Here is the study about the babies in NC who were diagnosed with
rickets.There were 30 cases in a 9 years period, 15 cases in the first 8
years.  I highlighted the information on the growth problems.
Also these babies were in the WIC program so we don't really know how much
they were breastfed since WIC's definition of bfing may be only once a day.
Also that county may not have a tremendous support system for breastfeeding
mothers on WIC, especially not in the early 1990's.

Barb Whitehead, BS, IBCLC, RLC
Eastern NC

Nutritional rickets in African American breast-fed infants.

Kreiter SR, Schwartz RP, Kirkman HN Jr, Charlton PA, Calikoglu AS, Davenport
ML.

Department of Pediatrics, Brenner Children's Hospital and Health Services,
Wake Forest University School of Medicine, Winston-Salem, North Carolina
27157, USA.

OBJECTIVE: To analyze the characteristics of infants and children diagnosed
with nutritional rickets at two medical centers in North Carolina in the
1990s. STUDY DESIGN: The physical and radiographic findings, calcium,
phosphorus, alkaline phosphatase, and 25-hydroxyvitamin D levels of infants
and children diagnosed with nutritional rickets at two medical centers were
reviewed. Breast-feeding data were obtained from the North Carolina Women,
Infants and Children Program (WIC). RESULTS: Thirty patients with nutritional
rickets were first seen between 1990 and June of 1999. Over half of the cases
occurred in 1998 and the first half of 1999. All patients were African
American children who were breast fed without receiving supplemental vitamin
D. The average duration of breast-feeding was 12.5 months. The age at
diagnosis was 5 to 25 months, with a median age of 15.5 months. Growth
failure was common: length was <5th percentile in 65% of cases, and weight
was <5th percentile in 43%. CONCLUSION: Factors that may have contributed to
the increase in referrals of children with nutritional rickets include more
African American women breast-feeding, fewer infants receiving vitamin D
supplements, and mothers and children exposed to less sunlight. We recommend
that all dark-skinned breast-fed infants and children receive vitamin D
supplementation.



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