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mamajoanA current topic of much debate and irritation in my life is Vitamin D. Specifically, the question of whether to give Vitamin D supplements to Ruthie.
Vitamin D is not actually a vitamin, but an amino acid (I believe?) which is manufactured by the body. Almost no foods on earth contain naturally-occurring vitamin D (the main exception being certain kinds of fish). The human body uses sunlight absorbed into the skin to make vitamin D. Most adults need an extremely minimal amount of sun exposure to make enough vitD, especially since most adults also eat foods that have been fortified with vitD, most notably cow milk. Infant formula is also fortified with vitD, so it's not a big issue for babies who are fed formula.
However, for breastfed babies under the age of one (one year being the age at which we're told we can start giving babies cow milk), it's a little trickier. The amount of vitD that passes to the baby via breastmilk is quite small (assuming that the mother is not vitD-deficient -- if she is, then so is her breastmilk). The vitD in breastmilk is more easily absorbed by the baby's body than the artificial vitD in fortified foods (this is called "bioavailable" as in, the vitD in breastmilk is more bioavailable than the vitD in cow milk). However, it still isn't sufficient to give baby all the vitD that s/he needs. This is by design. Biologically speaking, babies are meant to get some of their vitD from breastmilk and some from sun exposure. Studies have suggested that as little as four minutes per day of sun exposure (wearing nothing but a diaper) is sufficient for a breastfed baby to make all the vitD that s/he needs.
However, due to weather and societal/cultural factors, many babies don't even get that much. During the winter months November to February (roughly), in the northern latitudes including much of the northern United States, the sunlight isn't strong enough to do the trick (even if we exposed our babies to it fully, which of course we don't because it's, you know, winter). And in the summer, due to fears of skin cancer and so forth, parents are discouraged from exposing babies to the sun. Thus, in an extremely broad generalization, exclusively breastfed babies who live in northern latitudes are considered to be at risk for vitamin-D deficiency. This can lead to a fairly serious condition called rickets. However, studies have found that rickets is fairly rare even in babies who have low vitD levels; and is more common in babies with systematic vitD deprivation (e.g., babies who get little sun AND whose mothers are vitD-deficient). It should be noted, furthermore, that studies have also found that babies who get sufficient sun exposure during the summer months can store up enough vitamin D to get them through the winter.
Anyway, the American Academy of Pediatricians (AAP), the USA's main governing body, recently issued new guidelines calling for routine vitamin-D supplementation for all breastfed babies. This is a case of "give it to everyone so that the very few who really need it will get it." So, pediatricians across the country are now telling their breastfeeding patients to give vitamin D drops to their babies.
Why do I (and lots of others) think this is a bad thing? Two main reasons:
a. It fails to address the larger cultural issues. The reasons that a particular baby or child doesn't get enough sunlight can be very varied, from religious (e.g. religions that require girls and women to be completely covered) to criminal (family lives in a dangerous area so are nervous to take the baby outside) to economical (low-income families don't have the time/resources to take children outside to play) and more. Children's bodies (and adults' too) need sunlight. Addressing the potential vitamin-D deficiency that may result from a sunlight deficiency may not be enough.
b. It undermines the message that breastfeeding is best. Unless a pediatrician is VERY careful about how he/she presents the message, parents can easily get the impression that breastmilk is "incomplete" or not good enough, whereas formula is "complete nutrition." This could easily result in a mother giving up breastfeeding sooner than she otherwise might, or even not starting it in the first place. In that context, you'd probably not be surprised to learn that the main brands of vitamin D supplements available in the USA are produced by formula companies.
(There's also c, the supplements often contain other artificial crap that we shouldn't be feeding our babies...but that's a minor point by comparison.)
Now, after our pediatrician (henceforth Dr. B) mentioned the vitD supplements at Ruthie's last two checkups, I did a small amount of research in preparation for her 9-month checkup. I didn't glean all of the above from that, but did glean a general sense that most babies probably don't really need supplementation. I had a very brief but annoying conversation with Dr. B about it, either at Ruthie's 4-month or 6-month checkup -- can't remember which. That conversation went a little bit like this:
Dr: blah blah give her vitD
Me: I'm not planning to give that to her
Dr: why not?
