Nutritional rickets in African American breast-fed infants

doi:10.1067/mpd.2000.109009

The Journal of Pediatrics

Volume 137, Issue 2, August 2000, Pages 153-157

https://doi.org/10.1067/mpd.2000.109009 Get rights and content

Abstract

Objective: To analyze the characteristics of infants and children diagnosed with nutritional rickets at two medical centers in North Carolina in the 1990s. Study design: The physical and radiographic findings, calcium, phosphorus, alkaline phosphatase, and 25-hydroxyvitamin D levels of infants and children diagnosed with nutritional rickets at two medical centers were reviewed. Breast-feeding data were obtained from the North Carolina Women, Infants and Children Program (WIC). Results: Thirty patients with nutritional rickets were first seen between 1990 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 breast-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 percentile 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 breast-feeding, fewer infants receiving vitamin D supplements, and mothers and children exposed to less sunlight. We recommend that all dark-skinned breast-fed infants and children receive vitamin D supplementation. (J Pediatr 2000;137:153-7)

Section snippets

Methods

Records were reviewed on all patients with a diagnosis of nutritional rickets between the years 1990 and 1999. The patients were seen by at least one of the authors in the pediatric endocrinology clinic at Wake Forest University School of Medicine or in the pediatric endocrinology or genetic/metabolic clinics at the University of North Carolina School of Medicine at Chapel Hill and were referred from community health clinics and primary care providers from throughout North Carolina. Information

Results

Thirty patients with nutritional rickets were referred to the two medical centers between 1990 and June of 1999; 17 patients (57%) presented in 1998 and the first half of 1999. Of the total number of patients, 57% were male (n = 17) and 43% female (n = 13). All were African American. According to dietary history provided by the mother at the time of the referral visit, all were breast fed, with an average duration of breast-feeding of 12.5 months. Those children over 1 year of age had a history

Discussion

All of our patients with nutritional rickets were breast fed without vitamin D supplementation and all were African American, the largest minority group in North Carolina. As in other studies,3, 5, 6, 8 the vast majority of the patients were growth retarded in both height and weight by the time of diagnosis, and nearly one third were severely growth retarded. There are several possible causes for the increase in the number of cases of nutritional rickets seen at our two medical centers over the

Acknowledgements

We thank Alice Lenihan, RD, MPH, LDN, for providing the breast-feeding data on North Carolina women enrolled in the WIC program.

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^☆: Reprint requests: Shelley Kreiter, MD, Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, NC 27157.

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Original ArticlesNutritional rickets in African American breast-fed infants☆

Abstract

Section snippets

Methods

Results

Discussion

Acknowledgements

Am J Clin Nutr

Am J Clin Nutr

J Pediatr

The disappearance of rickets

Am J Public Health

An outbreak of vitamin D deficiency rickets in a susceptible population

Pediatrics