Due to the fortification of milk with vitamin D, rickets was nearly eradicated in the 1930s. A case study recently published in the New England Journal of Medicine discussed a 9-month-old boy who was diagnosed with rickets. These recent reports have shown an increase of incidences in infants.

Rickets is a vitamin D deficiency that impairs the mineralization of growing bones. It is characterized by structural abnormalities of the weight bearing bones and is associated with bone pain and muscular tenderness. The soft pliable bones caused by a vitamin D deficiency cannot withstand ordinary stresses and strains, resulting in bowed legs. The case study suggests that the signs and symptoms of early vitamin D deficiency in children are often missed because the symptoms of restlessness and irritability are common.

It is believed that there has been an increase in vitamin D deficiency because people are told to avoid the sun or to wear sunscreen. Even the American Academy of Pediatrics recommends that for the first six month of an infant’s life they do not receive any sun exposure. Another reason for the increase in deficiencies is that the daily recommended intake value of vitamin D for lactating women may not be high enough.

The amount of vitamin D found in human milk depends on the mother’s sun exposure and intake of foods that contain vitamin D, according to an article in the American Journal of Clinical Nutrition. It is recommended that a nursing mother gets 10 to 15 minutes of sun exposure at least two times per week to the face, arms, hands, or back without sunscreen and to eat foods that are a natural source of vitamin D — fish liver oil and fatty fish — or foods that are fortified with vitamin D — diary products, orange juices and cereals. If a mother has a limited exposure to the sun, a vitamin D supplement of 1,000 IU is recommend. The American Academy of Pediatrics recommends a supplement of 400 IU daily for all children from birth through adolescence.

It is possible to test vitamin D levels if a deficiency is a concern. The blood is tested for the serum concentration of 25-hydroxyvitmain D, which is the best indicator of vitamin D status. An infant should have a range of > 32. A yearly test is recommended to prevent any chronic diseases linked with a vitamin D deficiency. An X-ray can be done before the infant begins to walk to look for signs of rickets.

Research has shown that the incidents of vitamin D deficiency are on the rise. It is important for nursing mothers to ensure they are maintaining adequate vitamin D levels and are follow the recommendations that children receive a daily supplement. Following these nutrition guidelines will help prevent the development of rickets in children.

Melissa Black is a registered dietitian who lives in Erda and currently works for Intermountain Healthcare. She received her bachelor’s degree in nutrition and food science from Utah State University.