Preventative guidelines to reduce the incidence of rickets

Although rare, rickets has seen a spike in occurrence since the year 2000.1 There are even concerns that despite preventative measures, rickets remains consistent in children particularly those born to mothers who are substantially vitamin D deficient themselves.

This group includes those who live in Northern areas, as well as dark-skinned children who are breastfed without the use of vitamin D supplementation.2 The rise of rickets is such a concern that in 2016 an international panel published a global consensus in order to come up with preventative guidelines to help physicians reduce the incidence of rickets.[3]

Here are highlights of some of their recommendations:

 

• A daily dose of 400 IU of vitamin D is enough to prevent rickets and is recommended for all babies from birth to 12 months, regardless of whether the baby is breastfed or formula-fed.[3] The fact that the recommendation is the same for both breastfed and formula-fed babies demonstrates that the medical panel’ guidelines intend to ensure that all infants receive the adequate amount of vitamin D to protect them from developing rickets.[3]
• Rickets can be treated with a minimum dose of 2000 IU per day of vitamin D for at least a 3-month period. This treatment should be accompanied by 500 mg per day of oral calcium. A patient may need to be treated for a longer period. When treating rickets with a daily vitamin D regimen, vitamin D2 or D3 are considered to be equally effective. However, when a single large dose is given as treatment, vitamin D3 is considered is more advantageous. [3]
• Pregnant women should ensure that they are vitamin D sufficient themselves, and therefore should take 600 IU per day of vitamin D along with the other recommended micronutrients for prenatal care.[3]
• When the baby starts eating solids, which should be no later than 26 weeks of age, it is recommended that they continue to take 400 IU per day of vitamin D along with foods that are rich in calcium. [3]
• Breastfeeding mothers should continue to take 600 IU per day of vitamin D for themselves. The medical panel advises that the lactating mothers should not increase their vitamin D dosage to a large amount as a means to supplement their infant from their breastmilk. [3]

 

[1] Mayo Clin Proc. 2013 Feb; 88(2): 176–183. doi: 10.1016/j.mayocp.2012.10.018, PMCID: PMC3612965, NIHMSID: NIHMS43411
[2] Tom D. Thacher, MD et al. Increasing Incidence of Nutritional Rickets: A Population-Based Study in Olmsted County, Minnesota
[3] Craig F. Munns et al. Global Consensus Recommendations on Prevention and Management of Nutritional Rickets. J Clin Endocrinol Metab, February 2016, 101(2):394-415.