VITAMIN D DEFICIENCY IN CHILDREN

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VITAMIN D DEFICIENCY IN CHILDREN : 

VITAMIN D DEFICIENCY IN CHILDREN P.SAVITHIRI

Objectives : 

Objectives History What is vitamin D defediency Prevalence Risk factors Source Signs and symptoms Grading Recommendations Management

History : 

History English Physician Dr.Daniel Whistler first described rickets in 1645. Ayub Med Coll Abbottabad 2005;17(3) PRESENTATION AND PREDISPOSING FACTORS OF NUTRITIONAL RICKETS IN CHILDREN OF HAZARA DIVISION

History contd…. : 

History contd…. In 1861, Trousseau of France linked rickets with lack of sun exposure and faulty diet. At the start of 20th century McCollum discovered vitamin D by the technique of biological analysis of the food. J Ayub Med Coll Abbottabad 2005;17(3) PRESENTATION AND PREDISPOSING FACTORS OF NUTRITIONAL RICKETS IN CHILDREN OF HAZARA DIVISION

What is vitamin D defeciency : 

What is vitamin D defeciency Vitamin D deficiency was defined as a serum 25 (OH) D concentration of <80 -90nmol/l Heaney el.al ,jamcoll nutr,2003. 22:142-146

What is vitamin D deficiency : 

What is vitamin D deficiency Vitamin D deficiency was defined as a serum 25 (OH) D concentration of <50 nmol/l Postgrad Med J. 2007 Nov;83(985):713-6. Vitamin D status in apparently healthy adults in Kashmir Valley of Indian subcontinent.

Prevalence of Vitamin D : 

Prevalence of Vitamin D 69.6% employed group 100% household group Vitamin D deficiency was equally prevalent in subjects from rural and urban areas. Serum 25 (OH) D concentrations are significantly related to sun exposure. Postgrad Med J. 2007 Nov;83(985):713-6. Vitamin D status in apparently healthy adults in Kashmir Valley of Indian subcontinent.

Contd…… : 

Contd…… The prevalence of vitamin D deficiency was 12.1% (<=20 ng/ml) 40% had levels below an accepted optimal threshold (< or =30 ng/mL). The prevalence did not vary between infants and toddlers or by skin pigmentation Arch Pediatr Adolesc Med. 2008 Jun;162(6):505-12. Prevalence of vitamin D deficiency among healthy infants and toddlers.

source : 

source 7-dehydrocholestrol ultraviolet – B radiations cholechalciferol (vitamin - D3) Small amount of vitamin D is also derived from the diet J Ayub Med Coll Abbottabad 2005;17(3) PRESENTATION AND PREDISPOSING FACTORS OF NUTRITIONAL RICKETS IN CHILDREN OF HAZARA DIVISION

Food that contain vitamin D : 

Food that contain vitamin D Cod liver oil, 1 tablespoon (1,360 IU) 1 cup of milk (100 IU) 1 whole egg (20 IU) 3.5 ounces of cooked beef (15 IU) 1 ounce of cheese (12 IU) 3 ounces of tuna fish (345 IU)

Factors affecting cutaneous syenthesis : 

Factors affecting cutaneous syenthesis Decreased sun exposure Increased skin pigmentation Atmospheric pollution. J Ayub Med Coll Abbottabad 2005;17(3) PRESENTATION AND PREDISPOSING FACTORS OF NUTRITIONAL RICKETS IN CHILDREN OF HAZARA DIVISION

Factors affecting intestinal absorption : 

Factors affecting intestinal absorption High intake of the fibers Phytate . J Ayub Med Coll Abbottabad 2005;17(3) PRESENTATION AND PREDISPOSING FACTORS OF NUTRITIONAL RICKETS IN CHILDREN OF HAZARA DIVISION

Grading of vitamin D : 

Grading of vitamin D According to serum 25 hydroxy vit d mild 25-50 nmol/l moderate 12.5-25 nmol/l severe <12.5 nmol/l Vitamin D status in apparently healthy adults in Kashmir Valley of Indian subcontinent.

clinical signs and symptoms : 

clinical signs and symptoms Bowed legs Rickety rosary Frontal bossing of the skull Widened wrist and ankle joints Poor growth, delayed motor development Recurrent lower respiratory infections Chronic diarrhea Fits

Clinical presentations : 

Clinical presentations Symptoms No % Repeated lower respiratory tract infections 11 18.33 Delayed motor milestones 20 33.33 Recurrent diarrheas 12 20 Seizures 3 5   J Ayub Med Coll Abbottabad 2005;17(3) PRESENTATION AND PREDISPOSING FACTORS OF NUTRITIONAL RICKETS IN CHILDREN OF HAZARA DIVISION

Clinical signs : 

Clinical signs J Ayub Med Coll Abbottabad 2005;17(3) PRESENTATION AND PREDISPOSING FACTORS OF NUTRITIONAL RICKETS IN CHILDREN OF HAZARA DIVISION

Radiological findings on x-ray wrist : 

Radiological findings on x-ray wrist J Ayub Med Coll Abbottabad 2005;17(3) PRESENTATION AND PREDISPOSING FACTORS OF NUTRITIONAL RICKETS IN CHILDREN OF HAZARA DIVISION

Issues in daily recommendation of vit d : 

Issues in daily recommendation of vit d In 1963 - 400 IU/day In late 1970s- inconsistent recommendation, particularly for breast-feeding infants. In 2003 - 200 IU/d vitamin D for all infants and children. Am J Clin Nutr. 2004 Dec;80(6 Suppl):1759S-62S. Issues in establishing vitamin D recommendations for infants and children.

Issues …. : 

Issues …. In 2004 - The recommended intake of 200 IU/d may not be enough. Am J Clin Nutr. 2004 Dec;80(6 Suppl):1759S-62S. Issues in establishing vitamin D recommendations for infants and children.

Vitamin D levels should be multiplied by ten for children : 

Vitamin D levels should be multiplied by ten for children IN 2008 Raising current vitamin D levels from 200 International Units (IU) to 2,000 IU could boost bone health amongst children and have long-term health benefits By Stephen Daniells, 28-May-2008

Vitamin D recommendation : 

Vitamin D recommendation IN 2008 50 mug (2000 IU) /day younger 125 mug (5000 IU) /day adult No study reported adverse effects of using oral intakes about the current upper level of 50 mug (2000 IU). Int J Circumpolar Health. 2008 Jun;67(2-3):164-78. Vitamin D and living in northern latitudes--an endemic risk area for vitamin D deficiency.

Management : 

Management Ergocalciferol or cholecalciferol for 3 months 1000 IU/day if < 1 month of age; 3000 IU/day if 1-12 months of age 5000 IU/day if > 12 months of age). High-dose bolus therapy (300,000-500,000 IU) should be considered for children over 12 months of age if compliance or absorption issues are suspected. Med J Aust. 2006 Sep 4;185(5):268-72. Prevention and treatment of infant and childhood vitamin D deficiency in Australia and New Zealand: a consensus statement.

Management : 

Management Vitamin d defeciency in children and management 1,000-5000IU daily for 1 month Followed by 400IU maintenance daily Misra.etal.paediatrics:2008.122(2):398-417 Pediatrics. 2008 Aug;122(2):398-417. Vitamin D deficiency in children and its management: review of current knowledge and recommendations.

Thankyou : 

Thankyou

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