Rickets caused by vitamin D deficiency in breast-fed infants in the southern United States

Article Abstract:

A discussion is presented concerning rickets (a condition leading to abnormal bone development due to vitamin D deficiency) in breast-fed infants in the southern regions of the US, rarely considered a problem because of the plentiful sunshine (which assists the formation of vitamin D3 in skin). Four case histories are reported of black children who developed weakness, bowing of the legs, X-ray abnormalities, and inadequate weight gain (all signs of rickets); none had received vitamin D supplementation. Weight gain and bone healing followed only a few weeks of supplementation. Whether breast-fed infants should receive vitamin D supplements has been debated; although breast milk contains little vitamin D, babies who are nursed rarely develop rickets. The American Academy of Pediatrics recommends that infants who are breast-fed be given supplements if they are not exposed to the sunlight. Risk factors for rickets include dark skin (most cases in the US are among blacks living in the North or Northeast), prolonged breast-feeding without supplementation, and low consumption of solid foods. Black babies need considerably more sun exposure to derive the same benefits in terms of vitamin D as white babies; three of the patients described in the case reports had apparently adequate exposure. Lactating or pregnant women should take care to maintain their vitamin D levels. Physicians, especially younger ones, tend not to prescribe supplements for women living in sunny climates; moreover, pediatricians can be slow to diagnose rickets even when infants show signs of the disease. Skeletal changes are often slower to appear than systemic abnormalities. It is recommended that all black infants who are breast-fed be given 400 IU (international units) of supplementary vitamin D daily. Prevention is the best approach to this completely preventable disease. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Physiological aspects, Demographic aspects, Breast feeding, Vitamin D, Breast milk, Rickets, letter to the editor

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Blood lead, calcium status, and behavior in preschool children

Article Abstract:

Decreased intake of calcium has been correlated with increased absorption of lead, and studies done on animals have shown a direct relationship between decreased intake of calcium and lead pica (craving to eat substances that are not food - in this case, lead). A study of 64 urban black children was carried out to determine if calcium status is associated with blood lead levels and behavior. The children ranged in age from 18 to 47 months, and were divided into groups based upon low or high blood lead levels. The children received a pica score based on frequency of eating nonfood substances, the particular item ingested, the results of a screening questionnaire and parent checklist. A positive association was discovered between lead levels in the blood and pica. The children who had decreased calcium intake did not show a relationship between blood lead level and calcium intake, nor was there a relationship between blood lead level and blood calcium level. There was no difference in bone mineralization for either group. There were more children per household in the families of children with high blood lead levels, and the education level of the mother was generally lower in these same households than in those where the children had lower blood lead levels. However, these findings were not statistically significant. There was no association found between calcium intake and pica score. (Consumer Summary produced by Reliance Medical Information, Inc.)

Measurement, Pediatric diseases, Children, Diseases, Composition, Calcium in the body, Calcium (Nutrient), Blood, Pica (Pathology), Pica

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