A nurse is caring for a newborn who is receiving breast milk and supplemental vitamin D drops daily.

The nurse knows that vitamin D supplementation is necessary for breastfed infants because:

Breast milk does not contain enough vitamin D for bone health.Vitamin D is needed to support healthy bone development and to prevent rickets, a condition that causes weak or deformed bones.Breast milk alone does not provide infants with an adequate amount of vitamin D.The Dietary Guidelines for Americans and American Academy of Pediatrics recommend breastfed and partially breastfed infants be supplemented with 400 IU per day of vitamin D beginning in the first few days of life.

Choice B is wrong because breast milk does not interfere with vitamin D absorption from sunlight.However, reducing sun exposure is important for preventing skin cancer, and other factors such as clothing, air pollution, and skin type can also decrease the amount of vitamin D a person can make from sunlight.

Choice C is wrong because breast milk does not increase vitamin D excretion in urine.

Vitamin D is a fat-soluble vitamin that is stored in the body and not easily lost in urine.

Choice D is wrong because breast milk does not inhibit vitamin D synthesis in the liver.Vitamin D is synthesized in the skin from exposure to sunlight, and then activated in the liver and kidneys to its active form.

Breast milk does not affect this process.

Breasts are soft without engorgement or leakage.This indicates that lactation suppression has been successful and the woman is not experiencing any discomfort or risk of infection from milk accumulation.

Breasts are firm with mild tenderness or leakage is wrong because it suggests that lactation is still occurring and the woman may need to express some milk for comfort or use other non-pharmacological methods to suppress it.

Breasts are hard with moderate pain or leakage is wrong because it indicates that the woman is suffering from breast engorgement, which can lead to mastitis if not treated.The woman may need pharmacological intervention to suppress lactation and relieve pain.

Breasts are swollen with severe pain or leakage is wrong because it shows that the woman has developed mastitis, which is a bacterial infection of the breast tissue that requires antibiotics and analgesics.The woman may also need to drain the infected breast by expressing milk or using a pump.

Normal ranges for lactation suppression vary depending on the individual and the method used.Generally, lactation suppression can take from a few days to a few weeks.