NUTRITIONAL RICKETS IN SUBURBIA

Objective: Vitamin D deficiency continues to be a problem in pediatric s. This report presents four children, one Caucasian male and three Af rican-American females aged 4 to 24 months who were treated for vitami n D deficiency rickets. Methods: One female was diagnosed in the Emerg ency Department during evaluation of a viral syndrome, another present ed with hypocalcemic seizures and the third was a self-referral for ev aluation of widened wrists. The male had biochemical rickets discovere d incidentally during a hospitalization for pneumonia. All were breast fed without formula supplements. The 24-month female had severe cow an d soy protein allergies and received multivitamin supplements intermit tently. Birth order was from third to sixth child. Two families practi ced Islam and the mothers wore veils. The females had a weight deficit for height. The females demonstrated a rachitic rosary, widening of t he wrists and leg bowing. At diagnosis the serum calcium was 5.0-8.6 m g/dl, the inorganic phosphorus was 1.5-3.9 mg/dl and the alkaline phos phatase was 408-3324 U/L. The serum intact parathormone levels and the vitamin D levels were measured at Nichols Laboratories. The 25-OH vit amin D levels were 2-22 ng/ml and the 1,25(OH)(2) vitamin D levels wer e 14-122 pg/ml. All had elevated parathormone levels. The three female s had roentgenographic evidence of rickets. Two of the children also d emonstrated iron deficiency. Results: All patients responded to Vitami n D supplements, beginning at 2000 IU for the male and 8,000-10,000 IU daily for the females. Two children were also given calcium supplemen ts. The three females all showed complete healing of the rickets radio logically within six months. The serum intact parathormone demonstrate d an inverse correlation with the serum calcium during recovery (r= -0 .669; p<0.05). Conclusion: Vitamin D deficiency does still occur. Brea stfed children of multiparous mothers, with increased skin pigmentatio n, living in the higher latitudes are at increased risk and would bene fit from vitamin D supplementation while breastfeeding.