Food for Thought: Rickets on the Rise?
March 29, 2001 -- When Bianca Arrington's breastfed 7-month-old son Japhet had a seizure one day, she never thought the diagnosis would ultimately be rickets, a disease essentially caused by a kind of malnutrition and thought to be a disease of the past in industrialized nations.
"We were doing our regular routine when all of a sudden he fell back and started foaming at the mouth," recalls the young mother. "His eyes rolled to the side and his limbs tightened up, and he was shaking and gagging."
At the hospital, the 7-month-old was examined, but he was released quickly. Bianca was told that many babies have one seizure and then never have another.
But the next day, when she was following up with her pediatrician, Japhet had another seizure, and Bianca went back to the hospital. Although the CAT scan was normal, blood work revealed that Japhet's calcium, magnesium, and phosphorous levels were extremely low, and he was immediately transported to a larger hospital in Atlanta.
That's where Bianca met Norman Carvalho, MD, a staff pediatrician at Children's Health Care of Atlanta. Carvalho set out to find out why Japhet's mineral levels were so low.
"Dr. Carvalho said it was rickets," Bianca says. "I didn't know what rickets was; I had never heard of it."
Rickets is a disease typically caused by vitamin D deficiency; the classic symptom is weakened or deformed bones. The disease was common a century ago during the Industrial Revolution when children went malnourished and without regular exposure to the sun, which triggers the body to make vitamin D. But now, thanks to a better understanding of nutrition, and fortification of certain foods, rickets is preventable and extremely rare in the U.S.
So how could this have happened to Japhet?
"Throughout my pregnancy I read everything, I went to breastfeeding classes, I spoke to a lactation consultant, and I never heard of rickets, never heard of giving a baby [a] vitamin supplement," his mom says.
While numbers are hard to pin down because there is no national surveillance system or mandatory reporting for these diseases, some experts like Carvalho believe there may be an increase in the number of children with severe malnutrition. Carvalho himself reported two cases (including Japhet's) to the Georgia Department of Human Resources; in turn, the GDHR asked the Centers for Disease Control and Prevention (CDC) to investigate cases of severe malnutrition in Georgia.
After reviewing hospital records between January 1997 and June 1999, the CDC identified six cases of children with rickets and three cases of children with another disease, called protein energy malnutrition (PEM), that were not related to abnormalities present at birth or to chronic infection. These cases are reported in the current issue of the CDC's Morbidity and Mortality Weekly Report.