Study of Rickets in Exclusively Breast Fed Children below 6 Months

Aims: To study factors affecting rickets, clinical presentation of rickets and role of supplementation in prevention of rickets Study and design: prospective study done from June 2008 to October 2010 Methods: 60 infants who were on exclusively breast feeding and 0-6 months age, enrolled in study. Detailed history, clinical examination, Serum alkaline phosphatase and X-ray wrist done in all patients. Rickets defined by biochemical and/or radiological abnormalities. Patients with rickets with abnormal X-ray wrist Were treated with high dose of vitamin D, calcium and phosphorus. Others were given supplemental vitamin D, calcium and phosphorus. infants with normal X-ray and serum alkaline phosphatase also supplemented with vitamin D, calcium and phosphorus. All the infants were followed up after 12 weeks and repeat X-ray wrist and serum alkaline phosphatase done. Statistical analysis: Chi square test and Fishers exact test applied Results: Out of 60 patients 35 had rickets (58.33 %). Maximum cases seen in 5-6 months children (11/12-91.6 %). As age advances chances of rickets increases in 0-6 months children ( P value- 0.0033, significant). Incidance of rickets slightly higher in LBW (14/21-66.66 %) than NW ( 21/39- 53.84 %) but p value is not significant (0.4925). Lack of maternal supplementation will Vitamin D and calcium is most common risk factor (24/35- 71.42 %). Multiparty is second most common maternal risk factor (15/35-42.85 %). Most common illness associated with rickets is respiratory tract infection (15/35- 42.85 %). Craniotabes seen in (12/35 - 34.28 %) infants. Clinically normal infants with laboratory evidence in form of raised s. alk. phosphatase seen in (15/37) 40.54 % infants. All patients with rickets responded to therapy and showed resolution in form of radiological improvement and normalisation of serum alkaline phosphatase. Out of 25 normal infants without rickets, no one developed rickets after supplementation. Conclusion: Rickets seen through out 0-6 months and maximum cases seen in 5-6 months age. Lack of supplementation with calcium and vitamin D to mother is most important risk factor. Craniotabes is the most common clinical feature. significant number of infants have raised s. alk. phosphatase without clinical manifestation. There is favourable response to prophylactic supplementation with Vitamin D, calcium and phosphorus.