Me: well, you know, I just feel that for thousands of years...
Dr: ...people have been getting rickets.
ugh...and then we dropped it. But it came up again at the 9-month checkup, as I knew it would. Dr. B again said that I should be giving Ruthie the supplements. I again said that I choose not to. Upon which Dr. B said -- and she said this literally about a half-dozen times during our conversation -- "well, if you WANT your child to get rickets, that's your choice!" I honestly do not appreciate that kind of passive-aggressive threatening technique. I don't use it as a parenting technique on my children and I don't want my doctor using it on me. I think it's obnoxious.
But anyway, since I was not fully prepared with the research, I didn't get too deeply into it with her. I simply said that I felt that Ruthie had gotten sufficient sun exposure during the summer, and that I think we're going to manage fine through the winter, and if it comes to that, by March she'll be a year old and able to start taking in some vitamin-D-fortified milk and the whole thing will be moot. OH, and Dr. B said I should be supplementing because VitD is, she says, the one vitamin that isn't passed through the breastmilk. Which, as I noted above, is inaccurate.
I need to digress for a moment here and say that I also am not feeding Ruthie infant cereal. Now, the traditional way that "everyone knows you're supposed to" do things with regard to starting babies on solid food, is that you start with rice cereal and then progress on to pureed fruits and vegetables. Rice cereal is basically rice that has been processed and refined and ground up and processed some more until all nutritional value has been thoroughly processed out of it; then they add some artificially-created vitamins and minerals and call it "fortified." Basically, it has no nutritional value per se, except for the stuff that has been added (B vitamins, iron, etc.), which can also be obtained from other foods. Other foods that, furthermore, taste good -- which rice cereal doesn't. It tastes like cardboard, frankly. The reason rice cereal is pushed as a good "first food" is that it's very easy to digest and very few people are allergic to it. But I (and many of my fellow earthy-crunchy-hippie mama types) think it's pointless and unnecessary and dumb, so I have simply skipped it with Ruthie. We went directly to purees and finger foods, and she's quite happy that way.
So, to return to Ruthie's 9-month checkup: when Dr. B asked me about Ruthie's food intake, I told her that we aren't doing cereal, and she of course gave me crap about that too. And then she added that this was another reason to do the VitD supplements, because the infant cereal is fortified but Ruthie isn't getting that. This gave me pause. I actually started thinking, well, maybe it wouldn't be so terrible to get a box of rice cereal and start mixing it in with Ruthie's fruits a little bit just to get a bit more vitD into her.
But then I went to the grocery store and checked the nutrition panel on the boxes of rice cereal (and also the baby oatmeal just in case), and guess what? They don't list vitamin D on there at all. It ain't there.
To sum up:
* Dr. B was wrong about the vitD content of breastmilk.
* Dr. B was wrong about the presence of vitD in rice cereal.
* Dr. B seems to be spouting the AAP party line about vitD without really considering, or even knowing, the specifics.
* Dr. B used inflammatory rhetorical tactics on me. Repeatedly!
* Ruthie most likely doesn't need supplementation, since she got plenty of sun over the summer and I drink lots of vitD-fortified milk.
I'm irritated about all of this. I'm mainly upset on behalf of Dr. B's hypothetical other patients, other parents who may not be as informed or as confident in their decisions; who may simply do what Dr. B says because she said so (and believe me there are a LOT of parents out there who will ignore their own parental instincts or common sense in favor of "the doctor said"!). In particular, it galls me to think that Dr. B's ignorance and/or belligerence could turn other mothers away from breastfeeding.
So, I'm writing her a letter. I don't know whether I'll actually send it, mind you, but given how this has been gnawing at me, I have to at least write it.
