Children In Urban Areas Research Articles

A Study on Assessment of Obesity among High School Children in Urban Area of Eluru, Andhra Pradesh

A Study on Assessment of Obesity among High School Children in Urban Area of Eluru, Andhra Pradesh

Значимость ультразвукового метода в диагностике иммунных нарушений у детей, проживающих в условиях воздействия техногенных факторов среды обитания

In this article the possibility to use ultrasound study with calculation of splenic mass index (SMI) to assess the immune status of children living in man-caused impact conditions is justified. A comparative analysis of the prevalence of enlarged spleen and SMI values CCM by ultrasound 1 225 children aged 3 to 17 years old, living in urban areas of the Perm region and in ecologically clean regions and in the resort area of the Republic of Abkhazia was carried out. The prevalence of personal anamnestic data was analyzed at 846 children, out of the total number. The number of sickly children in urban areas more and spleen have significantly increased in comparison with rarely ill. The SMI significantly increases the likelihood of changes of some indicators general and immunological analysis of blood.

An Assessment of Communication about Family Planning on Desired Fertility: The Case of Rwanda


 Despite the recognition of the importance of spousal communication in family planning programs, it remains a challenge to many couples in sub Saharan Africa. This paper uses the 2000 Rwanda Demographic and Health Survey (RDHS) to assess spousal communication about family planning on desired fertility. Analysis is done on married people aged 15–49 years. Results indicate that communication about family planning is a significant covariate of the desire to have no more children. The direction of causation in this relationship is plausibly two-way: occurring when already established fertility desires are articulated to the partner, and when a discussion of advantages of child spacing or birth limitation is translated into lower fertility desires, for one or both partners. Results show that fertility desire of wives and husbands are shaped by the partner’s desire, whether or not these are explicitly communicated. Multivariate results show that current age has a small but highly significant effect on the desire for additional children among both men and women. Older men and women are more likely to want no more children. Urban residence is significantly related to desired fertility, indicating the overall level of wanting no more children in urban areas than in rural areas. The paper recommends various alternatives to encourage spousal communication about family planning, taking into consideration various challenges that prevail in African societies.

Dietary habits of school-age children and its associations with blood pressure level in Beijing, China

To study the dietary habits of school-age children in urban and rural districts and their association with blood pressure levels in Beijing, China. A stratified, randomly clustered sampling design was used, 29 primary and secondary schools from four urban districts and three rural districts in Beijing were randomly selected in 2004. 20 638 children aged 6-18 years old were surveyed, and 19 072 of them provided completed usable data. The weight, height and blood pressure of the subjects were measured according to standard method.10 food-groups' information was collected by a semi-quantitative food frequency questionnaire. The relationship between different dietary habits and the blood pressure levels in school children was analyzed by multiple linear regression model. The prevalence of obesity among children in urban area (12.2%, 1 218/9 984) was higher than that in rural area (6.7%, 609/9 088) (χ(2) = 4.62, P < 0.05) , whereas the prevalence of hypertension among children in urban area (8.0%, 799/9 984) was lower than that in rural area (8.9%, 809/9 088) (χ(2) = 167.32, P < 0.05) . The diastolic blood pressure (DBP) among children was (65.7 ± 8.6) mmHg (1 mmHg = 0.133 kPa) in urban area and (67.0 ± 8.7) mmHg in rural area, respectively (F = 86.44, P < 0.05) , and the systolic blood pressure (SBP) among children was (103.4 ± 12.2) mmHg in urban area and (104.3 ± 11.6) mmHg in rural area, respectively (F = 11.33, P < 0.05) . Factor analysis revealed 4 dietary habits labeled prudent habit, protein habit, high-fat and high-calorie habit and vegetables and fruits habit. The 4 dietary habits' variance contribution rate respectively was 24.7%, 14.6%, 14.0%, 8.9%, and the 4 dietary habits totally reflect 62.2% characteristics of the 10 food-groups.In urban area, prudent habit was inversely associated with DBP (β' = -0.026, P < 0.05) , Protein habit was inversely associated with both children's SBP (β' = -0.018, P < 0.05) and DBP (β' = -0.030, P < 0.05) .In rural area, prudent habit was associated with children's SBP (β' = -0.050, P < 0.05) and DBP (β' = -0.039, P < 0.05) . The dietary habits of school age children varied by sociodemographic characters in Beijing. The prudent habit and protein habit may decrease the children's blood pressure levels.

