Lack of sun exposure causing rickets in Australia

[stan@sunsys]

The Courier-Mail

NATIONAL NEWS

Covered-up kids risk soft bones

04jul05
CHILDHOOD rickets is soaring in Australia, particularly among babies born to mothers who cover up for religious and cultural reasons or who have dark skin, an expert says.

The number of cases has doubled at three Sydney hospitals between 2002 and 2003, and specialists in Melbourne and Adelaide have recounted similar experiences, according to pediatric endocrinologist Chris Cowell.

Associate Professor Cowell, of the Children's Hospital at Westmead, said the number of cases of childhood rickets had spiked considerably in the past four or five years, in line with increasing immigration from countries where women often wear veils for cultural and religious reasons or have darker skin types.

Rickets, a bone-softening disease, is common among children in Europe during the industrial revolution when factories produced so much smoke that when ultraviolet rays from the sun are blocked, reducing vitamin D levels.

Vitamin D is important for helping bones absorb calcium. Low levels can cause rickets.

The darker the skin colour, the harder it is to produce vitamin D, requiring those with dark complexions to spend more time in the sun to reach adequate levels.

Prof Cowell said studies had suggested 30 to 45 minutes of sun exposure to the face, hands and feet about three times a week was enough to maintain normal vitamin D levels in adults.

"It has to be direct on your skin," he said in an interview.

All but five of the 126 cases of rickets reported by three Sydney hospitals in the 11 years to 2003 occurred in immigrant families –37 per cent were in people of Indian heritage, 33 per cent African and 11 per cent of Middle Eastern origin.

Almost half of the cases - 44 per cent - were aged under 12 months.

A retrospective study into the cases at the Sydney Children's Hospital, St George Hospital and the Children's Hospital at Westmead, is described as the largest case series of vitamin D-deficient rickets reported by a developed country.

The study was published recently in the Archives of Disease in Childhood.

Prof Cowell, of the University of Sydney, said low levels of vitamin D in pregnant women could lead to babies developing rickets in their first year, particularly if they were exclusively breast fed.

"Very little vitamin D is transferred in breast milk," he said.

Young children with rickets are often taken to hospital with seizures, bowed legs and bone pain.

Professor Cowell said the condition could be easily treated with vitamin D supplements and advice about adequate sunlight exposure.

Babies are recommended to have 30 minutes sun exposure a week wearing only a nappy or two hours a week fully clothed without a hat.

"The swaddling of babies, poor accommodation, ethnic and religious practices, and campaigns to decrease sunlight exposure may all increase the risk of rickets," the researchers wrote.

They recommended screening of at-risk immigrant families should be implemented through public health policies and for general practitioners to be alert to the possibilities of babies having rickets.

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