I should say that there are many things I love about Dr. B, which I shan't go into now since this post is already so long and it's so late. But this particular issue really highlights all the philosophcal differences I have with her, to put it mildly.
Wow, that got long. O.O Bed now.
Vitamin D is not actually a vitamin, but an amino acid (I believe?) which is manufactured by the body. Almost no foods on earth contain naturally-occurring vitamin D (the main exception being certain kinds of fish). The human body uses sunlight absorbed into the skin to make vitamin D. Most adults need an extremely minimal amount of sun exposure to make enough vitD, especially since most adults also eat foods that have been fortified with vitD, most notably cow milk. Infant formula is also fortified with vitD, so it's not a big issue for babies who are fed formula.
However, for breastfed babies under the age of one (one year being the age at which we're told we can start giving babies cow milk), it's a little trickier. The amount of vitD that passes to the baby via breastmilk is quite small (assuming that the mother is not vitD-deficient -- if she is, then so is her breastmilk). The vitD in breastmilk is more easily absorbed by the baby's body than the artificial vitD in fortified foods (this is called "bioavailable" as in, the vitD in breastmilk is more bioavailable than the vitD in cow milk). However, it still isn't sufficient to give baby all the vitD that s/he needs. This is by design. Biologically speaking, babies are meant to get some of their vitD from breastmilk and some from sun exposure. Studies have suggested that as little as four minutes per day of sun exposure (wearing nothing but a diaper) is sufficient for a breastfed baby to make all the vitD that s/he needs.
However, due to weather and societal/cultural factors, many babies don't even get that much. During the winter months November to February (roughly), in the northern latitudes including much of the northern United States, the sunlight isn't strong enough to do the trick (even if we exposed our babies to it fully, which of course we don't because it's, you know, winter). And in the summer, due to fears of skin cancer and so forth, parents are discouraged from exposing babies to the sun. Thus, in an extremely broad generalization, exclusively breastfed babies who live in northern latitudes are considered to be at risk for vitamin-D deficiency. This can lead to a fairly serious condition called rickets. However, studies have found that rickets is fairly rare even in babies who have low vitD levels; and is more common in babies with systematic vitD deprivation (e.g., babies who get little sun AND whose mothers are vitD-deficient). It should be noted, furthermore, that studies have also found that babies who get sufficient sun exposure during the summer months can store up enough vitamin D to get them through the winter.
Anyway, the American Academy of Pediatricians (AAP), the USA's main governing body, recently issued new guidelines calling for routine vitamin-D supplementation for all breastfed babies. This is a case of "give it to everyone so that the very few who really need it will get it." So, pediatricians across the country are now telling their breastfeeding patients to give vitamin D drops to their babies.
Why do I (and lots of others) think this is a bad thing? Two main reasons:
a. It fails to address the larger cultural issues. The reasons that a particular baby or child doesn't get enough sunlight can be very varied, from religious (e.g. religions that require girls and women to be completely covered) to criminal (family lives in a dangerous area so are nervous to take the baby outside) to economical (low-income families don't have the time/resources to take children outside to play) and more. Children's bodies (and adults' too) need sunlight. Addressing the potential vitamin-D deficiency that may result from a sunlight deficiency may not be enough.
b. It undermines the message that breastfeeding is best. Unless a pediatrician is VERY careful about how he/she presents the message, parents can easily get the impression that breastmilk is "incomplete" or not good enough, whereas formula is "complete nutrition." This could easily result in a mother giving up breastfeeding sooner than she otherwise might, or even not starting it in the first place. In that context, you'd probably not be surprised to learn that the main brands of vitamin D supplements available in the USA are produced by formula companies.
(There's also c, the supplements often contain other artificial crap that we shouldn't be feeding our babies...but that's a minor point by comparison.)
Now, after our pediatrician (henceforth Dr. B) mentioned the vitD supplements at Ruthie's last two checkups, I did a small amount of research in preparation for her 9-month checkup. I didn't glean all of the above from that, but did glean a general sense that most babies probably don't really need supplementation. I had a very brief but annoying conversation with Dr. B about it, either at Ruthie's 4-month or 6-month checkup -- can't remember which. That conversation went a little bit like this:
Dr: blah blah give her vitD
Me: I'm not planning to give that to her
Dr: why not?