Age-specific strategies for immunization reminders and recalls: a registry-based randomized trial.

Although previous studies have found reminder/recall to be effective in increasing immunization rates, little guidance exists regarding the specific ages at which it is optimal to send reminder/recall notices. To assess the relative effectiveness of centralized reminder/recall strategies targeting age-specific vaccination milestones among children in urban areas during June 2008-June 2009. Three reminder/recall strategies used capabilities of the Michigan Care Improvement Registry (MCIR), a statewide immunization information system: a 7-month recall strategy, a 12-month reminder strategy, and a 19-month recall strategy. Eligible children were randomized to notification (intervention) or no notification groups (control). Primary study outcomes included MCIR-recorded immunization activity (administration of ≥1 new dose, entry of ≥1 historic dose, entry of immunization waiver) within 60 days following each notification cycle. A total of 10,175 children were included: 2,072 for the 7-month recall, 3,502 for the 12-month reminder, and 4,601 for the 19-month recall. Immunization activity was similar between notification versus no notification groups at both 7 and 12 months. Significantly more 19-month-old children in the recall group (26%) had immunization activity compared to their counterparts who did not receive a recall notification (19%). Although recall notifications can positively affect immunization activity, the effect may vary by targeted age group. Many 7- and 12-month-olds had immunization activity following reminder/recall; however, levels of activity were similar irrespective of notification, suggesting that these groups were likely to receive medical care or immunization services without prompting.

Impact of Health Education on the Knowledge and Practice Regarding Personal Hygiene among Primary School Children in Urban Area of Karnataka, India

Introduction: Poor personal hygiene, in combination with insanitary conditions and contaminated water, creates a serious public health threat to school children. Children are not conscious of personal hygiene at school level. For better knowledge health education is needed. Objective: To assess the change on knowledge and practice regarding personal hygiene among primary school children after educational interventions. Material and methods: Out of 7 schools Government Urdu Primary School was selected by Simple Random Sampling. All of students of grade 3 rd , 4 th and 5 th were included. Baseline and end line survey was done in February and September 2013.Health education sessions were conducted once a week for six weeks. Paired t test, Mc Nemar test and proportions were calculated. Ethical clearance and informed consent was obtained. Results: The mean knowledge score of personal hygiene increased from 51.55 to 75.46 which was statistically significant at paired t 13.01, df 19 and p<0.01. The mean practice score of personal hygiene increased from 44.19 to 69.22 which was statistically significant at paired t 7.26, df 8 and p<0.01. Conclusion: There is need of proper health education intervention through framework of schools to the school children, for improvement regarding personal hygiene among them, throughout the nation.

Diet and asthma: An observational study

Introduction: Asthma as we know has multiple etiologies and risk factors. Among the noncommunicable diseases, asthma remains a global giant, a disease that has numerous predictors some proven and some under scrutiny. Linking diet with asthma has been crucial and treacherous for long. With all the studies that have been undertaken, some clearly state the protective effects/adverse effects of certain foods, while others deepen the dilemma. This study has been undertaken in order to enlarge the spectrum of studies performed in this regard. The study evaluates the dietary habits (vegetarian and nonvegetarian) as a whole of 554 school going children and categorizes them into asthmatics (along with allergic disorders) (both physician diagnosed) and nonasthmatics. Aims and Objectives: The aim was to establish the correlation between diet and physician diagnosed asthma (and allergic disorders) in school going children. Materials and Methods: A questionnaire inspired by the International study for Asthma and Allergy in Children questionnaire was used to evaluate the dietary habits and disease status of the 554 school going children of urban areas of Jaipur. The children had to fill the questionnaire under parental/teachers' guidance. Results: Asthma and allergic disorders were found to be more prevalent in those consuming a lacto-ovo vegetarian diet (odds ratio [OR]: 0.289, P - 0.004). Junk food was also significantly correlated (OR: 1.643, P - 0.004), as well as a positive family history (OR: 0.585, P - 0.002). Conclusion: Although studies linking a vegetarian diet to be protective against asthma are numerous, our study shows a different picture. The school of thought that considers vegetarian diet to be protective may lay its basis on the high antioxidant levels in the blood, which according to a new hypothesis, on the contrary may be related to increased risk of allergies too.

