Rickets

Factors that can increase a child’s risk of rickets include:

• Darker skin pigmentation. Brown or Black skin has more of the pigment melanin, which lowers the skin’s ability to produce vitamin D from sunlight.
• Mother’s vitamin D deficiency during pregnancy. A baby born to a mother with serious vitamin D deficiency can be born with symptoms of rickets or develop them within a few months after birth.
• Northern latitudes. Children who live in geographical locations where there is less sunshine are at higher risk of rickets.
• Premature birth. Babies born before their due dates tend have lower levels of vitamin D because they had less time to receive the vitamin from their mothers in the womb.
• Medicines. Certain types of anti-seizure medicines and antiretroviral medicines, used to treat HIV infections, appear to interfere with the body’s ability to use vitamin D.
• Exclusive breastfeeding. Breast milk doesn’t contain enough vitamin D to prevent rickets. Babies who are exclusively breastfed typically receive vitamin D drops.

If not treated, rickets can lead to:

• Failure to grow.
• Bone deformities.
• Dental defects.
• Seizures.

Exposure to sunlight provides the best source of vitamin D. During most seasons, 10 to 15 minutes of exposure to the sun near midday is enough. But if you have brown or Black skin, if it’s winter, or if you live in northern latitudes, you might not be able to get enough vitamin D from sun exposure.

In addition, because of skin cancer concerns, infants and young children, especially, are warned to avoid direct sun or to wear sunscreen and protective clothing.

To prevent rickets, make sure your child eats foods that contain vitamin D naturally — fatty fish such as salmon and tuna, fish oil, and egg yolks — or that have been fortified with vitamin D, such as:

• Infant formula.
• Cereal.
• Bread.
• Milk, but not foods made from milk, such as some yogurts and cheese.
• Orange juice.

Check labels to determine the vitamin D content of fortified foods.

If you’re pregnant, ask your healthcare professional about taking vitamin D supplements.

Guidelines recommend that all infants should receive 400 international units (IU) a day of vitamin D. Because human milk contains only a small amount of vitamin D, infants who are exclusively breastfed should receive supplemental vitamin D daily. Some bottle-fed infants also may need vitamin D supplements if they aren’t receiving enough from their formula.