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Posted on 12.11.00
UNC CERTs Rickets Project Changes State Policy
By Sue Tolleson-Rinehart, PhD
Rickets, once a common bone disease in children, is caused by a deficiency of vitamin D and sunlight. Breast milk, otherwise an excellent source of nutrition, is generally lacking in vitamin D, meaning that, without supplements, breast-fed children can develop rickets.
Dr. Marsha Davenport, a pediatrician and CERTs investigator, began seeing more cases of rickets in her clinic. She thought that rickets might be on the rise among African-American children in North Carolina because more and more black women have begun breast-feeding.
Davenport and her colleagues conducted a mail survey of pediatricians in the state, asking them whether they usually gave breast-feeding women vitamin D supplements. Davenport found that younger doctors were less likely to use vitamin D than were older doctors, who may have remembered rickets from the past.
Next, the group examined all infants and children with rickets who had come to UNC and Wake Forest medical centers. They also obtained information about breast-feeding from children in the North Carolina Women, Infants, and Children (WIC) program.
Of the 30 cases of rickets at the two centers between 1990 and 1999, over half of them occurred in 1998 and 1999 alone. ALL of the cases were in African-American children who had been breast-fed (for an average of 12.5 months) but had not been given vitamin D supplements. These infants with rickets were not growing as they should, as measured by length and weight.
When the state of North Carolina learned of these results, it immediately made free vitamin D available to ALL breast-feeding women and their infants in the state, without regard for the ability to pay. The vitamin is being distributed through the WIC program, although breast-feeding women who can afford to can simply buy vitamin D.
As of autumn 2000, 744 children already had received their vitamin D. The UNC CERTs encourages all doctors to recommend vitamin D supplements to their breast-feeding patients.