Rickets makes a comeback: Breastfeeding boon partly to blame

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Rickets makes a comeback: Breastfeeding boon partly to blame

By Jessica Heslam / Boston Herald
Sunday, January 29, 2006

Despite a national push to give vitamin D to breastfed babies, some Boston-area children -- mostly African-American -- are still suffering from rickets, a virtually extinct disease that has roared back to plague physicians and patients alike.

"It’s now becoming a worldwide problem once again," said Dr. Michael Holick, professor of medicine, physiology and dermatology at the Boston University School of Medicine. "It’s resurrecting its ugly head from 100 years ago."

The boon in breastfeeding -- mother’s milk doesn’t have sufficient vitamin D -- is partly to blame. So is the widespread advice to stay out of the sun. Rickets, which can deform bones and stunt growth, is caused by a severe deficiency in vitamin D, the chief sources of which are dairy milk and sunlight.

Investigators at Boston Medical Center did a one-year study that found 81 percent of mothers giving birth -- predominantly black and Hispanic women -- and 76 percent of their infants were vitamin D deficient at the time of birth, Holick said. The study has been submitted for publication in a pediatrics journal.

Holick is also conducting a "full review" of rickets cases worldwide. It’s "for one of the major medical journals because they are concerned about this," Holick said.

"There really is a mild form of rickets that is highly prevalent especially in young children that are being solely breastfed," Holick said. "This will stunt their growth and have an impact on their bone health for the rest of their lives."

Holick said rickets has returned within the last five years and remains a concern in Boston. "We see about 10 to 15 cases a year here," said Holik, referring to Boston Medical Center.

Most of the cases are breastfed black children whose mothers are vitamin D deficient, Holick said. Experts say blacks are five times more deficient in vitamin D than whites.

While an increasing number of mothers breastfeed, breast milk doesn’t have an adequate amount of vitamin D, which enables the body to absorb bone- fortifying calcium, doctors said.

Some pediatricians don’t tell mothers they need to give their babies vitamin D for fear that they won’t breastfeed -- which has many benefits.
"That’s what drives this," said Holick, who advises moms to breastfeed and give their babies vitamin D supplements.

Two years ago, the American Academy of Pediatrics issued recommendations that children, especially those who are soley breastfed, get a minimum of 200 international units of vitamin D a day beginning during the first two months of life. The recommendations were prompted by isolated cases of rickets among breastfed babies in the north.
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