Rickets used to be a very common childhood bone disease associated predominantly with a lack of vitamin D, a vital vitamin which is obtained through diet and exposure to sunshine. Rickets is characterised by bowing of an affected child’s legs, swelling of their wrists and ankles and a failure to thrive. Incidences of the disease were greatly reduced with the introduction of vitamin D supplementation of infant formula and milk, leading to the condition becoming rare. However, cases of rickets continue to be reported in the certain areas of the world; both in the developed and developing world. The Middle East has a reportedly high incidence of rickets in some communities, despite the high levels of sunshine found in this region.
Vitamin D – sunshine or supplements?
Vitamin D can be created in the body by exposure to sunlight, as sunlight stimulates vitamin D production in the skin. Dark skinned children and those that aren’t exposed to enough sunlight are thought to be at risk of rickets. There is also an increasing awareness of the damaging effects of direct sunlight on the skin, with exposure without protection being known to increase a child’s risk of getting skin cancer. Guidelines now advise a liberal application of sunscreen with a protection factor of at least SPF 15 to 30 before going outside and with this level of protection, the body’s ability to vitamin D is greatly reduced. In this part of the world there may also be cultural reasons for covering the skin, which also results in a diminished vitamin D synthesis. It is now recommended that children receive vitamin D supplementation if they are not drinking vitamin D fortified milk, the dose being at least 400 IU (International Units) of vitamin D each day.
Vitamin D supplementation
Most children can receive sufficient levels of vitamin D from drinking at least 1000mls or eating at least 1000g each day of vitamin D fortified infant formula, milk or other foodstuff. Both cow’s milk and many brands of soy milk are fortified with vitamin D, as are some yogurts, other dairy products, and juices. You can check food labels to find the foodstuffs that have been fortified with vitamin D, especially if your child doesn’t drink much milk. Vitamin D is also available in supplemental form from pharmacists, generally in combination with other vitamins as a multi-vitamin. However, you should never give your child such supplements without first consulting your doctor and getting their advice.