Do exclusively breast-fed infants need vitamin D supplements?

Having been a breastfeeding advocate as well as researcher for over 25 years, I normally find that the “breastfeeding community” is well informed and presents its arguments in a strong, scientific fashion. I regret to say that this does not seem to be the case in the debate going on in the USA about whether breast milk is “deficient” in vitamin D and thus whether exclusively breast-fed infants should routinely receive supplementation. Vitamin D is essential for skeletal health, and severe deficiency leads to defective mineralization resulting in rickets or its adult equivalent, osteomalacia.
