Vitamin D Status in Abused and Nonabused Children Younger Than 2 Years Old With Fractures

Schilling, Samantha; Wood, Joanne N.; Levine, Michael A.; Langdon, David R.; Christian, Cindy W.

doi:10.1542/peds.2010-0533

Cited by 77 publications

(31 citation statements)

References 31 publications

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“…In addition, serum 25OHD levels are similar in infants with accidental and nonaccidental injuries [53] . Thus, simple vitamin D deficiency, that is vitamin D deficiency without biochemical or radiological signs of rickets, has not been associated with an increased fracture risk in infants and children.…”

Section: 2 Evidencementioning

confidence: 92%

Global Consensus Recommendations on Prevention and Management of Nutritional Rickets

Munns¹,

Shaw²,

Kiely³

et al. 2016

Horm Res Paediatr

359

477

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Background: Vitamin D and calcium deficiencies are common worldwide, causing nutritional rickets and osteomalacia, which have a major impact on health, growth, and development of infants, children, and adolescents; the consequences can be lethal or can last into adulthood. The goals of this evidence-based consensus document are to provide health care professionals with guidance for prevention, diagnosis, and management of nutritional rickets and to provide policy makers with a framework to work toward its eradication. Evidence: A systematic literature search examining the definition, diagnosis, treatment, and prevention of nutritional rickets in children was conducted. Evidence-based recommendations were developed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system that describes the strength of the recommendation and the quality of supporting evidence. Process: Thirty-three nominated experts in pediatric endocrinology, pediatrics, nutrition, epidemiology, public health, and health economics evaluated the evidence on specific questions within five working groups. The consensus group, representing 11 international scientific organizations, participated in a multiday conference in May 2014 to reach a global evidence-based consensus. Results: This consensus document defines nutritional rickets and its diagnostic criteria and describes the clinical management of rickets and osteomalacia. Risk factors, particularly in mothers and infants, are ranked, and specific prevention recommendations including food fortification and supplementation are offered for both the clinical and public health contexts. Conclusion: Rickets, osteomalacia, and vitamin D and calcium deficiencies are preventable global public health problems in infants, children, and adolescents. Implementation of international rickets prevention programs, including supplementation and food fortification, is urgently required. nology, pediatrics, nutrition, epidemiology, public health, and health economics evaluated the evidence on specific questions within five working groups. The consensus group, representing 11 international scientific organizations, participated in a multiday conference in May 2014 to reach a global evidence-based consensus. Results: This consensus document defines nutritional rickets and its diagnostic criteria and describes the clinical management of rickets and osteomalacia. Risk factors, particularly in mothers and infants, are ranked, and specific prevention recommendations including food fortification and supplementation are offered for both the clinical and public health contexts. Conclusion: Rickets, osteomalacia, and vitamin D and calcium deficiencies are preventable global public health problems in infants, children, and adolescents. Implementation of international rickets prevention programs, including supplementation and food fortification, is urgently required. Key WordsRickets · Nutrition · Vitamin D · Calcium · Consensus recommendations Abstract Background: Vitamin D and ca...

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Section: 2 Evidencementioning

confidence: 92%

Global Consensus Recommendations on Prevention and Management of Nutritional Rickets

Munns¹,

Shaw²,

Kiely³

et al. 2016

Horm Res Paediatr

359

477

View full text Add to dashboard Cite

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“…A physiologic PTH level in infants with fractures has not been identified, but a study showed that children with rib fractures are more likely to have elevated PTH than children with fractures in other bones, and the younger the child, the more elevated the PTH. 9 Our patient also had a 25-hydroxyvitamin D level that was in the insufficient range. Although vitamin D insufficiency has been proposed as a factor predisposing children to fractures and potentially causing erroneous diagnoses of abuse, the 1 study of vitamin D levels in infants and children with fractures showed no increased fracture risk with vitamin D levels in the insufficient range (20Y30 ng/mL).…”

Section: Discussionmentioning

confidence: 60%

Nonaccidental Trauma Presenting With Respiratory Distress and Pleural Effusion

Sagar

Shukla²,

Bradley-Dodds³

2012

Pediatric Emergency Care

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Nonaccidental trauma (NAT) is common and presents with varied symptoms. Pleural effusion as a complication of physical abuse has not been described in the past. We report the case of a 10-week-old infant who presented with multiple nonspecific complaints that included respiratory distress, refusal to feed, constipation, and lethargy. Sepsis was the working diagnosis on admission, but a massive pleural effusion and rib fractures seen on chest imaging ultimately led to the diagnosis of nonaccidental trauma. This interesting case highlights the importance of maintaining a high index of suspicion for abuse irrespective of atypical presenting signs.

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“…In a recent review of children with vitamin D deficiency, the rachitic changes and demineralization were uncommon, and the fracture risk was low (Perez-Rossello, Feldman, Kleinman, Connolly, Fair, Myers, & Gordon, 2012). In a separate study of vitamin D levels and fractures, the authors concluded that the vitamin D insufficiency was not associated with multiple fractures and diagnosis of child abuse, and nonaccidental trauma remains the most common cause of multiple fractures in young children (Schilling, Wood, Levine, Langdon, & Christian, 2011).…”

Section: Differential Diagnosismentioning

confidence: 99%