Me: well, you know, I just feel that for thousands of years...
Dr: ...people have been getting rickets.
ugh...and then we dropped it. But it came up again at the 9-month checkup, as I knew it would. Dr. B again said that I should be giving Ruthie the supplements. I again said that I choose not to. Upon which Dr. B said -- and she said this literally about a half-dozen times during our conversation -- "well, if you WANT your child to get rickets, that's your choice!" I honestly do not appreciate that kind of passive-aggressive threatening technique. I don't use it as a parenting technique on my children and I don't want my doctor using it on me. I think it's obnoxious.
But anyway, since I was not fully prepared with the research, I didn't get too deeply into it with her. I simply said that I felt that Ruthie had gotten sufficient sun exposure during the summer, and that I think we're going to manage fine through the winter, and if it comes to that, by March she'll be a year old and able to start taking in some vitamin-D-fortified milk and the whole thing will be moot. OH, and Dr. B said I should be supplementing because VitD is, she says, the one vitamin that isn't passed through the breastmilk. Which, as I noted above, is inaccurate.
I need to digress for a moment here and say that I also am not feeding Ruthie infant cereal. Now, the traditional way that "everyone knows you're supposed to" do things with regard to starting babies on solid food, is that you start with rice cereal and then progress on to pureed fruits and vegetables. Rice cereal is basically rice that has been processed and refined and ground up and processed some more until all nutritional value has been thoroughly processed out of it; then they add some artificially-created vitamins and minerals and call it "fortified." Basically, it has no nutritional value per se, except for the stuff that has been added (B vitamins, iron, etc.), which can also be obtained from other foods. Other foods that, furthermore, taste good -- which rice cereal doesn't. It tastes like cardboard, frankly. The reason rice cereal is pushed as a good "first food" is that it's very easy to digest and very few people are allergic to it. But I (and many of my fellow earthy-crunchy-hippie mama types) think it's pointless and unnecessary and dumb, so I have simply skipped it with Ruthie. We went directly to purees and finger foods, and she's quite happy that way.
So, to return to Ruthie's 9-month checkup: when Dr. B asked me about Ruthie's food intake, I told her that we aren't doing cereal, and she of course gave me crap about that too. And then she added that this was another reason to do the VitD supplements, because the infant cereal is fortified but Ruthie isn't getting that. This gave me pause. I actually started thinking, well, maybe it wouldn't be so terrible to get a box of rice cereal and start mixing it in with Ruthie's fruits a little bit just to get a bit more vitD into her.
But then I went to the grocery store and checked the nutrition panel on the boxes of rice cereal (and also the baby oatmeal just in case), and guess what? They don't list vitamin D on there at all. It ain't there.
To sum up:
* Dr. B was wrong about the vitD content of breastmilk.
* Dr. B was wrong about the presence of vitD in rice cereal.
* Dr. B seems to be spouting the AAP party line about vitD without really considering, or even knowing, the specifics.
* Dr. B used inflammatory rhetorical tactics on me. Repeatedly!
* Ruthie most likely doesn't need supplementation, since she got plenty of sun over the summer and I drink lots of vitD-fortified milk.
I'm irritated about all of this. I'm mainly upset on behalf of Dr. B's hypothetical other patients, other parents who may not be as informed or as confident in their decisions; who may simply do what Dr. B says because she said so (and believe me there are a LOT of parents out there who will ignore their own parental instincts or common sense in favor of "the doctor said"!). In particular, it galls me to think that Dr. B's ignorance and/or belligerence could turn other mothers away from breastfeeding.
So, I'm writing her a letter. I don't know whether I'll actually send it, mind you, but given how this has been gnawing at me, I have to at least write it.
