Q: My son is 3 years old. We took him to an orthopaedic specialist because he was short in height as compared to his friends. He also complains of getting tired quickly while playing. The doctor advised us some blood tests, urine analysis and x-ray of the knee and wrists, as he doubted rickets. X-ray reports were OK but some blood tests showed out of range results: Creatinine - 0.3 (normal range 0.6 - 1.3); Haemoglobin - 12.3; Haematocrit - 38.4; Mean Corpuscular Volume 79.4; Mean Corpuscular Haemoglobin 25.4; RDW 15.8; WBC Differential Count: Lymphocytes - 41%; Urine Analysis: Nitrate detected. Does the above confirm rickets and what should be the remedy?

A:Rickets is caused by the failure of osteoid calcification in a growing child and is usually due to vitamin D metabolite (cholecalciferol) deficiency, which is formed in the skin after exposure to ultraviolet light. Human milk contains very little vitamin D and thus, breast-fed children are at an increased risk of vitamin D deficiency. In addition, those with darkly pigmented skin or who cover their bodies are also at higher risk. Rickets in Indian children is common due to skin colour, prolonged breast-feeding, and low maternal vitamin D levels. The disease is diagnosed by x-ray examination of leg bones. A distinct pattern of irregularities, abnormalities, and a coarse appearance can be clearly seen with rickets. A blood test may be done which reveals phosphorus level to be invariably low for age and elevated alkaline phosphatase levels. Your child’s values are essentially normal; please be guided by your paediatrician’s advice.