Child labour and its relationship to Body Mass Index (BMI), school attendance and academic marks

To determine the relationship between work and the BMI, average attendance and marks obtained by school children in rural and urban areas of Pondicherry. A cross-sectional study was carried out in the schools situated in the service areas of Jawaharlal Institute Rural Health Center (JIRHC) and Jawaharlal Institute Urban Health Center (JIUHC) of JIPMER, Pondicherry. In all the classes studied, working children in the urban area scored slightly lower marks. In the urban area the average attendance at school among the working children was found to be slightly, but not significantly, lower compared to the non-working children. In rural areas compared to the non-working children, the average BMI of the working children was slightly lower in classes VIII and IX. The average BMI of the working children in the urban area was slightly lower in all the classes compared to the not working children. Key words: Child labour, Body mass index, school attendance, Academic marks, Pondicherry

Low Visual-Perceptive Ability Cognitive Profile Places Urban Greek Kindergarten Children “At Risk” For Dyslexic Learning Difficulties

A low visual-perceptive cognitive profile may predispose Greek kindergarten-aged children in urban areas to develop subsequent learning difficulties. The aim of the current study was, through the use of static and nonstatic diagnostic tools and early diagnostic procedures and a special intervention program, to equalize the big declinations in the children’s performances, among the different cognitive areas, to reduce the cognitive risk factor and, possibly, to avoid the appearance of learning difficulties at a later age. The Detroit Test of Learning Aptitude–2 (DTLA-2) was used to assess 60 children aged between 6.0 and 6.3 years, and a 20-session educational intervention program was implemented. One-year follow-up (35 children) shows a better balance in their cognitive profile was achieved compared with the control group. These results underline the importance of early diagnosis and appropriate intervention in children with specific cognitive profiles, who are “at risk” of developing subsequent learning difficulties.

Family and Neighborhood Correlates of Overweight and Obesogenic Behaviors Among Chinese Children

The prevalence of childhood obesity is increasing rapidly in China. However, research on its modifiable environmental determinants to inform preventive interventions is limited. This paper reports a cross-sectional study that aimed to identify family and neighborhood environmental correlates of overweight and related health behavior among Chinese primary school-aged children in urban areas. Routinely collected height and weight data of third year students (8-10 years) from four primary schools in socioeconomically distinct districts of two southern cities of China was obtained. Using the WHO 2007 reference values, children were categorized into overweight/obese or non-overweight. Parents of the same children completed a questionnaire, comprising mainly validated questions, about family and perceived neighborhood environments, parental physical activity habits, and the child's dietary and physical activity patterns. Multiple logistic regression analysis was performed to examine the association between these environmental factors and childhood overweight or whether or not the child engages in at least 1 h daily moderate to vigorous physical activity. Multiple linear regression analysis was undertaken to examine the association between environmental factors and the frequency of consumption of unhealthy snacks, fruit, and vegetables in children. Data on 497 children were available. Children who were mainly cared for by their grandparents were over twice as likely to be overweight/obese (adjusted OR 2.03; 95% CI 1.19-3.47) and to have higher consumption of unhealthy snacks and sugar-added drinks (B = 2.13, 95% CI 0.87-3.40), compared with children who were mainly cared for by their parents or other adult. Children who lived with at least two grandparents in the household were at higher risk for being overweight/obese than children who lived without any grandparent (adjusted OR 1.72; 95% CI 1.00-2.94). No evidence was found for associations between perceived neighborhood environmental characteristics and child's weight status and obesogenic behaviors in this study. Children's family environment, particularly the living-in grandparents, should be targeted in future preventive interventions among China's southern urban populations.

Correlates of diarrhoea among children below the age of 5 years in Sudan

The Millennium Development Goals recognise child health and survival as an important socio-development issue. To determine the correlates of diarrhoea among children aged below 5 years in north Sudan. We conducted secondary data analysis of the Sudan Multiple Cluster Indicators Survey II. Altogether, 23,295 children were included in the survey. Half (50.0%) of the children were males, and 22.5% of them were of age less than one year. Boys were 3% (p=0.044) more likely to have diarrhoea compared to girls. Compared with the oldest age group (48-59 months), children less than 6 months of age and those aged 36-47 months had 25% and 18% lower prevalence of diarrhoea, respectively, while children aged 6-24 months and those aged 24-35 months had 1.5 fold and 1.17 fold higher prevalence of diarrhoea. Children in urban areas were 6% more likely to have diarrhoea. Children from households with 1 or 2 people per room were 8% less likely to have diarrhoea compared to children from households with more than 3 people per room. Diarrhoea was associated with child's age, gender, and social status. Our findings provide a useful baseline for interventions and comparisons with future studies.

