THURSDAY, March 29 (HealthScout) -- Government health officials are urging new mothers to talk with their pediatricians about the risk of severe nutritional deficiencies, particularly a bone-weakening lack of vitamin D.

The Centers for Disease Control and Prevention says it is alarmed by a Georgia survey showing several cases of rickets, which can stunt growth and make children permanently bow-limbed, in babies breast-fed for prolonged periods or weaned onto vegetable-based milk products that lack the nutrient.

The body uses sunlight to synthesize vitamin D, which is needed for calcium absorption. But some infants, particularly those with dark skin, can have trouble making the conversion.

The survey also turned up cases of profound protein energy shortage in some infants, related to drinking substitute milk products poor in that nutrient. Lack of protein can lead to swelling, skin sores, and thinning, discolored hair.

In all, as many as five babies in a million born in Georgia were hospitalized with rickets between 1997 and 1999, and two in a million had severe protein energy malnutrition (PEM) during that period, the research shows. But the actual rate of these conditions is likely higher, experts say, because they are typically treated outside the hospital and doctors are not required to report them.

"I think the cases that we've identified are just the tip of the iceberg," says Dr. Norman Carvalho, a pediatrician at Children's Healthcare in Atlanta and one of the researchers involved in the study.

Talk diet with the doctor

"It's really critical that parents have a discussion about nutrition and diet" at every regularly scheduled visit to the child's doctor, says Dr. Shanna Nesby-O'Dell, a CDC epidemiologist and a co-author of the study, which appears in the March 30 issue of the agency's Morbidity and Mortality Weekly Report. Versions of the same data will also be published in the April issue of the journal Pediatrics.

Breast milk is a poor source of vitamin D, but the advent of fortified baby formula has all but eliminated rickets in this country. Most cases are reversible if caught early. Still, "a minority of cases will need corrective surgery," says Dr. Kay Tomashek, a CDC pediatrician who collaborated on the latest research.

The American Academy of Pediatrics recommends that babies get at least 200 International Units (IU) a day of vitamin D (the amount in two 8-ounce cups of milk), with 400 IU being optimal. Babies whose mothers are vitamin D deficient, or who aren't exposed to enough sunlight, should get at least 400 IU of the vitamin.

The CDC investigation was prompted by reports from Carvalho's hospital of rickets and a form of protein dearth called kwashiorkor in two African-American infants.

Both had breast-fed for at least 10 months, and had also been eating alternative milk products. In the rickets case, the soy drink the infant had consumed had no vitamin D added, and the baby with protein deficiency was given a rice drink with no protein.

A subsequent review of hospital records in Georgia turned up nine cases of severe malnutrition unrelated to other disease, including three cases of protein shortage and six of rickets. All the rickets cases involved babies who nursed for six months or more and who did not get any vitamin D supplements. Several were also dark complexioned.

"Probably the simplest solution would be to have vitamin D supplements for breast-fed infants," Carvalho says. And for parents who don't want to breast-feed, "the safest approach for is to stick with products specifically formulated for toddlers."

Baby formula, made from cow's milk, should contain ample protein, vitamins and other nutrients.

Dr. Bess Dawson-Hughes, an osteoporosis expert at Tufts University in Boston, says given the "stunning" number of adults with vitamin D deficiency, it's not surprising that rickets would be cropping up in infants.

Although 10 to 15 minutes in the sun at low latitudes can be ample for your skin to generate sufficient vitamin D, even during the winter, northern areas don't see enough sun from November to March, Dawson-Hughes says. Therefore, breast-fed babies who aren't getting vitamin D supplements during those months will need them.

　　From HealthScout