A 1-month-old, full-term African-American boy is brought to the office for a routine check-up. He is exclusively breastfed. The boy does not have any medical problems, and his hospital stay after birth was unremarkable. His mother consumes a well-balanced diet, takes no medications, and does not drink alcohol. The boy is at the 50th percentile for weight and the 60th percentile for height. His physical examination is normal. At this time, supplementation with which of the following should be recommended for this infant?

Question

A 1-month-old, full-term African-American boy is brought to the office for a routine check-up.  He is exclusively breastfed.  The boy does not have any medical problems, and his hospital stay after birth was unremarkable.  His mother consumes a well-balanced diet, takes no medications, and does not drink alcohol.  The boy is at the 50th percentile for weight and the 60th percentile for height.  His physical examination is normal.  At this time, supplementation with which of the following should be recommended for this infant?

Quizplus · Accepted Answer

11ec160b_3cc0_eb72_9249_f54def5f9974_MD0001_00 Breast milk is the gold standard of infant nutrition; it contains proteins, carbohydrates, fats, vitamins, trace minerals, immunoglobulins, amino acids, and enzymes. All vitamins and trace minerals are present in adequate amounts except vitamins D and K. Vitamin K is supplemented by an intramuscular injection at delivery to prevent hemorrhagic disease in the newborn. Regular sunlight exposure typically provides sufficient vitamin D. However, infants are generally shielded from direct sunlight due to sunburn risk. In addition, infants with dark skin pigmentation require more sunlight exposure to produce adequate vitamin D. Melanin is a natural sunblock and prevents ultraviolet rays from reaching the skin for vitamin D synthesis. Prolonged vitamin D insufficiency can lead to rickets (inadequate bone and cartilage mineralization). Therefore, all exclusively breastfed infants should receive vitamin D supplementation to prevent rickets. Formula-fed infants do not require supplementation as formula is fortified with adequate amounts of vitamin D. (Choices A, C, and D) Human breast milk normally provides adequate amounts of folic acid, riboflavin, and thiamine for full-term infants. (Choice B) Although breast milk has low iron content, the bioavailability of iron in breastmilk is considerably higher than supplemental iron and is sufficient for infants until age 4 months. Due to decreasing iron concentration in breast milk over time, supplementation is recommended for breastfed infants at age >4 months until solid food intake provides an adequate amount. (Choice E) Vitamin A stores in the liver are low at birth but rapidly increase due to the large amount in colostrum and breast milk. Educational objective: The breast milk content of vitamins D and K is typically insufficient for the nutritional needs of the newborn. Vitamin K is given parenterally to all newborns at birth to prevent hemorrhagic disease of the newborn. Exclusively breastfed infants require vitamin D supplementation due to lack of sunlight exposure and to prevent rickets. __________ References: Is vitamin D supplementation necessary in healthy full-term breastfed infants? A follow-up study of bone mineralization in healthy full-term infants with and without supplemental vitamin D. (http://www.ncbi.nlm.nih.gov/pubmed/23685376) Adherence to vitamin D recommendations among US infants. (http://www.ncbi.nlm.nih.gov/pubmed/20308221) Prevalence and risk factors for vitamin D deficiency among healthy infants and young children in Sacramento, California. (http://www.ncbi.nlm.nih.gov/pubmed/20532799)

A 1-Month-Old, Full-Term African-American Boy Is Brought to the Office