Pediatrician failure to follow the AAP's 2003 vitamin D guidelines in infants

Background: In 2008, the American Academy of Pediatrics (AAP) revised their 2003 guidelines on vitamin D supplementation, recommending an increase from 200 IU/day (2003), to 400 IU/day (2008). Breastfed infants receive supplementation as multivitamin drops; non-breastfed infants receive supplementation via formula. The 2003 AAP guidelines recommended vitamin drops for infants consuming <500 mL/day of vitamin D fortified formula.

Objective: To determine whether a cohort of infants was supplemented according to the 2003 AAP guidelines

Methods: From 2004-2007, we enrolled 193 newborns at an urban Boston hospital. Between 2-3 months, we obtained data on infant feeding status; on prescription of vitamin D supplements, and on dose, as well as demographic information.

Results: Data were available on 173 infants; 92 were consuming < 500 mL/day of formula (exclusively breastfed or mostly breastfed). Of these, 45 (49%) were not prescribed any supplement; 14 (15%) were prescribed the supplement but took it fewer than 5 times a week, and 33 (36%) were prescribed a supplement which they took at least 5 days a week. In 96% of cases, when multivitamins were prescribed, the prescribed dose was “1cc a day”. All multivitamins contained 400 IU in 1cc.

Conclusion: Only 2% of breastfed/mostly breastfed infants were supplemented per 2003 AAP guidelines. Almost half of infants were not prescribed supplements, and 96% of infants who were prescribed supplements were prescribed twice the amount recommended. Increasing AAP vitamin D supplementation guidelines will not improve vitamin D status if pediatricians fail to follow the guidelines.