Blood lead levels among children aged 0 to 6 years in 16 cities of China, 2004-2008

Background The adverse health effects of lead for children under 6 years are well known. Studies to assess the lead exposure among children in China are small in sample size and lack of national representative data. The aim of this study therefore was to describe blood lead levels and identify risk factors for lead exposure among children aged 0 to 6 years living in 16 cities in China. Methods We analyzed data from blood lead levels surveillance in China carried out in 16 large cities between 2004 and 2008. A stratified clustered random sampling strategy was used. A total of 69 968 children aged 0 to 6 years were included. We conducted multiple Logistic regression analyses to explore risk factors to high blood lead level. Results The geometric mean blood lead level of the children was 4.50 μg/dl (median: 4.90 μg/dl; IQR: 3.20-7.00 μg/dl). Overall prevalence of blood lead level ≥10.00 μg/dl among 0- to 6-year-old children was 7.57%. But the proportion of blood lead level ≥5.00 but &lt;10.00 μg/dl was 42.12%. Blood lead levels were significantly higher in boys (4.63 μg/dl) than in girls (4.35 μg/dl) (P &lt;0.0001). The geometric mean blood lead levels and prevalence of blood lead level ≥10.00 μg/dl increased with age (P &lt;0.0001 for the two trends). After controlling for sociodemographic, dietary and behavior factors, multivariable analysis indicated that lower maternal education, male gender, younger age, often biting pencil or/and toys, walking or playing for long time on the street, not washing hands before eating are major risk factors for higher lead levels. Conclusions The blood lead levels among Chinese children in urban areas are lower than previous studies but close to those of developed countries. However, children with low lead exposure account for almost half and the sociodemographic factors (age, male sex, and low mother education level) continue to be associated with higher blood lead levels.

Prenatal and early life home environment exposure in relation to preschool children’s asthma, allergic rhinitis and eczema in Taiyuan, China

Prenatal and early life home environment might be related to children’s asthma or allergic diseases later in life. A cross-sectional epidemiological study was designed and a questionnaire survey was performed in 3700 preschool children in urban areas in Taiyuan, Shanxi Province, China. Questions on children’s asthma and allergic diseases from the International Study on Asthma and Allergies in Childhood (ISAAC) were integrated with questions on home environment from the Swedish Dampness in Buildings and Health (DBH) study, appropriately modified for Chinese life habits. By multivariate regression analyses controlling for age, gender, heredity, location in urban/suburban or rural areas, environmental tobacco smoke (ETS) and breastfeeding, we found that home new furniture (HNF) before birth (referring to 1 year before pregnancy and during pregnancy) was positively associated with wheezing ever (odds ratio(OR) 1.23 with 95% CI of 1.03–1.48) and wheezing last 12 months (1.24,1.00–1.54), allergic rhinitis (AR) (1.26,1.06–1.51), and eczema (1.42,1.01–1.99). HNF between 0–1 years old was also positively associated with wheezing last 12 months. Home new decoration (HND) during 0–1 years old was positively associated with AR symptoms and eczema symptoms, more in the last 12 months. Stronger positive associations were found for signs of home mold and dampness with almost all children’s asthmatic and allergic symptoms (OR ranging from 1.23–1.85, P<0.05). By mutual adjustment between HNF before children’s birth and home mold or dampness, all the significance remained unchanged. Prenatal HNF and home mold or dampness was independently associated with children’s asthmatic and allergic diseases later in life.

Studying the Roles of Nonprofits, Government, and Business in Providing Activities and Services to Youth in the Phoenix Metropolitan Area

The article addresses the questions, What do children in urban areas do on Saturdays? What types of organizational resources do they have access to? Does this vary by social class? Using diary data on children’s activities on Saturdays in the Phoenix-Mesa-Scottsdale metropolitan area, the authors describe the different types of venues (households, businesses, public space, associations, charities, congregations, and government/tribal agencies) that served different types of children. They find that the likelihood of using a charity or business rather than a government or tribal provider increased with family income. Also, the likelihood of using a congregation or a government facility rather than a business, charity, or household increased with being Hispanic. The authors discuss the implications for the urban division of labor on Saturdays and offer research questions that need further investigation.

