Nutritional rickets among children of Northern Kerala, India


  • Soumya Jose Department of Pediatrics, KMCT Medical College, Mukkam, Kerala, India
  • Bindu A. Department of Pediatrics, MES Medical College, Perinthalmanna, Kerala, India



Biochemical, Clinical, Nutritional rickets, Radiological profile, Vitamin D


Background: Vitamin D deficiency is a very common micronutrient deficiency in our country and ranks among the 5 most common disease in children worldwide.

Methods: To study the presentation and predisposing factors of rickets among children in Northern Kerala.

Results: This study was conducted in the department of Pediatrics in a tertiary care hospital in Northern Kerala. Nutritional rickets diagnosis was based on clinical, radiological and biochemical parameters and appearance of provisional zone of calcification after vitamin D therapy. Data was analyzed and presented as percentage and mean. Student t-test was used for statistical analysis of the results.

Conclusions: A total of 54 children having a variety of clinical presentations of rickets were seen during the study period. There were 46.3% males and 53.7% females. The mean age of diagnosis was 24 months.70.4% children were exclusively breast fed up to 6 months. None of the breast-fed infants had received vitamin D supplementation according to current guidelines. 66.7% children were not exposed to sunlight. Rickets was commonly found in children with no protein energy malnutrition. Genu varum and wrist widening were the most frequent clinical features observed in 92.6% patients. The radiological and biochemical characteristics of cases were ascertained before and after therapy. The biochemical changes were analyzed by student (t) test. There was a significant decrease in the ALP activity after vitamin D therapy (P= 0.000). Out of these 54 children with rickets 47(87.03%) responded to treatment with vitamin D3 and 7 (12.96%) were resistant to treatment with vitamin D3. 


Welch TR, Bergstrom WH, Tsang RC. Vitamin D-deficient rickets: the reemergence of a once-conquered disease. J Ped. 2000;137(2):143-5.

Wagner CL, Greer FR. Prevention of rickets and vitamin D deficiency in infants, children, and adolescents. American Academy of Pediatrics Section on Breastfeeding; AAP Committee on Nutrition Pediatrics. 2008;122(5):1142-52.

Allen W. Root: Disorders of bone mineralization. In Rudolph’s Pediatrics. 21st ed. Mc Graw Hill Companiies; 2003:2156-60.

Khattak AA, Rehman G, Shah FU. Study of rickets in admitted patients at lady reading hospital Peshawar. JPMI. 2011;18(1):52-8.

Molla AM, Badawi MH, AlYaish S, Sharma P, El‐Salam RS. Risk factors for nutritional rickets among children in Kuwait. Pediatr Int. 2000;42(3):280-4.

Crocombe S, Mughal MZ, Berry JL. Symptomatic vitamin D deficiency among non-Caucasian adolescents living in the United Kingdom. Archiv Dis Childhood. 2004;89(2):197-9.

Rajakumar M. Vitamin D, cod liver oil, sunlight and rickets: a historical perspective. Pediatr. 2003;112: l32-5.

Pesce MA. Laboratory tests and procedures Kliegman, Behrman, et al. Nelson text book of pediatrics, 19 ed. South Asian ed, Saunders, Elsevier, New Delhi; 2011:2946-8.

Onyiriuka AN, Abiodun PO, Onyiriuka FU. Nutritional rickets in childhood: retrospective assessment of clinical data of forty-five cases seen in a Nigerian tertiary healthcare institution. Current Pediatr. 2012;16(2):129-33.

Siddiqui TS, Rai MI. Presentation and predisposing factors of nutritional rickets in children of Hazara Division. J Ayub Med Coll Abbottabad. 2005;17(3):29-32.

Yener E, Coker C, Cura A, Keskinoglu, Mir S. Lymphocytes subpopulation in children with vitamin D deficient rickets. Acta Pediatr Jpn. 1995;37(4):500-2.

McGrath J. Does imprinting with low prenatal vitamin D contributes to the risk of various adult disorders. Med Hypothesis. 2001;56:367-71.

Bouk GR, Siddiqui AI. Clinical presentations of nutritional rickets in children under 2 year of age. Medical Channel. 2009;15:55-8.

Balasubramanian S, Ganesh R. Vitamin D deficiency in exclusively breast-fed infants. Indian J Med Res. 2008;127:250-5.

Nakao H. Nutritional significance of human milk vitamin D in the neonatal period. Kobe J Med Sci. 1988;34:121-8.

Hollis BW, Roos BA, Draper HH, et al. Vitamin D and its metabolites in human and bovine milk. J Nutr. 1981;111:1240-8.

Specker BL, Valanis B, Hertzberg V, Edwards N, Tsang RC. Sunshine exposure and serum 25-hydroxyvitamin D concentrations in exclusively breast-fed infants. J Pediatr. 1985;107(3):372-6.

Greer FR, Marshall S. Bone mineral content, serum vitamin D metabolite concentrations and ultraviolet B light exposure in infants fed human milk with and without vitamin D2 supplements. J Pediatr. 1989;114:204-12.

Thacher TD. Case-Control study of factors associated with nutritional rickets in Nigerian children. J Pediatr. 2000;137(3):367-73.

Wondale Y, Shifieraw F, Lulseged S. A systematic review of nutritional rickets in Ethiopia, status and prospects. Ethiop Med J. 2005;43:203-10.

Ahmed IR, Ejaz MS, Mehnaz A, Shaikh FA. Nutritional rickets: correlation between clinical, biochemical and radiological profile. Pak J Med Sci. 2011;27(3):603-7.

Majeed RY, Memon MK, Majeed M, Usman A, Rajar U. Contributing factors of rickets among children at Hyderabad. J Liaquat Uni Med Health Sci. 2007;6(2):60-5.

Matsuo K, Mukai T, Suzuki S and Fujieda K. Prevalence and risk factors of vitamin D deficiency rickets in Hokkaido Japan. Pediatr Int. 2009;51:559-562.

Molla AM, Badawi MH, Al‐Yaish S, Sharma P, El‐Salam RS. Risk factors for nutritional rickets among children in Kuwait. Pediatr Int. 2000;42(3):280-4.

Taylor JA, Richter M, Done S, Feldman KW. The utility of alkaline phosphatase measurement as a screening test for rickets in breast-fed infants and toddlers: a study from the puget sound pediatric research network. Clin Pediatr. 2010;49(12):1103-10.

Al-Mukhtar SB, Ahmad AJ. Nutritional rickets in northern Iraqi children- response to vitamin D. Raf J Sci. 2005;16(3):54-59.






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