RICKETS IN BREAST-FED INFANTS BELOW SIX MONTHS OF AGE WITHOUT VITAMIN D SUPPLEMENTATION IN TEHRAN

Background and Objectives-Although breast-feeding is highly appraised and widely practiced in Iran, human milk supplies all necessary nutrients except a few including vitamin D. Despite abundance of sunshine, vitamin D deficiency rickets is not rare in Iran. Methods-In a retrospective study, the medical records of all patients with rickets admitted to Bahrami Children’s Hospital in a 16-year (March 1982-1998) period who were below 6 months of age and not receiving vitamin D supplementation, were reviewed. Result-Forty-one cases of rickets less than 6 months of age without a history of vitamin D supplementation were detected. Convulsion was the most common presenting feature. Rachitic rosary and widening of the wrists were present in one-third of the cases while a quarter showed craniotabes. Ninety-five percent of the patients belonged to the lower socioeconomic class. Vaccination was not performed or was delayed and incomplete in 21 cases. Conclusion-Early occurrence and presence of rickets in breast-fed infants below six months of age with no vitamin D supplementation is documented in Iran. Health professionals should be informed of this risk and should supervise the oral administration of vitamin D in breast-fed infants and other measures, including sunlight exposure and vitamin supplementation in lactating mothers, should be encouraged.