Temperature, metabolic adaptation and crying in healthy full-term newborns cared for skin to skin or in a cot. Acta Pediatrics, 81, 488-493.
Cornblath, M., Hawdon, J.M., Williams, A. F., Aynsley-Green, A., Ward-Platt, M. P., Schwartz, R. and Kalhan, S. C. (2000). Controversies regarding definition of neonatal hypoglycemia: Suggested operational thresholds. Pediatrics, 105(5), 1141-1145.
Hanniger, N. C. and Farley, C. L. (2001). Screening for hypoglycemia in healthy term neonates: Effects on breastfeeding. Journal of Midwifery and Women’s Health, 46(5), 292-301.
Hawdon, J.M., Ward-Platt, M. P. and Aynsley-Green, A. (1992). Patterns of metabolic adaptation for preterm and term infants in the first neonatal week. Archives of Disease in Childhood, 67, 357-365.
Heck, L. J., and Erenberg, A. (1987). Serum glucose levels in term neonates during the first 48 hours of life. Journal of Pediatrics, 110(1), 119-122.
http://www.gentlebirth.org/archives/hypoglyc.html
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Url:http://www.who.int/child-adolescent-health/New_Publications/NUTRITION/hypoclyc.htm