I should say that there are many things I love about Dr. B, which I shan't go into now since this post is already so long and it's so late. But this particular issue really highlights all the philosophcal differences I have with her, to put it mildly.
Wow, that got long. O.O Bed now.
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no subject
Date: 2007-01-04 05:30 am (UTC)Just reading your rant is making me mad too. But I'm trying to instead focus on how much I got to learn :)
no subject
Date: 2007-01-04 06:05 am (UTC)but seriously ... this is the sort of thing that warrants a second opinion. I forget: what did you do for Isaac?
no subject
Date: 2007-01-04 01:13 pm (UTC)no subject
Date: 2007-01-04 07:01 am (UTC)Do you take supplements or Vit D milk?
Seems that should be sufficient, and you wouldn't want to be in a position where you wished you had...
no subject
Date: 2007-01-04 01:11 pm (UTC)My Bad
Date: 2007-01-04 04:58 pm (UTC)no subject
Date: 2007-01-04 12:20 pm (UTC)Are you going to to lectures later about discipline, meat-eating, the whole iron thing?
I know you don't want to change doctors, but I couldn't go back to yours (I wouldn't have made it through the appointment without crying.)
- Helen
no subject
Date: 2007-01-04 01:12 pm (UTC)Honestly, I have moments when I DO want to change doctors, but I waffle on it a lot. I don't want to cause any family drama and anyway, there's the whole inertia thing. But this may turn out to be the proverbial straw.
no subject
Date: 2007-01-04 03:59 pm (UTC)If so, Bastian's doc makes a point of defering to well-informed parental instinct. She breasfed her daughter and is on the nutty-crunchy side, herself. Just in case you need her.
no subject
Date: 2007-01-04 01:05 pm (UTC)*growl*
no subject
Date: 2007-01-04 02:39 pm (UTC)Also, every once in a long while, I see a kid or young adult who seems otherwise healthy and whose stance or walk looks more like rickets than, say, cerebral palsy or an injury. When I've seen kids like that, they've been African-American, and I think it's probably a good guess that it's a combination of factors, like living in a neighborhood where it's not safe to go outside, having dark skin in a northern latitude, and having poor family nutrition.
My understanding, though, is that it takes a very, very severe deficiency (and probably multiple factors) to cause rickets. I remember my daughter's first pediatrician saying that even the tiniest bit of sunlight goes a long way for a baby's vitamin D needs.
no subject
Date: 2007-01-04 03:32 pm (UTC)I am taking a long sentences rest day.
no subject
Date: 2007-01-04 03:32 pm (UTC)no subject
Date: 2007-01-04 03:45 pm (UTC)no subject
Date: 2007-01-09 01:47 am (UTC)"vitamin D
generic descriptor for all steroids exhibiting the biologic activity of ergocalciferol or cholecalciferol, the antirachitic vitamins popularly called the “sun-ray vitamins.” They promote the proper utilization of calcium and phosphorus, thereby producing growth, together with proper bone and tooth formation, in young children; the sulfate, a water-soluble conjugate, is found in the aqueous phase of human milk; vitamin D1 is a 1:1 mixture of lumisterol and vitamin D2."
More readably, from Merriam-Webster's Medical Dictionary:
"any or all of several fat-soluble vitamins chemically related to steroids, essential for normal bone and tooth structure, and found especially in fish-liver oils, egg yolk, and milk or produced by activation (as by ultraviolet irradiation) of sterols: as a : CALCIFEROL b : CHOLECALCIFEROL called also sunshine vitamin"
So it's related to steroids, but not an amino acid.
That's a side point, though. If you do write that letter to Dr. B, you might want to use the sandwich method of criticism: start with praise for something good about her, then criticize, then end with something else good. The good things are the bread in the sandwich. ;-) I suggest this because you do say there are many things you love about Dr. B, and if you tell her about them she's more likely to actually take in the less complimentary meat in your sandwich.
(Yes, I know, vegetarian, but calling it the cucumber in your sandwich doesn't seem to go with the metaphor.)