Rickets is re-emerging in Australian children, spurring calls for a major campaign about the risk of vitamin D deficiency in pregnant women and babies.
Despite living in one the sunniest places on the planet, hundreds of children have been diagnosed with vitamin D deficiency rickets, a preventable bone disease that can cause delayed growth and skeletal deformities.
![Baby Willow was diagnosed with vitamin D deficiency when she was born. She is pictured with pediatric endocrinologist ...](http://web.archive.org./web/20180206010158im_/https://www.fairfaxstatic.com.au/content/dam/images/h/0/s/a/u/r/image.related.articleLeadwide.620x349.p4yzb8.png/1517660426105.jpg)
A recent spate of unusual cases at Monash Children’s Hospital in Melbourne has rung alarm bells.
It saw four infants over six months with complications including rickets and seizures.
Doctors are concerned that vitamin D deficiency is going undetected in hospitals, because the mothers of the babies that had problems were known to be vitamin deficient during pregnancy, yet the babies did not receive any supplements after being born.
“In some of the babies that we saw, there had been changes already occurring in the skeleton,” said Jacky Hewitt, a paediatric endocrinologist at Monash Children’s Hospital.
“If we can detect this problem early and treat [it] then there is a good chance the skeletal changes will improve in time.
“However, if the problem is not detected and left untreated for a long period of time, there can be permanent deformational changes.”
Babies can develop vitamin D deficiency from their mother, and it can continue while they are breastfed, as breast milk, despite its many benefits, is low in vitamin D. The problem is thought to affect around 1 in 10 infants in Australia.
Risk factors include those with darker skin, and those who wear veils when outside. According to a 2012 study, almost half of 398 Australian children with vitamin D rickets had parents born in Sudan.
However, people with pale skin are not immune.
IT worker Catherine Be is of Vietnamese background and has fairer skin. She was treated for vitamin D deficiency when she was pregnant with her first child, Willow.
And when her daughter was born two weeks ago, Willow also received a vitamin D supplement.
The Clayton South mother said she was not getting enough sun, as her desk job meant she was constantly indoors.
“I was always a person who avoided the sun,” she said.
Craig Munns, a professor of paediatric bone and mineral medicine in Sydney, authored a 2012 study that described vitamin D deficiency and rickets as a re-emerging and major public health issue in Australia.
At the time, he called for a public health campaign to improve awareness of at-risk groups.
But he said nothing had eventuated.
Six years later, he says a campaign is still needed, and that every woman should be given vitamin D when they are pregnant, and every baby given vitamin D supplements in their first 12 months.
This is in line with the UK, which recommends vitamin D supplements for breastfed babies.
Australian guidelines only recommend supplements for breastfed children with heightened risk factors, including a mother with a known vitamin D deficiency.
However, Dr Hewitt said these recommendations were not always being followed, because newborns at risk were still going without supplements and landing in emergency departments.
A review of protocols at a number of hospitals found inconsistent systems around how babies likely to be deficient were being identified, she said.
“In one case, it was the mother’s responsibility to seek treatment for their infant,” Dr Hewitt said.
“Given this problem and our experiences in a number of cases where there where significant complications following the mistreatment, we recommend that doctors, allied health professionals and the general public are made more aware of the issue,” she said.
Monash doctors are also calling for a new check box to be included in the child health record to confirm if a baby is at risk, saying without assessment some children will continue to suffer serious complications from missed treatment.