Rickets, a softening and weakening of the bones caused by an extreme and prolonged deficiency of vitamin D, continues to be reported in the United States, according the American Academy of Pediatrics.

Vitamin D deficiency can be present long before the symptoms of rickets develop—skeletal deformities, fragile bones, impaired growth, dental problems, bone pain and muscle weakness, as reports the Mayo Clinic.

It's therefore important to ensure that infants and children receive adequate vitamin D, to help them develop strong bones. Articles on the American Academy of Pediatrics website recommend a minimum intake of 200 internal units (IUs) of vitamin D daily, beginning during the first two months of life and continuing throughout childhood and adolescence.

Vitamin D requirements for breast-fed and bottle-fed babies

Many parents believe that breast-fed babies receive an adequate supply of vitamin D. However, human milk typically contains 25 IU or less of vitamin D—not enough to prevent rickets, as noted on the American Academy of Pediatrics website. Formula-fed infants in the United States, the website articles continue, receive enough vitamin D as long as they are drinking at least 500 milliliters of formula per day.

For babies, liquid multi-vitamin drops that contain vitamin D are available. The drops, which are given once a day, do not interfere with breastfeeding. Older children who drink less than a quart of milk per day should take a multi-vitamin tablet daily—most children's multi-vitamins contain 500 IUs of vitamin D.

Sunscreen recommendations

Humans absorb vitamin D in two ways—from exposure to sunlight and from foods rich in vitamin D. Rickets has become more prevalent in children partly because of their decreased exposure to sunlight and inadequate intake of vitamin D.

It's important to follow medical recommendations for sunlight exposure and sunscreen application.

Articles on the American Academy of Pediatrics' website advise that infants and young children be kept out of direct sunlight, since studies show that sunlight exposure increases their risk of skin cancer later in life.

"Sun exposure is a known carcinogen that has been linked to melanoma and squamous cell carcinoma," cautions T. Casey Gallagher, M.D., a dermatologist in Boulder, CO, who co-founded the Boulder Valley Center for Dermatology. He notes that in 2009 the American Academy of Dermatology recommended that people meet their Vitamin D requirements through diet and supplements.

"This is a very confusing topic for many people," Dr. Gallagher says, "since the message to maintain an adequate level of Vitamin D and to avoid the sun seem to be in direct conflict. By addressing Vitamin D levels through diet and supplementation, people can continue to practice sun-smart behavior," he says.

Parents, Dr. Gallagher adds, should look for a "broad-spectrum sunscreen" for children that protects against both UVA and UVB rays.

Sources:
Mayo Clinic
http://www.mayoclinic.com/health/rickets/DS00813/DSECTION=symptoms

American Academy of Pediatrics
http://aappolicy.aappublications.org/cgi/content/full/pediatrics;111/4/908
http://www.aap.org/family/vitdpatients.htm
http://pediatrics.aappublications.org/cgi/content/full/122/2/398

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