NUTRITIONAL RICKETS – REVISITED

Abstract

Nutritional rickets is a bone disease in early childhood resulting in bone pain, delayed motor development, and bending of the bones, caused by vitamin D deficiency and/or inadequate dietary calcium intake. The consequences of nutritional rickets include stunted growth, developmental delay, lifelong bone deformities, seizures, cardiomyopathy, and even death. Dark skin pigmentation, sun avoidance, covering the skin, prolonged breast feeding without vitamin D supplementation, insufficient calcium supply, are important risk factors for nutritional rickets. The disease is most commonly seen in children from the Middle East, Africa, and South Asia in high-income countries. European Vitamin D Association (EVIDAS) recommends screening all children from the risk groups (dark skin ethnic groups) for nutritional rickets. Nutritional rickets is entirely preventable when regular vitamin D supplementation and adequate dietary calcium intake are implemented. Vitamin D supplementation of all neonates and infants with a use of 400 IU/d during the first year of life and with at least 600 IU/d of vitamin D and 500mg/d of calcium thereafter will effectively prevent nutritional rickets. EVIDAS call on national health authorities to implement vitamin D deficiency prevention programs as addition to vaccination programs.