Lesson of the week: Florid rickets associated with prolonged breast feeding without vitamin D supplementation

The Chakaria food system study: household-level, case–control study to identify risk factor for rickets in Bangladesh

“…It tends to be thought of in historic terms, without the recognition in many quarters that it continues to be a source of disability in the developing world. In recent years, rickets has been reported in some 21 countries (Bishop, 2001), including Tibet (Harris et al, 2001), Kuwait (Majid Molla et al, 2000), Ethiopia (Muhe et al, 1997), Yemen, (Banajeh et al, 1997), Mongolia (Fraser & Tserendolgor, 2001), the United Kingdom (Mughal et al, 1999), the United States (Eugster et al, 1996;Pugliese et al, 1998;Kreiter et al, 2000;Shah et al, 2000), South Africa (Pettifor et al, 1978), Nigeria (Okonofua et al, 1991;Oginni et al, 1996;Thacher et al, 1997Thacher et al, , 1999Thacher et al, , 2000a, and Bangladesh (Snedecor & Cochran, 1967;Anonymous, 1998;Fischer et al, 1999;Staab et al, 1999;Karim et al, 2001). While some of these reports describe sporadic occurrences of the disease in association with lifestyle and the lack of solar exposure sufficient to support adequate vitamin D biosynthesis, studies in South Africa (Pettifor et al, 1978) and Nigeria (Okonofua et al, 1991;Oginni et al, 1996;Thacher et al, 1997Thacher et al, , 1999Thacher et al, , 2000a have shown the disease to be caused by primary dietary deficiencies of calcium (Ca).…”

Mode of presentation of symptomatic vitamin D deficiency in tertiary care centre in Jharkhand, India

“…8,9 This suggests that vitamin D content of breast milk is inadequate due to impact of maternal vitamin D deficiency during pregnancy. 10,11 Due to this important factor, present recommendation is to give vitamin D supplementation to all babies in infantile period irrespective of mode of feeding. 12 Bone pain as mode of presentation is found in two children.…”

Nutritional Rickets Revisited

“…A community-based study is necessary to find the true incidence, and primary healthcare doctors should be more vigilant in detecting early this treatable and preventable condition. Along with others 3,17,18 we recommend that breastfed infants receive daily vitamin D supplementation, particularly infants in vulnerable communities. Weaning food should be started from the age of 4 to 6 months.…”

“…Breastfeeding was also noted as a factor in other studies. 3,6,7,15 Although paediatricians encourage breast feeding and discourage formula feeding, we must also emphasize the importance of weaning food from the age of 4 to 6 months. A significantly higher prevalence of NR was associated with the late introduction of cereals to the infant's diet in our study and in another study.…”