VITAMIN D DEFICIENCY IN CHILDREN AND ITS MANAGEMENT

Vitamin D IS a prohormone that is essential for normal absorption of calcium from the gut, and deficiency of vitamin D is associated with rickets in growing children and osteomalacia in adults. Rickets is the lack of mineralization ability of growing bone and cartilage. At the turn of the 20th century, with industrialization, this disease became endemic until it was discovered that exposure to sunlight and cod liver oil could both prevent and treat rickets. Once vitamin D was identified and easy ways to supplement foods were developed, nutritional rickets almost disappeared from industrialized countries. However, there has been a reappearance of rickets from vitamin D deficiency in recent decades as a result of multiple factors. Dark-skinned infants who are exclusively breastfed and infants born to mothers who were vitamin D deficient through pregnancy seem to be at particularly high risk. However, rickets is also being reported in older children. The increasing numbers of reports of rickets in Western industrialized nations are related to the practice of exclusive breastfeeding without concomitant vitamin D supplementation in northern latitudes, decreased UV-B exposure (particularly in dark-skinned people), and the excessive use of sunscreen. Recommendations for fortification of commonly used foods with vitamin D are necessary in keeping with various cultural norms of food intake and geography. Current recommendations of sun exposure and vitamin D supplementation are limited because of a paucity of studies in children A low threshold for assessing vitamin D sufficiency in infants, children, and adolescents is recommended given the growing knowledge about effects of vitamin D not only on bone mineral metabolism but also on the immune system and in preventing various kinds of cancer.