We thank the authors for their critical appraisal of
our work.
1. The mothers were instructed to chart the sun
exposure on the given performa. No additional instructions or
information was provided, which could have limited or promoted sun
exposure. We did not find any positive influence of this exercise on
their sun-exposure behavior as serially collected data did not show
any mean increase in sun exposure with study duration. The children
who were found vitamin D deficient were supplemented with vitamin D
at 400 IU per day to be given till 12 months of age.
2. The antenatal calcium supplements being
received by the mothers contained only calcium salt without vitamin
D. The global consensus for prevention of nutritional rickets
recommends daily supplemental maternal intake of 600 IU vitamin D
[2]. It may be worthwhile to evaluate maternal vitamin D
supplementation strategies to prevent rickets in infants and improve
maternal bone health.
3. The maternal sun exposure details were not
collected, and hence cannot be commented upon. The factors
associated with high rate of vitamin D deficiency in a sunlight rich
country like India definitely require further evaluation.
We agree with the authors that treatment or
supplementation of mother would be a more practical, feasible and
healthier solution as it would improve the vitamin D status of both
mother and child [2]. Routine vitamin D supplementation of infants till
12 months is seldom practiced in Indian settings, and therefore may not
be a practical solution, as highlighted by the authors. However, more
robust experimental studies are needed to support the early findings
obtained from our study before we recommend replacing supplemental
vitamin D with sunlight exposure during infancy.
Additional comment: There has been a
misinterpretation of our study in the accompanying editorial [3].
Authors have commented "The authors advised mothers to expose their
newborns to sunshine for a duration of six months, when the association
between duration and timing of the sunshine exposure and serum 25(OH)D
was analyzed." [3]. Our study was purely an observational study, and no
advice regarding sun exposure was given during the study.
References
1. Meena P, Dabas A, Shah D, Malhotra RK, Madhu SV,
Gupta P. Sunlight exposure and vitamin D status in breastfed infants.
Indian Pediatr. 2017;54:105-11.
2. Munns CG, Shaw N, Kiely M, Specker BL, Thacher TD,
Ozono K, et al. Global Consensus Recommendations on prevention
and management of nutritional rickets. Horm Res Paediatr.
2016;85:83-106.
3. Goswami R, Sachdev HPS. Vitamin D sufficiency through sunshine in
infants? Indian Pediatr. 2017;54:103-4.
