Lesson of the week: Florid rickets associated with prolonged breast feeding without vitamin D supplementation

BMJ 1999;318:39-40 ( 2 January )

Clinical review

Lesson of the week

Florid rickets associated with prolonged breast feeding without vitamin D supplementation

Editorial by Wharton Papers p 28

M Z Mughal, consultant paediatrician, ^a H Salama, specialist registrar in paediatrics, ^a T Greenaway, general practitioner, ^b I Laing, consultant biochemist, ^a E B Mawer, professor of bone and mineral metabolism. ^c

^a St Mary's Hospital, Central Manchester Healthcare Trust, Manchester M13 0JH, ^b Alexandra Practice, Manchester M16 8NG, ^c University Department of Medicine, Manchester Royal Infirmary, Manchester M13 9WL

Correspondence to: Dr Mughal mmughal@fs1.cmhct.nwest.nhs.uk

The first 150 words of the full text of this article appear below.

The incidence of rickets caused by vitamin D deficiency, once a common health problem among British Asian children, seemsto have declined during the past decade.¹ We describe six casesof florid rickets in infants aged 10 to 28 months who were referredto our paediatric unit by local general practitioners between1995 and 1997. They were all born in the United Kingdom to parentswho were either postgraduate students or recent immigrants. Allthe children had been breast fed for a prolonged period withoutvitamin D supplementation. The mothers of these infants had notreceived vitamin D supplements during pregnancy orlactation.

Case reports

All six patients had several of the clinical signs and symptoms of rickets: bow legs, rickety rosary, swelling of the endsof long bones, frontal bossing of the skull, delayed dentition,poor growth, and slow motor development. They all had classicradiological features of rickets, including generalised osteopenia,widening of the . . . [Full text of this article]

CiteULike

Complore

Connotea

Del.icio.us Add to Digg

Digg

Technorati What's this?

Relevant Articles

Diagnosis and management of hypocalcaemia: Mark S Cooper and Neil J L Gittoes
BMJ 2008 336: 1298-1302. [Extract] [Full Text] [PDF]

Prevention message is not getting through: Scott Williamson and Stephen Greene
BMJ 2007 334: 1288. [Extract] [Full Text] [PDF]

Asian children in the UK may need vitamin D
BMJ 1999 318: 0. [Full Text]

Low plasma vitamin D in Asian toddlers in Britain: B A Wharton
BMJ 1999 318: 2-3. [Extract] [Full Text] [PDF]

Vitamin D concentrations in Asian children aged 2 years living in England: population survey: Margaret Lawson and Margaret Thomas
BMJ 1999 318: 28. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

