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Rickets Caused by Vitamin D Deficiency in Breast-fed Infants in the Southern United States FREE

SAMARK K. BHOWMICK, MD; KEVIN R. JOHNSON, MD; KENNETH R. RETTIG, MD
Am J Dis Child. 1991;145(2):127-130. doi:10.1001/archpedi.1991.02160020017006.
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Sir.—Rickets caused by vitamin D deficiency in breast-fed infants is rarely reported in patients from the southern part of the United States. Milder winters, a perennially sunny climate, and liberal vitamin D supplementation are the most likely reasons for this low incidence. We report four cases of rickets in breast-fed black infants who received no vitamin D supplementation. Except for one patient, there was no history of patients being overdressed or deprived of sunlight exposure. Lack of familiarity with the disease, stemming from the rarity of its occurrence in warm climates,

probably delayed the diagnosis in two cases.

Patient Reports.—Patient 1.—A 13-month-old black boy presented to the Pediatric Clinic of the United States Air Force (USAF) Medical Center, Keesler Air Force Base, Miss, with failure to thrive, inability to walk, and muscle weakness.

REFERENCES

Lawrence RA.  Practices and attitudes toward breast feeding among medical professionals . Pediatrics . 1982;; 70:912-920.
Howard RB, Winter HS. Nutrition and Feeding of the Infant and Toddler . Boston, Mass; Little Brown & Co Inc; 1984;:89.
Finberg L.  Human milk feeding and vitamin D supplement . J Pediatr. 1981;;99:228-229.
Birkbeck JA, Scott HF.  25 Hydroxycholecalciferol serum levels in breastfed infants . Arch Dis Child . 1980;;55:691-695.
Greer FR, Marshall S.  Bone mineral content, serum vitamin D metabolite concentration and ultraviolet B light exposure in infants fed human milk with and without Vitamin D2 supplements . J Pediatr . 1989;;114:204-212.
American Academy of Pediatrics Committee on Nutrition.  Nutrition and lactation . Pediatrics . 1981;;68:435-443.
Cosgrove L, Dietrich A.  Nutritional rickets in breast fed infants . J Fam Pract . 1985;;21:205-209.
Bachrach S, Fisher J, Parks JS.  An outbreak of vitamin D deficiency rickets in a susceptible population . Pediatrics . 1977;;64:871-877.
Hayward I, Stein MT, Gibson Ml.  Nutritional rickets in San Diego . AJDC . 1987;;141:1060-1062.
Specker BL, Valaris B, Hertzberg V.  Sunshine exposure and serum 25-hydroxy vitamin D concentration in exclusively breast fed infants . J Pediatr . 1985;;107:372-376.
Belton NR.  Rickets—not only the 'English disease.' Acta Paediatr Scand Suppl . 1986;;323:68-75.
Clemens TL, Adams JS, Henderson SL, Holick MF.  Increased skin pigmentation reduces the capacity of skin to synthesize vitamin D3 . Lancet . 1982;;1:74-76.
Ala-Houhala M, Koskinen T, Terho A, Koivula T, Visakorpi J.  Maternal compared with infant vitamin D supplementation . Arch Dis Child . 1986;;61:1159-1163.
Forbes GB, Woodruff CW, eds. Pediatric Nutrition Handbook . Elk Grove, Ill: Committee on Nutrition, American Academy of Pediatrics; 1985;:350-356.
Torres CF, Forbes GB, Decancq GH.  Muscle weakness in infants with rickets: distribution, course and recovery . Pediatr Neurol . 1986;;2:95-98.
Rudolf M, Arulanantham K, Greenstein RM.  Unsuspected nutritional rickets . Pediatrics . 1980;;66:72-76.
Chesney RW.  Requirements and upper limits of vitamin D intake in the term neonate, infant and older child . J Pediatr . 1990;;116:159-166.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

References

Lawrence RA.  Practices and attitudes toward breast feeding among medical professionals . Pediatrics . 1982;; 70:912-920.
Howard RB, Winter HS. Nutrition and Feeding of the Infant and Toddler . Boston, Mass; Little Brown & Co Inc; 1984;:89.
Finberg L.  Human milk feeding and vitamin D supplement . J Pediatr. 1981;;99:228-229.
Birkbeck JA, Scott HF.  25 Hydroxycholecalciferol serum levels in breastfed infants . Arch Dis Child . 1980;;55:691-695.
Greer FR, Marshall S.  Bone mineral content, serum vitamin D metabolite concentration and ultraviolet B light exposure in infants fed human milk with and without Vitamin D2 supplements . J Pediatr . 1989;;114:204-212.
American Academy of Pediatrics Committee on Nutrition.  Nutrition and lactation . Pediatrics . 1981;;68:435-443.
Cosgrove L, Dietrich A.  Nutritional rickets in breast fed infants . J Fam Pract . 1985;;21:205-209.
Bachrach S, Fisher J, Parks JS.  An outbreak of vitamin D deficiency rickets in a susceptible population . Pediatrics . 1977;;64:871-877.
Hayward I, Stein MT, Gibson Ml.  Nutritional rickets in San Diego . AJDC . 1987;;141:1060-1062.
Specker BL, Valaris B, Hertzberg V.  Sunshine exposure and serum 25-hydroxy vitamin D concentration in exclusively breast fed infants . J Pediatr . 1985;;107:372-376.
Belton NR.  Rickets—not only the 'English disease.' Acta Paediatr Scand Suppl . 1986;;323:68-75.
Clemens TL, Adams JS, Henderson SL, Holick MF.  Increased skin pigmentation reduces the capacity of skin to synthesize vitamin D3 . Lancet . 1982;;1:74-76.
Ala-Houhala M, Koskinen T, Terho A, Koivula T, Visakorpi J.  Maternal compared with infant vitamin D supplementation . Arch Dis Child . 1986;;61:1159-1163.
Forbes GB, Woodruff CW, eds. Pediatric Nutrition Handbook . Elk Grove, Ill: Committee on Nutrition, American Academy of Pediatrics; 1985;:350-356.
Torres CF, Forbes GB, Decancq GH.  Muscle weakness in infants with rickets: distribution, course and recovery . Pediatr Neurol . 1986;;2:95-98.
Rudolf M, Arulanantham K, Greenstein RM.  Unsuspected nutritional rickets . Pediatrics . 1980;;66:72-76.
Chesney RW.  Requirements and upper limits of vitamin D intake in the term neonate, infant and older child . J Pediatr . 1990;;116:159-166.

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