Achieving comprehensive childhood immunization: an analysis of obstacles and opportunities in The Gambia

Introduction Immunization is a vital component in the drive to decrease global childhood mortality, yet challenges remain in ensuring wide coverage of immunization and full immunization, particularly in low- and middle-income countries. This study assessed immunization coverage and the determinants of immunization in a semi-rural area in The Gambia.Methods Data were drawn from the Farafenni Health and Demographic Surveillance System. Children born within the surveillance area between January 2000 and December 2010 were included. Main outcomes assessed included measles, BCG and DTP vaccination status and full immunization by 12 months of age as reported on child healthcards. Predictor variables were evaluated based on a literature review and included gender, ethnicity, area of residence, household wealth and mother’s age.Results Of the 7363 children included in the study, immunization coverage was 73% (CI 72–74) for measles, 86% (CI 86–87) for BCG, 79% (CI 78–80) for three doses of DTP and 52% (CI 51–53) for full immunization. Coverage was significantly associated with area of residence and ethnicity, with children in urban areas and of Mandinka ethnicity being least likely to be fully immunized.Conclusions Despite high levels of coverage of many individual vaccines, delivery of vaccinations later in the schedule and achieving high coverage of full immunization remain challenges, even in a country with a committed childhood immunization programme, such as The Gambia. Our data indicate areas for targeted interventions by the national Expanded Programme of Immunization.

Noise and children′s health: Research in Central, Eastern and South-Eastern Europe and Newly Independent States

Many reviews have documented the adverse effects of noise on children's health, but the international scientific community was previously unfamiliar with noise research in Central and Eastern Europe (CEE), South-East Europe (SEE), and Newly Independent States (NIS). The aim of this review was to present studies on the effects of noise on children's health, conducted in aforementioned countries in the second half of the 20 th century, interpret their findings, and criticize their methodology and results wherever possible. This review focused on 30 papers published in national journals in the period from 1965 to 2000. By design, 22 studies were observational and cross-sectional, and eight studies were experimental. The outcomes under the study included auditory changes, stress reactions, sleep disturbances, school performance, upright posture, and vegetative functions. Researchers from CEE, SEE, and NIS were the pioneers in the assessment of noise-induced changes of vegetative functions and blood pressure of children in urban areas, as well as of infants exposed to noise in incubators. Future research should focus on intervention studies and follow-up of children's health in relation to noise exposure.

Report on Childhood Obesity in China (10): Association of Sleep Duration with Obesity

ObjectiveTo explore the association of sleep duration with obesity among children in urban areas of China. MethodsA total of 6 576 children (3 293 boys and 3 283 girls) aged 7–11 years were randomly selected from 36 primary schools in 6 metropolitan cities in China. A 7-day Physical Activity Recall was used to assess the sleep duration and physical activity level. The height, weight, waist circumference (WC) and percentage of body fat (%BF, as determined by bioelectrical impedance analysis technique) were measured by following the standardized operation procedures. The information on demography, lifestyle and eating habits was collected with a self-administered questionnaire from participants and their parents. ResultsThe average sleep duration per night in the children was 9.7 h with the decreasing trends along with the increase of age (P<0.05). The sleep duration was negatively associated with body mass index (BMI) and WC in both boys and girls after adjustment for confounders (β value −0.23 and −0.82 for boys, −0.24 and −0.91 for girls, respectively, P<0.01). However, no significant association of sleep duration with %BF was found. Children who slept less than 9.0 h per night had a higher risk for overweight and obesity (OR=1.29, 95% CI: 1.01, 1.64) and abdominal obesity (OR=1.38, 95% CI: 1.04, 1.83) as compared with those who slept for 10.0−10.9 h. ConclusionsShort sleep duration is associated with obesity. It is important to ensure adequate sleep duration of children and foster their healthy lifestyle at an early stage of life.

