breastfed DD has rickets sequelae

[CristinaTheAstonishing]

DD is 18 months old. A paediatrician diagnosed her with rickets sequelae - on clinical grounds alone. She suggested it's from breastfeeding her for so long and advised vitamin D and all sorts of other drops.

What are your DD's particular symptoms?

Is she a poor eater?

Very poor eater and has no other milk whatsoever (and I tried). She has a rounded forehead and widening of the rib cage. Her appetite has been slightly better since taking the drops.

so sorry, how serious is it ?

It is normal to be prescribed Vitamin D drops in Europe for the first year of b'feeding and my then paediatrician was surprised it wasn't advised here. However I suppose as most UK babies have formula to which it is added by then, it is quite a rare condition now. The natural way for bodies to make it is exposure to sunlight but that too is less recommended.

Hi Lizs - I forgot to mention that the paed who saw her was in Romania and she too wondered that she hadn't had vit D supplements. I asked at the LLL group this morning and most babies don't need supplements at all in the UK. DD is quite light skinned and I have taken her out in the sun. It was disappointing and worrying though and made me question for the first time if I was doing the right thing.

BTW - it's not too serious, noone else had noticed it. Her legs are fine and overall she's a strong little girl.

How can the breastfeeding be contributory, surely it's helping.

The problem would surely be worse if she wasn't feeding?

I don't know - not having enough milk (I know, I know, but you start wondering), not eating enough solids because of having too much milk (contradiction with not having enough milk as stated earlier), I don't know. It's just that it crossed my mind that if DD had had formula she might have had a better vitamin D intake. I guess I have to be more imaginative with cheese and other foods.

CTA...it must be worrying...but don't feel mislead that if you had given formula there wouldn't be a problem...yes Formula does probably contain a higher amount of Vits and minerals, but only because they are not as easily digested from Formula!
Hope those Vit D drops and some sun exposure will help your lil one!

omg !! really makes me worry

oh Cristina, how awful for you

But I agree, this isn't a formula/bf issue, it's a food thing, I'm sure if you keep going with widening her diet she will get there. I'm sure having breastmilk must be the best thing for a child in her position, not a cause!

Surely a child with rickets would get a referral to a dietician who may be able to help you with her eating? Are you getting any specific help?

I'm sure you are doing the right thing in bfing btw!

christina, i found this on the net

When the mother has a low vitamin D level, the child can be born with a relative vitamin D deficiency as a result of decreased maternal transfer. In these cases, vitamin D supplementation during pregnancy can increase birthweight and growth. Additionally, the breast milk contains less vitamin D than in healthy children, adding to the risk of development of rickets. However, even in mothers with a normal vitamin D level, breastfeeding can cause rickets, since the recommended daily vitamin D intake for infants is 200 IU, while even with adequate maternal intake, breast milk contains only 12-60 IU/L. This has led to the advice to supplement vitamin D in breastfeeding

its from here

are you getting enough vit D?

i never knew this either.

Christina, I am massively sceptical - you need a proper diagnosis, surely (x rays? blood tests?).

However, babies who do not have vit D containing solids and remain on breastmilk or formula alone for a long time and who don't get out into the sunlight are at risk.

In the UK, cases of rickets appear to be almost exclusively confined to toddlers of Asian origin, who need more sunlight, and whose diets may remain milk-only for longer than the mainstream norm.

Have you thought about getting a second opinion?

Having said that, vit drops and a good diet are sensible measures.

The paediatrician I saw (in her 50s-60s) would have seen quite a number of cases in Romania. Once she'd said it it became obvious for me too: the prominent forehead, big tummy, thoracic rosary. She didn't recommend any X-rays or further testing because we were on a relatively short holiday there. DD had a standard blood test which came back normal (haemoglobin, leucocytes) except for increased eosinophyles - so now she's having treatment for possible intestinal parasites too. The paed prescribed a herbal remedy for this as she said DD is too young for the standard medicine which can be hepatotoxic. So now she's taking these drops and we are waiting for her to poo an anaconda. (Of course, she may not have parasites at all, but we're not investigating this further at this stage.)

I will make an appt to see our GP here as well, esp to see if there's any medicine she could take rather than just herbs. Also to see what to do further about Sylvia's calcium/vit D intake.

Thanks for the replies. I didn't mean to worry anyone - just something that's been on my mind these past few days.

Hope you get good help. Cristina....let us know what the GP says. I wonder what the GP will say about it, and the treatment of parasites with herbal medicine - wd be quite unusual here, I think.

misdee - I would quibble with that quote! Breastfeeding does not 'cause' rickets. It's a lack of appropriate solid food at the appropriate time and lack of sunlight on the skin that can lead to vit d deficiency and thus rickets. It's fine to continue breastfeeding as long as solids are also in the diet at the appropriate time, and the child gets out of doors.

Changed my name for this....

Cristina, like tiktok I'm sceptical. I think in your place I would insist on a proper biochemical diagnosis. That way, you know exactly what you're dealing with and how to put it right.

And herbs for worms........... hmmmmm.

PMSL about "poo an anaconda" by the way!

Hi Christina

When my (bottle-fed) DS was a baby we were living in Bulgaria and it was standard to be advised to give a supp containing Vit D particulary for those babies who were "winter babies" - DS born August so not out in sun much over winter.

The nurse I saw was Swedish and she said it was routine there too.

Re the herbal medicine - found IME that Eastern Europeans are very into alternative/homeopathic/natural-type remedies for a lot of things.

Hope the supps help your DD.

Hope she doesn't "poo an anaconda"! (I did pass a worm once - not a pleasant experience!!!)

....and intestinal parasites are only one of many causes of raised eosinophils. Parasites could also (theoretically)affect the absorbtion of VitD from the diet (by competing for it), but from what you've said, poor diet is the most likely cause.

BTW, why did you take your daughter to a paediatrician in Romania, on what you describe as a "relatively short holiday"? What were you worried about?

Agree, get a clearer diagnosis. No harm in supplementing her with drops, but work on varying her diet as well.

In this case I would try and cut back on the breastfeeding - just a little bit. Maybe if you are feeding on demand try and distract or offer something else or maybe cut out any nighttime feeding. I really am all for prolonged breastfeeding but at 18 months old if the breastmilk is being used as a substitute for food then she may need to be a little bit more hungry so she can be tempted to try other things to eat.

By 18 months old I do think breastfeeding should generally be supplementing food, not the other way round .

I would completely agree that breastfeeding does not 'cause rickets' however in a child with a small appetite who prefers to breastfeed than eat they may not be hungry enough to try other things to eat so a cycle develops of more breastfeeding to make up for the small amount of food taken leading to less appetite for anything else.

In the meantime food supplements seem a good idea

I agree, lazycow. At this age, breastfeeding is definitely something to have in addition to a normal range of solid foods, and not instead of.

Sound advice, I think.

Thank you.