To Your Health
Return of Rickets?

by Paulette Avery RN, MSN, IBCLC

I associate the childhood bone disease rickets with the dim past, something I learned about years ago in history class. Unfortunately, this nearly forgotten disease has reemerged and is showing up in infants as young as three months old.

Rickets results from a prolonged and severe deficiency of vitamin D in children, which causes bone weakness that sometimes leads to bowed legs. During the Industrial Revolution and the early 1900s, rickets was so common in England and many cities in Europe and North America that an estimated 85 percent of children had the disease. The smog created by industrialization blocked the sun and prevented children from getting the vitamin D normally provided by sun exposure. Without vitamin D, the body cannot effectively use the calcium and phosphorous necessary to build strong bones. But by the 1920s the use of cod liver oil, fortified milk, and vitamin supplements began to eliminate vitamin D deficiency, and rickets gradually disappeared.

Now, nearly 100 years later, rickets remains relatively rare, but it is increasing. Researchers at Children's Hospital Oakland found 59 cases of rickets among children up to age two seen at the hospital over the past six years. Those aged from one to two years old had symptoms including bowed legs, thickening around the ankles and wrists, bone fractures, tooth decay, and erosion of tooth enamel. Nearly all of the children in the study had darker skin. Many were African American; others were Indian, Latino, or Middle Eastern. Darker skin can increase the risk of rickets because more sunlight is required to create vitamin D.

Another factor found in many of the children was being exclusively breast-fed. Despite the many benefits of breast feeding, breast milk may not contain sufficient vitamin D, particularly if the mother is also vitamin D deficient. The American Academy of Pediatrics recommends that all babies, including those who are exclusively breast-fed, receive at least 200 IU of vitamin D a day beginning at age two months and throughout childhood.

Also, expectant mothers need prenatal vitamins and should eat foods rich in vitamin D. Children no longer receiving breast milk or infant formula should drink milk rather than sodas or juice. Provide children with an hour a day of sunlight without sunscreen during the morning or evening. Sunlight is the best source for vitamin D, but during midday exposure, sunscreen should be applied. During the winter, give children one tablespoon of cod liver oil every night. Include foods rich in vitamin D such as fish, liver, and milk in your family's diet.

Remember that exposure to sunlight as a source of vitamin D is important for adults as well. Research discussed in my February 2006 column indicates that a deficiency in vitamin D can increase the risk of several types of cancer, osteoporosis, diabetes, and schizophrenia.

By combining our awareness about rickets with the recommendations for preventing it, we can work toward returning this disease to the history books.

Paulette Avery is a registered nurse and a freelance writer who specializes in health issues.