Geographical Rural Status and Health Outcomes in Pediatric Liver Transplantation: An Analysis of 6 Years of National United Network of Organ Sharing Data

To determine whether children in rural areas have worse health than children in urban areas after liver transplantation (LT). We used urban influence codes published by the US Department of Agriculture to categorize 3307 pediatric patients undergoing LT in the United Network of Organ Sharing database between 2004 and 2009 as urban or rural. Allograft rejection, patient death, and graft failure were used as primary outcome measures of post-LT health. Pediatric end-stage liver disease/model of end-stage liver disease scores >20 was used to measure worse pre-LT health. In a multivariate analysis, we found greater rates of allograft rejection within 6 months of LT (OR 1.27; 95% CI 1.05-1.53) and a lower occurrence of posttransplantation lymphoproliferative disorder (OR 0.64; 95% CI 0.41-0.99) in patients in rural areas. The difference in allograft rejection was eliminated at 1 year of LT (OR 1.18; 95% CI 0.98-1.42). Rural location did not impact other outcome measures. We conclude that rural location makes a negative impact on patient health within the first 6 months of LT by increasing the risk for allograft rejection, although patients in rural areas may have lower rates of developing posttransplantation lymphoproliferative disorder. Long-term adverse health effects were not seen.

Stunting, underweight and overweight: A major health problem among children under 3 years of age in urban areas of West Bengal, India

Background: Malnutrition is still highly pervasive in developing countries, and pre-school age children may be a particular high-risk population. However, nutritional status of this group is poorly documented, particularly in urban areas. Aims: To assess the stunting, underweight, thinness and overweight in urban Bengalee pre-school age children. Methods: A total of 1060 children aged 1-3 years who attended the immunisation clinic of Midnapore District Red Cross Hospital of West Bengal, India during three years were enrolled in the study. The prevalence of underweight and stunting in pre-school age children were assessed using the SD classification based on the 2007 World Health Organization (WHO) child growth standards. The BMI classification was also used to assess thinness, overweight and obesity. Results: Mean anthropometric variables were significantly higher among the boys than girls (p≤ 0.05). The results showed that the prevalence of undernutrition, particularly stunting (50.9%), was much higher than underweight (28.6%). The prevalence of underweight was more pronounced among boys. Conversely, girls tended to be more stunted than boys. The study revealed that approximately 14.4% of pre-school age children were overweight and that boys (16.6%) exhibited more overweight compared to girls (11.8%). The study also indicated the co-occurrence of stunting and overweight among the participants. Conclusions: The present study emphasised that malnutrition is a growing public health issue, regardless of as stunting and overweight were highly prevalent among the Bengalee pre-school age children in urban areas of West Bengal.

Calciferol Deficiency Mimicking Abusive Fractures in Infants: Is There Any Evidence?

T he history of calciferol metabolism and biochemistry is tightly intertwined with that of American pediatrics. Rickets was a widespread affliction of children in urban areas in the 19th and early 20th centuries. Mellanby recognized the anti-rachitic properties of a fat-soluble substance that was incorrectly named ‘‘vitamin’’ D. Shortly thereafter, Eliot undertook a seminal clinical trial in New Haven that demonstrated the ability of cod-liver oil to prevent rickets in infants. Within decades, supplementation of nursing infants became nearly universal, and clinical rickets largely disappeared. In the latter part of the 20th century, lax prescribing of calciferol supplements to nursing children, combined with an increasing number of mothers of darkly pigmented infants choosing to breast feed, led to a resurgence of clinical rickets. Because we are well into the 21st century, clinical rickets in infants again is largely disappearing. As this has happened, there has been an increasing interest in the possibility that degrees of calciferol deficiency insufficient to cause frank rickets could still have deleterious skeletal effects. This interest has been informed by recent information in adults suggesting that levels of calciferol (as assessed by 25hydroxycholecalciferol [25(OH)D]) we have previously considered normal may actually be low. This, in turn, has led to the suggestion that mild degrees of calciferol deficiency, in the absence of actual rickets, could predispose the infant to fractures. It is sometimes argued that such subclinical calciferol deficiency could explain some fractures that have been ascribed to abuse. Multiple longbone fractures have long been recognized as an indicator for child abuse. The implications for the child when fractures caused by abuse aremistakenly attributed to fractures caused by rickets are potentially life-threatening. Similarly, misdiagnosis of abuse in the setting of clinical rickets has significant legal, social, emotional, and clinical implications. In this commentary, we will provide a review of our current understanding of the metabolism of calciferol in infants. We will then discuss recent data defining normal levels of calciferol at various ages, including in infants. We will examine the fracture risk associated with actual clinical rickets and the evidence that this risk is present with milder degrees of calciferol deficiency. Lastly, we will consider the proposition that mild degrees of calciferol deficiency can predispose infants to fractures mimicking those caused by non-accidental trauma of infants.