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

1. Dr.Singaram.A

2. Calcium Phosphorus

6. 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)

8. 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

9. Type 1 and 2
Autosomal recessive, present between 3 to 6
months of age

11. RTA
Chronic kidney disease
Oncogenic rickets (benign mesenchymal
tumors)

16. 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

20. 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

21. 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)