title: Nutritional rickets among children in the United States: review of cases reported between 1986 and 2003.
abstract: Reports of hypovitaminosis D among adults in the United States have drawn attention to the vitamin D status of children. National data on hypovitaminosis D among children are not yet available. Reports from 2000 and 2001 of rickets among children living in North Carolina, Texas, Georgia, and the mid-Atlantic region, however, confirmed the presence of vitamin D deficiency among some US children and prompted new clinical guidelines to prevent its occurrence. We reviewed reports of nutritional rickets among US children <18 y of age that were published between 1986 and 2003. We identified 166 cases of rickets in 22 published studies. Patients were 4-54 mo of age, although in 17 studies the maximal age was <30 mo. Approximately 83% of children with rickets were described as African American or black, and 96% were breast-fed. Among children who were breast-fed, only 5% of records indicated vitamin D supplementation during breast-feeding. The American Academy of Pediatrics (AAP) recently recommended a minimal intake of 200 IU/d vitamin D for all infants, beginning in the first 2 mo of life. AAP recommends a vitamin D supplement for breast-fed infants who do not consume at least 500 mL of a vitamin D-fortified beverage. Given our finding of a disproportionate number of rickets cases among young, breast-fed, black children, we recommend that education regarding AAP guidelines emphasize the higher risk of rickets among these children. Education should also emphasize the importance of weaning children to a diet adequate in both vitamin D and calcium.
authors.affiliation: Maternal Child Nutrition Branch, Division of Nutrition and Physical Activity, Centers for Disease Control and Prevention, Atlanta, GA 30341-3724, USA.
authors.forename: Pamela
authors.initials: P
authors.lastname: Weisberg
authors.forename: Kelley S
authors.initials: KS
authors.lastname: Scanlon
authors.forename: Ruowei
authors.initials: R
authors.lastname: Li
authors.forename: Mary E
authors.initials: ME
authors.lastname: Cogswell
mesh_terms: D000293:Adolescent; D044383:Black People; D001942:Breast Feeding / Q000009:adverse effects; D002648:Child; D015362:Child Nutrition Disorders / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D002675:Child, Preschool; D005260:Female; D017408:Guidelines as Topic; D006801:Humans; D007223:Infant; D008297:Male; D018673:Nutrition Policy; D012279:Rickets / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D014481:United States / Q000453:epidemiology; D001741:Black or African American