Ward, K. A., Das, G., Berry, J. L., Roberts, S. A., Rawer, R., Adams, J. E., Mughal, Z. (2009). Vitamin D Status and Muscle Function in Post-Menarchal Adolescent Girls. J. Clin. Endocrinol. Metab. 94: 559-563 [Abstract] [Full text]
Belostotsky, V, Mughal, M Z, Berry, J L, Webb, N J A (2008). Vitamin D deficiency in children with renal disease. Arch. Dis. Child. 93: 959-962 [Abstract] [Full text]
Misra, M., Pacaud, D., Petryk, A., Collett-Solberg, P. F., Kappy, M., on behalf of the Drug and Therapeutics Committee o, (2008). Vitamin D Deficiency in Children and Its Management: Review of Current Knowledge and Recommendations. Pediatrics 122: 398-417 [Abstract] [Full text]
Cooper, M. S, Gittoes, N. J L (2008). Diagnosis and management of hypocalcaemia. BMJ 336: 1298-1302 [Full text]
Nickkho-Amiry, M, Prentice, A, Ledi, F, Laskey, M A, Das, G, Berry, J L, Mughal, M Z (2008). Maternal vitamin D status and breast milk concentrations of calcium and phosphorus. Arch. Dis. Child. 93: 179-179 [Full text]
Williamson, S., Greene, S. (2007). Prevention message is not getting through. BMJ 334: 1288-1288 [Full text]
Hypponen, E., Power, C. (2007). Hypovitaminosis D in British adults at age 45 y: nationwide cohort study of dietary and lifestyle predictors. Am. J. Clin. Nutr. 85: 860-868 [Abstract] [Full text]
Leaf, A A, on behalf of the RCPCH Standing Committee on Nutri, (2007). Vitamins for babies and young children. Arch. Dis. Child. 92: 160-164 [Abstract] [Full text]
Zipitis, C S, Markides, G A, Swann, I L (2006). Vitamin D deficiency: prevention or treatment?. Arch. Dis. Child. 91: 1011-1014 [Abstract] [Full text]
Ziegler, E. E., Hollis, B. W., Nelson, S. E., Jeter, J. M. (2006). Vitamin D Deficiency in Breastfed Infants in Iowa. Pediatrics 118: 603-610 [Abstract] [Full text]
Das, G, Crocombe, S, McGrath, M, Berry, J L, Mughal, M Z (2006). Hypovitaminosis D among healthy adolescent girls attending an inner city school. Arch. Dis. Child. 91: 569-572 [Abstract] [Full text]
(2006). Primary vitamin D deficiency in children. DTB 44: 12-16 [Abstract] [Full text]
Rennie, L M, Beattie, T F, Wilkinson, A G, Crofton, P, Bath, L E (2005). Incidental radiological diagnosis of rickets. Emerg. Med. J. 22: 534-537 [Abstract] [Full text]
Ladhani, S, Srinivasan, L, Buchanan, C, Allgrove, J (2004). Presentation of vitamin D deficiency. Arch. Dis. Child. 89: 781-784 [Abstract] [Full text]
Crocombe, S, Mughal, M Z, Berry, J L (2004). Symptomatic vitamin D deficiency among non-Caucasian adolescents living in the United Kingdom. Arch. Dis. Child. 89: 197-199 [Full text]
Hannam, S, Lee, S, Sellars, M (2004). Severe vitamin D deficient rickets in black Afro-Caribbean children. Arch. Dis. Child. 89: 91-92 [Full text]
Peng, L. F, Serwint, J. R. (2003). A Comparison of Breastfed Children with Nutritional Rickets Who Present During and After the First Year of Life. CLIN PEDIATR 42: 711-717 [Abstract]
Prentice, A. (2003). Micronutrients and the Bone Mineral Content of the Mother, Fetus and Newborn. J. Nutr. 133: 1693S-1699 [Abstract] [Full text]
Ashraf, S, Mughal, M Z (2002). The prevalence of rickets among non-Caucasian children. Arch. Dis. Child. 87: 263-264 [Full text]
Chesney, R. W. (2002). Rickets: The Third Wave. CLIN PEDIATR 41: 137-139
Shaw, N J, Pal, B R (2002). Vitamin D deficiency in UK Asian families: activating a new concern. Arch. Dis. Child. 86: 147-149 [Abstract] [Full text]
Zlotkin, S., Blumsohn, A. (1999). Vitamin D concentrations in Asian children living in England. BMJ 318: 1417-1417 [Full text]

Rapid Responses:

Read all Rapid Responses

Questioning terminology: "prolonged" breastfeeding: Leslie Ayre-Jaschke
bmj.com, 4 Jan 1999 [Full text]
Considering factors in vitamin deficiency: Audrey Trenholme
bmj.com, 6 Jan 1999 [Full text]
Vitamin D deficiency presenting acutely in an infant: Edmund Lamb
bmj.com, 30 Jan 1999 [Full text]
Vitamin D and Iron deficiency in Asian children: Indra Ariyawansa
bmj.com, 16 Jul 1999 [Full text]
Prevention of Rickets, is the message getting through?: Scott Williamson, et al.
bmj.com, 12 Jun 2007 [Full text]