How many infants are born with rickets?

Posted on: April 29, 2015   by  John Cannell, MD

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On the weekend of April 19, 2015, news flashed around the UK of an epidemic of vitamin D deficient rickets in England.

Newton J. The return of rickets: Doctors call for vitamin D supplements for under-fours to battle rise in condition caused by lack of sunlight. Daily Mail, 2015, April 19.

Those of you who read this blog regularly will remember the sad stories of parents whose infants had multiple fractures and who were accused of child abuse. Their infants were taken away when all that really happened was the infants had rickets, because the pediatrician failed to prescribe vitamin D supplementation.

Cannell JJ. Child abuse or infantile rickets, 8/1/2015.

Cannell JJ. Another rickets tragedy. 1/19/2012.

Cannell JJ. Misdiagnosed child abuse, yet again. 8/25/2011.

Cannell JJ. Vitamin D deficient rickets, yet another family shattered. 3/4/2011.

Cannell JJ. Newsletter: child abuse or vitamin D deficient rickets? 6/29/2009.

What is actually known about congenital rickets? Congenital rickets refers to the type of rickets that the infant develops while still inside the mother.

Paterson CR, Ayoub D. Congenital rickets due to vitamin D deficiency in the mothers. Clin Nutr. 2014 Dec 17.

The authors found 25 infants with congenital rickets in the literature and 33% of these infants had fractures. However, the true prevalence of fractures was unknown because skeletal surveys were not done on the infants.

No one knows how common infantile rickets is because no one has conducted the appropriate studies. In a middle-class series of otherwise normal newborns, clinical evidence (craniotabes) of infantile rickets was 22%. Craniotabes is when pressure on the skull makes it snap in and out like pressing on a ping-pong ball.

Yorifuji J, Yorifuji T, Tachibana K, Nagai S, Kawai M, Momoi T, Nagasaka H, Hatayama H, Nakahata T. Craniotabes in normal newborns: the earliest sign of subclinical vitamin D deficiency. J Clin Endocrinol Metab. 2008 May;93(5):1784-8.

The authors concluded,

“Large-scale, prospective epidemiological studies are necessary to elucidate the effects of early-life vitamin D deficiency on the later health status of otherwise normal neonates. Until the whole picture of perinatal vitamin D deficiency is elucidated, for safety, we suggest . . . treating all pregnant women with vitamin D.”

One study that needs to be done, but will never be done, is a x-ray or ultrasound survey of “normal” three month old infants to observe the prevalence of silent fractures in “normal” infants. The reason this study will never be done is due to the fact that parents would have to be told in advance that if fractures were found in their infant, the parents would be reported to child protective services for child abuse. Would you participate in such a study?

The Vitamin D Council will soon start selling a gift pack for pregnant women. It will include 3 things: an in-home 25(OH)D blood test kit, a bottle of vitamin D and an information sheet about the importance of vitamin D during pregnancy. It will help ensure that the pregnant women you know forgo the potential nightmare of infantile rickets.

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