Patient's question:
Main symptoms: Crying before going to sleepOnset time: 85 days
Laboratory test results: The doctor said it's a condition called "jiu lou disease"
Doctor's answer:
Serum alkaline phosphatase is currently a commonly used indicator for the examination and diagnosis of rickets, offering the advantages of sensitivity, specificity, simplicity, and speed. It has already replaced the traditional "three tests for rickets" (serum calcium, serum phosphorus, and serum alkaline phosphatase), becoming the main auxiliary examination for the early diagnosis of rickets. Although alkaline phosphatase is not as sensitive and specific as serum 25-(OH)D3 and 1,25-(OH)2D3, it can basically meet the requirements for clinical diagnosis of rickets. Currently, many hospitals have implemented this test (e.g., the Provincial Maternal and Child Health Hospital offers this test), and the cost is not very high, around 30 to 40 yuan.Test Method: Very simple, involves pricking a finger for blood collection, and results are usually available within half an hour.
Normal Value Range: Less than or equal to 200 U/L.
Grading: The higher the alkaline phosphatase level, the more severe the "calcium deficiency."
| Grading of Alkaline Phosphatase (U/L) | Prevention or Treatment Methods |
|--------------------------------------|----------------------------------|
| Normal (≤200) | Take one fish oil tablet daily for prevention |
| Mild (200–250, excluding 250) | Take one fish oil tablet daily for treatment |
| Moderate (250–300, excluding 300) | Treat with high-dose vitamin D3 |
| Severe (≥300) | Treat with high-dose vitamin D3 |
Recommendations:
1. Premature infants and babies with low birth weight (less than 3 kg)
2. Babies born to mothers who suffered from calcium deficiency during pregnancy
3. Babies breastfed by mothers with calcium deficiency
4. Babies who get little sun exposure, as sunlight deficiency is a major or underlying cause of vitamin D deficiency
5. Babies with rapid growth
6. Babies who drink little milk
These six types of babies are prone to calcium deficiency and are key targets for prevention.
Lifestyle Care:
Rickets prevention is crucial because once skeletal deformation occurs, it may leave lasting sequelae. Therefore, prevention is key, and proactive measures must be taken to avoid skeletal deformation. The focus today is on how to prevent rickets.
Preventing rickets should start from the fetal stage, and infants under one year old are the primary focus. This is the first sentence of the "Plan." The specific routine prevention measures are as follows:
Fetal Stage:
1. Pregnant women should get more sun exposure and outdoor activities.
2. Pregnant women should drink more milk.
3. After the fifth month of pregnancy, start taking an appropriate amount of calcium daily (about 500 mg, equivalent to 6 adult calcium tablets of Jin Gu Bang).
4. During the second and third trimesters, supplement with vitamin D; 400–800 IU daily (equivalent to one Betaling or Yike Xin tablet). However, many obstetricians believe that the safety of vitamin D for fetuses is not yet fully confirmed, so they rarely prescribe vitamin D to pregnant women. Although this information may no longer be valuable to you, you can share it with your friends.
Infancy (Under One Year Old):
This period is the key focus:
1. Babies should get more sun exposure and outdoor activities. This is the first and most important point, as well as the most economical and effective.
2. Starting from the full moon, supplement with an appropriate amount of vitamin D daily (400–800 IU, equivalent to one Betaling or Yike Xin tablet). Fish oil should be taken daily and continued until around 18 months of age.
3. Promote breastfeeding. During breastfeeding, the mother should supplement with calcium, fish oil, and get more sun exposure, while drinking milk.
4. After six months, supplement with an appropriate amount of calcium daily.
5. Drink more milk.
Sunlight and outdoor activities are not the same. Outdoor activities do not necessarily mean sun exposure. Sun exposure refers to direct sunlight exposure to the skin. The recommended daily exposure time is 0.5–1 hour. In winter, the parts of the body that can be exposed to sunlight include the face, small hands, small feet, and buttocks. Parents should adjust the duration and method of exposure based on specific conditions.
Fish oil must be taken daily. If you forget today, take two tomorrow to ensure one dose per day. Fish oil and sun exposure should be combined and complementary. For example, if it has been cloudy for a long time and there is no sun exposure, you can take 9 fish oil tablets per week. Everyone must believe that following the above dosage for vitamin D supplementation will never lead to toxicity, and there is absolutely no need to worry about this.
