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Clinical Review Lesson of the week

Florid rickets associated with prolonged breast feeding without vitamin D supplementation

BMJ 1999; 318 doi: (Published 02 January 1999) Cite this as: BMJ 1999;318:39
  1. M Z Mughal, consultant paediatrician (,
  2. H Salama, specialist registrar in paediatricsa,
  3. T Greenaway, general practitionerb,
  4. I Laing, consultant biochemisa,
  5. E B Mawer, professor of bone and mineral metabolism.c
  1. aSt Mary's Hospital, Central Manchester Healthcare Trust, Manchester M13 0JH
  2. bAlexandra Practice, Manchester M16 8NG
  3. cUniversity Department of Medicine, Manchester Royal Infirmary, Manchester M13 9WL
  1. Correspondence to: Dr Mughal

    The incidence of rickets caused by vitamin D deficiency, once a common health problem among British Asian children, seems to have declined during the past decade.1 We describe six cases of florid rickets in infants aged 10to 28months who were referred to our paediatric unit by local general practitioners between 1995and 1997.They were all born in the United Kingdom to parents who were either postgraduate students or recent immigrants. All the children had been breast fed for a prolonged period without vitamin D supplementation. The mothers of these infants had not received vitamin D supplements during pregnancy or lactation.

    Case reports

    All six patients had several of the clinical signs and symptoms of rickets: bow legs, rickety rosary, swelling of the ends of long bones, frontal bossing of the skull, delayed dentition, poor growth, and slow motor development. They all had classic radiological features of rickets, including generalised osteopenia, widening of the growth plates, and cupping of metaphyseal regions of long bones (figure). As shown in table 1,biochemical features of the disease included increased serum alkaline phosphatase activity for their age, low …

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