Nutritional rickets in African American breast-fed infants

Objective: To analyze the characteristics of infants and children diagnosed with nutritional rickets at two medical centers in North Carolina in the 1 990s. Study design: The physical and radiographic findings, calcium, phosph orus, alkaline phosphatase, and 25-hydroxyvitamin D levels of infants and c hildren diagnosed with nutritional rickets at two medical centers were revi ewed. Breast-feeding data were obtained from the North Carolina Women, Infa nts and Children Program (WIC). Results: Thirty patients with nutritional rickets were first seen between 1 990 and June of 1999. Over half of the cases occurred in 1998 and the first half of 1999. All patients were African American children who were breast fed without receiving supplemental vitamin D. The average duration of breas t-feeding was 12.5 months. The age at diagnosis was 5 to 25 months, with a median age of 15.5 months. Growth failure was common: length was <5th perce ntile in 65% of cases, and weight was <5th percentile in 43%. Conclusion: Factors that may have contributed to the increase in referrals of children with nutritional rickets include more African American women br east-feeding, fewer infants receiving vitamin D supplements, and mothers an d children exposed to less sunlight. We recommend that all dark-skinned bre ast-fed infants and children receive vitamin D supplementation.