Approach to childhood rickets

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A comprehensive approach to Nutritional rickets and other rare types of rickets encountered in pediatrics

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Approach to childhood rickets

  1. 1. Dr.Singaram.A
  2. 2. Calcium Phosphorus
  3. 3. Age Male Female Pregnancy Lactation 0–12 months 400 IU (10 mcg) 400 IU (10 mcg) 1–13 years 600 IU (15 mcg) 600 IU (15 mcg) 14–18 years 600 IU (15 mcg) 600 IU (15 mcg) 600 IU (15 mcg) 600 IU (15 mcg) 19–50 years 600 IU (15 mcg) 600 IU (15 mcg) 600 IU (15 mcg) 600 IU (15 mcg) 51–70 years 600 IU (15 mcg) 600 IU (15 mcg) >70 years 800 IU (20 mcg) 800 IU (20 mcg)
  4. 4. Poor intake and inadequate cutaneous synthesis Transplacental transfer of Vitamin D – sufficient for 1st 2 months of life Strict vegetarian diet Prematurity Malabsorption and other medical conditions Obesity Medications – anticonvulsants, isoniazid, rifampin, antiretroviral drugs, steroids, azoles
  5. 5. Type 1 and 2 Autosomal recessive, present between 3 to 6 months of age
  6. 6. RTA Chronic kidney disease Oncogenic rickets (benign mesenchymal tumors)
  7. 7. Vitamin D deficiency  Stoss therapy, 300,000-600,000 IU of vitamin D - administered orally or intramuscularly as 2-4 doses over 1 day (or)  daily, high-dose vitamin D, with doses ranging from 2,000-5,000 IU/day over 4-6 wk.  Always ensure adequate calcium supplementation (30 to 75 mg/kg/day) during therapy to avoid “Hungry-bone” syndrome
  8. 8. AAP recommends minimum intake of 400 IU/day for all children Children who are obese and those on anticonvulsants, glucocorticoids, and on medications for HIV infection may require higher doses of vitamin D All breast fed infants should be given Vitamin D Administer high doses of vitamin D (4000 to 6400 int. units per day) to the lactating mother. Food fortification
  9. 9. Vitamin D supplementation of pregnant women (600 IU/day) Exposure to sunlight – 10 to 15 minutes daily (between 10:00 a.m to 3:00 p.m)

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