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Monday, 21 August, 2000, 12:21 GMT 13:21 UK
Rickets makes a comeback
Leg x-ray
Rickets leads to deformity of the bones
The crippling bone disorder rickets has re-emerged in the US and UK - decades after it was all but eradicated.

Experts believe the problem could be linked to a failure to give vitamin D supplements to children who are breastfed.

They believe that dark skinned children are particularly at risk.

If you walk around any area with high immigration you often see children walking with a funny-looking gait that could well be rickets

Dr Zulf Mughal, St Mary's Hospital, Manchester

Nutritional rickets is caused by a lack of vitamin D in the diet.

This impairs the body's ability to absorb the calcium needed to produce strong, healthy bones.

In children, this can lead to severe deformities which can require corrective surgery.

Nutritional rickets was a fairly common disease in urban areas of the US and UK at the beginning of the 20th century.

However, the introduction of routine vitamin D supplements helped to virtually eradicate the disorder by the 1950s.

Making a comeback

Now research in the Journal of Pediatrics suggests the disorder has recently made a comeback.

Researchers from Wake Forest University and the University of North Carolina studied 30 children diagnosed with nutritional rickets over a 10-year period.

All the infants were African-American and breast-fed without supplemental vitamin D.

Most people produce vitamin D when their skin is exposed to sunlight.

However, the researchers suggested that these infants were at risk because their heavily pigmented skin may have reduced their ability to produce vitamin D.

The Healthy People 2000 initiative introduced in the US has set a target of 75% of American infants breast-feeding for at least six months.

But, in an editorial in the journal, Dr Thomas Welch, of the Cincinnati Children's Hospital, warns: "Unless this is accompanied by the provision of vitamin D supplementation to replace that currently derived from formula, an epidemic of rickets seems inevitable."

Dr Welch said he had treated several infants recently for nutritional rickets, and suggested that the problem was increasing throughout the US.

He said: "It's ironic that in an era of expensive, high-tech medicine, a serious disease is reappearing because of neglect of a decades-old intervention that costs pennies a day, is completely safe, and 100% effective."

Similar pattern in the UK

Dr Zulf Mughal, an expert in rickets based at St Mary's Hospital, Manchester, said a similar pattern was emerging in the UK.

He said it was difficult to assess the full scope of the problem as many doctors were unfamiliar with the condition, and therefore failed to diagnose it.

"However, if you are attuned to the problem, if you walk around any area with high immigration, certainly in the north west of England, you often see children walking with a funny-looking gait that could well be rickets."

Professor Barbara Mawer, of Manchester Royal Infirmary, has worked with Dr Mughal in treating rickets in the UK.

She said those most at risk were infants, usually from immigrant communities, whose mothers continued to breastfeed for long periods, and who, for religious reasons, did not believe in exposing the skin to sunlight.

Professor Mawer said she had seen 20-30 cases over the last two years, which meant there were probably hundreds of cases nation-wide.

She said: "I would not wish to discourage breastfeeding, but it is important that babies are also given vitamin A and D drops from an early age."

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