Note: I emphasize that there is absolutely no risk of toxicity.
Calcium Supplementation Dosage:
- 6–12 months: 100 mg per day
- 12–24 months: 150–200 mg per day
- After 2 years: 250 mg per day
Recommended Milk Intake:
- Under 4 months: All milk
- 4–6 months: 1–2 times of complementary foods daily, with the rest being milk
- 6–8 months: 600–800 ml
- 9–12 months: 800 ml or more
- Over 1 year: 600 ml
- Over 2 years: 500 ml
Early Childhood (1–3 Years Old):
1. Babies should get more sun exposure and outdoor activities. This is the first and most important point, as well as the most economical and effective.
2. Supplement with an appropriate amount of vitamin D daily. For 1–1.5 years, take one fish oil tablet daily (400–800 IU, equivalent to one Betaling or Yike Xin tablet). After 1.5 years, if sun exposure is limited, supplement with 3–5 fish oil tablets per week.
3. Supplement with an appropriate amount of calcium daily.
4. Drink more milk (500–600 ml per day).
How to Scientifically and Professionally Diagnose Whether a Baby Has Rickets:
This is also something that many parents are interested in. First, I must emphasize that diagnosing rickets cannot rely on a single factor; it requires a comprehensive analysis. This includes whether there are risk factors for calcium deficiency, whether there are symptoms of calcium deficiency, whether there is skeletal deformation, and combining the results of biochemical tests.
Prevention:
- Fetal Stage: Pregnant women and fetuses have increasing needs for vitamin D and calcium. Pregnant women should engage in frequent outdoor activities, get more sun exposure, and consume nutrient-rich foods. Those with hypocalcemia and osteomalacia should be treated actively. For pregnant women with limited sunlight exposure, poor appetite, weak health, or those in the winter trimester, vitamin D and calcium supplements should be provided to prevent congenital rickets. During the second and third trimesters, supplement with vitamin D; 400–800 IU daily, or 5–10 million IU per month, once or divided doses orally; or a single dose of 15–20 million IU, with calcium supplementation simultaneously.
- Infancy: Since vitamin D deficiency rickets has a significant impact on child development and is caused by a series of lesions resulting from vitamin D deficiency due to various factors, rickets can be prevented. The skin contains 7-dehydrocholesterol, which, under the exposure of ultraviolet rays in sunlight, becomes cholecalciferol (endogenous vitamin D3), the main source of human vitamin D. Therefore, rickets prevention can be carried out in two ways: sunlight exposure and vitamin D supplementation. Infants should be exposed to sunlight as early as possible. As long as the outdoor temperature is above 18°C and the wind is not too strong, the baby can be taken outdoors for sun exposure, but direct eye exposure should be avoided. Outdoor activities should be maintained throughout spring, summer, autumn, and winter, with the duration gradually increasing to 20–30 minutes. Avoid staying indoors for too long.
Additionally, the vitamin content in breast milk is about 4–6 IU/dL, similar to that in cow's milk. Therefore, whether breastfeeding or artificial feeding, vitamin D prevention should be started about one month after birth, with 400 IU daily (400 international units). Premature infants should be given vitamin D two weeks earlier, with the dosage doubled in the first three months (800 IU daily). After three months, reduce to 400 IU daily. Generally, after the age of 2, growth slows, outdoor activities increase, and rickets is less likely to occur, making further vitamin D supplementation unnecessary.
- Early Childhood: After the age of 1, the "sunlight in summer, vitamin D in winter" prevention method can be adopted. Generally, 20–30 million IU of vitamin D is given once in winter, with increased nutrition and sun exposure during other times. In high-risk areas, vitamin D can be supplemented again every 2–3 months with 20–30 million IU.
- Childhood (5 years and older to puberty): Late-onset rickets can occur in children after the age of 5. For those with frequent fatigue, weakness, leg weakness, leg pain, or joint pain without other identifiable causes, further examination and treatment should be conducted. Vitamin D prevention methods and dosages are the same as in early childhood. When using vitamin D for prevention, breastfed infants do not need additional calcium. However, for infants who are weaned after 6 months, artificially fed, have poor appetite, rapid growth, or are in puberty or have chronic diseases, appropriate calcium supplementation should be provided.