Rickets due to vitamin D deficiency in infants

This is an automatically translated article.

The article is professionally consulted by Master, Doctor Vu Quoc Anh - Department of Pediatrics - Neonatology - Vinmec Danang International General Hospital. Dr. Anh has nearly 10 years of experience as a resident doctor and treating doctor at Hue Central Hospital and Danang Children's Hospital.
Rickets in infants with vitamin D deficiency is quite common, especially in premature, low birth weight babies. It is possible to treat rickets in infants with vitamin D deficiency by giving infants vitamin D, and at the same time combining them with exposure to sunlight,...

1. Infants with vitamin D deficiency have rickets

Vitamin D deficiency rickets in infants is a bone dystrophy that makes bones soft and fragile. Rickets caused by vitamin D deficiency, also known as nutritional rickets, is quite common in infants, especially premature, low birth weight babies.
Rickets in infants vitamin D deficiency affects the child's development, if not treated promptly can increase the risk of bacterial infections, including respiratory infections such as pneumonia.

2. Causes of rickets in infants vitamin D deficiency

Rickets in infants with vitamin D deficiency can be due to one of the following reasons:
Pregnant mother has vitamin D deficiency: The fetus absorbs vitamin D from the mother through the placenta. After birth, the baby's source of vitamins is mainly from breast milk. If the mother is deficient in vitamin D, it will also make the child vitamin D deficient and lead to early rickets.

Premature, premature, and low birth weight babies: Newborns with vitamin D deficiency are usually premature babies, with low birth weight (< 2.5 kg), because their bodies do not store enough vitamin D when they are still fetuses. In premature and low birth weight infants, the enzyme system involved in vitamin D metabolism is also weaker than in normal children. Children's nutrition: Infants with vitamin D deficiency due to not being breastfed, instead, children who are fed formula milk have a higher risk of rickets. Both breast milk and formula are equally low in vitamin D, but babies absorb vitamin D from breast milk more easily. In addition, infants to the weaning stage, if eaten early on spices such as salt, seasoning powder, monosodium glutamate, fish sauce, ... may increase the risk of rickets due to phytic acid present in the foods. This spice reduces the child's ability to absorb vitamin D. Children often sick and ill: Rickets in infants with vitamin D deficiency can be caused by frequent intestinal diseases such as infections, prolonged diarrhea, biliary obstruction, hepatitis, etc. affect the child's ability to absorb vitamin D. Lack of exposure to sunlight: Children are not exposed to sunlight due to factors such as geography, climate, polluted living environment, cramped, children being kept indoors,... reduce the absorption of vitamin D in children.

3. Manifestations of rickets in infants with vitamin D deficiency

Infants with vitamin D deficiency may have early and late symptoms as follows.

3.1 Early manifestations of rickets in infants with vitamin D deficiency

The child has trouble sleeping, or is startled, or the child is fussy. Children often sweat a lot, especially at night, even when it's cold. Children have turban hair loss at the back of the head. Children have physical retardation, flabby muscles, decreased muscle tone, pale skin, enlarged spleen.

3.2 Late manifestations of rickets in infants with vitamin D deficiency

Children are slow in motor skills such as rolling, crawling, walking, ... Children have wide fontanelles, soft fontanelles are palpable, and they heal slowly. The child's skull is deformed, the head is flat, and when pressed or touched, it can be seen to be concave, the skull bone is soft. The skull may have a hump, usually in the apex or forehead region. Children with delayed teething, teeth may grow out of balance. Ribs, rib cage deformed, crooked, kyphosis spine. Deformed legs, bow legs, developed carpal bones, hypertrophy, enlargement, underdeveloped pelvis. Children can have seizures when blood calcium levels drop low due to vitamin D deficiency.

4. Diagnosis of rickets in infants with vitamin D deficiency

Diagnosis of rickets due to vitamin D deficiency in infants is based on some basic tests as follows:
Biochemical test: When a child has rickets due to vitamin D deficiency, the phosphorus level in the blood decreases to about 1 .5 - 3.5 mg/dL, while the normal value is around 4.5 - 6.5 mg/dL. Based on the level of 25(OH) D in the blood to assess the status and degree of vitamin D deficiency. 25(OH) D content > 75 nmol/L is enough vitamin D. Bone X-ray: Bone X-ray It is also a method used to diagnose rickets caused by vitamin D deficiency in infants. X-ray allows to evaluate the ossification of the bones, children with rickets will have images of reduced bone density, large bone heads, slow ossification, and irregular ossification margins.

5. Treatment of rickets by giving infants vitamin D

Giving infants vitamin D as prescribed by a doctor is a method to treat rickets, the specific dosage is as follows:
Children aged 0-18 months: Children are breastfed or drink formula milk but the amount of milk <1l milk/day, or vitamin D unresponsive about 400 units/day, give the child continuous vitamin D supplementation at a dose of 400 units/day. Premature, low birth weight, premature infants, twins, dark skin: After 2 weeks of birth, consider giving infants vitamin D supplements continuously at a dose of 400-800 units/day for 15 months. Children from 6 to 18 months old: Give vitamin D to children at a dose of 200,000 units/6 months/time.

6. Prevention of rickets caused by vitamin D deficiency in infants

Rickets caused by vitamin D deficiency in infants can be prevented by the following measures:
Exclusive breastfeeding for the first 6 months after birth, during this time, the mother needs to pay attention to supplementing with supplements. , multivitamins to increase vitamin D content in breast milk for babies. Children from 6 months of age and older and starting to eat solid foods need to pay attention to giving them additional and enhanced green vegetables. In addition to giving infants vitamin D, it is necessary to combine them with sunbathing and exposure to sunlight every day. Sunbathing time is gradually increased from 5 to 20 minutes, suitable sunbathing time is before 8 am. Care should be taken to avoid letting children get cold or hot when sunbathing.
Infants with vitamin D deficiency will lead to rickets, causing delays in physical and intellectual development. It is possible to prevent rickets in children by paying attention to providing enough vitamin D for children every day through breast milk or formula, and exposing children to sunlight in the morning.

In addition to vitamin D, parents also need to supplement their children with other important vitamins and minerals such as zinc, lysine, chromium, B vitamins,... little sickness.
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