UNC CERTs Projects: Rickets and Vitamin D Supplementation

Rickets is a disease of vitamin deficiency. It happens when infants and children get too little vitamin D. Vitamin D is necessary for proper bone formation. Infants and children who get too little vitamin D get rickets - which shows itself in deformities of the skeleton and in other growth and development problems. Most of us thought that rickets was a thing of the past, but to the surprise and concern of many, rickets is on the rise again in developed countries such as the U.S.

We believe rickets is on the rise for several reasons: Babies may be getting less exposure to sunlight, and sunlight is an important source of vitamin D. Today, fewer doctors recommend that pregnant women and infants take vitamin D, meaning that many nursing mothers and their infants may be deficient in this nutrient. Finally, health professionals have long wanted to see more minority mothers breastfeed their babies, but, ironically, the increased number of minority babies being breastfed is associated with increases in cases of rickets.

Most of the rickets cases in countries like the U.S. in the past ten years have been in breastfed infants and children who have dark skin, or who stay fully clothed for religious or social reasons. These babies, who get little sunshine on bare skin, or whose dark skin protects them from the sun, are the babies most likely to get less vitamin D from sun exposure than they need. These breastfed babies have another risk, since their mothers' breast milk is also more likely to be deficient in vitamin D.

Rickets can have a profound effect on skeletal growth and development. Many children with rickets have retarded growth. Their bones are deformed even by normal stress on their skeletons. Depending on the way these children carry their weight, their wrists and knees may be larger than normal. When these children begin to walk, it is common to see their legs beginning to bow - in fact, bowed legs can be the first sign that alerts doctors to the possibility of rickets. (Other skeletal abnormalities can include an hourglass shaped thorax, delayed closure of the fontanelles, frontal bossing and postural molding of the skull.)

Rickets also causes nerve and muscle problems. One of them is hypotonia, or abnormal muscle tone, with abnormally stretched or weak muscles. Children with rickets also may not reach normal milestones in muscle development, and these problems may appear before the skeletal problems do. Since vitamin D helps us absorb and use calcium, some children with vitamin D deficiency are jittery. They may also have twitches and spasms, or even seizures, from their low calcium levels. The bones of children with vitamin D deficiency may not ever become as dense as those of children with normal vitamin D levels. Bones that are not as dense are more likely to break, whether in childhood or adulthood. This is just one example of the long-term results of vitamin D deficiency.

Vitamin D contributes to the growth and function of a broad range of cells in the body. New studies link vitamin D deficiency to an increased risk of other diseases, including multiple sclerosis, some cancers, some mental illnesses, and diabetes.

The tragedy of rickets is that it is so easy to prevent. Babies who get enough vitamin D do not get rickets. Getting enough vitamin D may mean giving vitamin D supplements to all breastfed infants and children up to the age of three, as health professionals in England now recommend.

Here in the U.S., the American Academy of Pediatricians now recommends a supplement of 200 IUs (International Units) of vitamin D each day for these groups:

1. All breastfed infants, unless they are weaned to at least 500 mL per day of vitamin D-fortified formula or milk.
2. All nonbreastfed infants who are ingesting less than 500 mL per day of vitamin D-fortified formula or milk.
3. Children and adolescents who do not get regular sunlight exposure, do not ingest at least 500 mL per day of vitamin
D-fortified milk, or do not take a daily multivitamin supplement containing at least 200 IU of vitamin D.

The UNC CERTs strongly recommends giving vitamin D supplements to prevent rickets.



	Rickets and Vitamin D Supplementation
	Rickets is a disease of vitamin deficiency. It happens when infants and children get too little vitamin D. Vitamin D is necessary for proper bone formation. Infants and children who get too little vitamin D get rickets - which shows itself in deformities of the skeleton and in other growth and development problems. Most of us thought that rickets was a thing of the past, but to the surprise and concern of many, rickets is on the rise again in developed countries such as the U.S. We believe rickets is on the rise for several reasons: Babies may be getting less exposure to sunlight, and sunlight is an important source of vitamin D. Today, fewer doctors recommend that pregnant women and infants take vitamin D, meaning that many nursing mothers and their infants may be deficient in this nutrient. Finally, health professionals have long wanted to see more minority mothers breastfeed their babies, but, ironically, the increased number of minority babies being breastfed is associated with increases in cases of rickets. Most of the rickets cases in countries like the U.S. in the past ten years have been in breastfed infants and children who have dark skin, or who stay fully clothed for religious or social reasons. These babies, who get little sunshine on bare skin, or whose dark skin protects them from the sun, are the babies most likely to get less vitamin D from sun exposure than they need. These breastfed babies have another risk, since their mothers' breast milk is also more likely to be deficient in vitamin D. Rickets can have a profound effect on skeletal growth and development. Many children with rickets have retarded growth. Their bones are deformed even by normal stress on their skeletons. Depending on the way these children carry their weight, their wrists and knees may be larger than normal. When these children begin to walk, it is common to see their legs beginning to bow - in fact, bowed legs can be the first sign that alerts doctors to the possibility of rickets. (Other skeletal abnormalities can include an hourglass shaped thorax, delayed closure of the fontanelles, frontal bossing and postural molding of the skull.) Rickets also causes nerve and muscle problems. One of them is hypotonia, or abnormal muscle tone, with abnormally stretched or weak muscles. Children with rickets also may not reach normal milestones in muscle development, and these problems may appear before the skeletal problems do. Since vitamin D helps us absorb and use calcium, some children with vitamin D deficiency are jittery. They may also have twitches and spasms, or even seizures, from their low calcium levels. The bones of children with vitamin D deficiency may not ever become as dense as those of children with normal vitamin D levels. Bones that are not as dense are more likely to break, whether in childhood or adulthood. This is just one example of the long-term results of vitamin D deficiency. Vitamin D contributes to the growth and function of a broad range of cells in the body. New studies link vitamin D deficiency to an increased risk of other diseases, including multiple sclerosis, some cancers, some mental illnesses, and diabetes. The tragedy of rickets is that it is so easy to prevent. Babies who get enough vitamin D do not get rickets. Getting enough vitamin D may mean giving vitamin D supplements to all breastfed infants and children up to the age of three, as health professionals in England now recommend. Here in the U.S., the American Academy of Pediatricians now recommends a supplement of 200 IUs (International Units) of vitamin D each day for these groups: 1. All breastfed infants, unless they are weaned to at least 500 mL per day of vitamin D-fortified formula or milk. 2. All nonbreastfed infants who are ingesting less than 500 mL per day of vitamin D-fortified formula or milk. 3. Children and adolescents who do not get regular sunlight exposure, do not ingest at least 500 mL per day of vitamin D-fortified milk, or do not take a daily multivitamin supplement containing at least 200 IU of vitamin D. The UNC CERTs strongly recommends giving vitamin D supplements to prevent rickets.
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