Kindly tell me the treatment for vitamin D deficiency in a child.

Question

Hello doctor,

My son is 1.7 years. He had rickets sometimes back and was put on supplements for six months. Upon taking him for review, alkaline phosphatase was extremely high but calcium level was okay and was referred to an endocrinologist. Upon doing several laboratory tests, TSH was okay, PTH was low, vitamin D levels were fine and wrist X-ray was normal. The boy cannot walk and does not look as if he will soon. When standing, he bends his legs at knee point and also clenches his fists when grasping. From the looks, he seems okay. Please help.

Answer 1

Hello,

Welcome to icliniq.com.

Rickets can be due to vitamin D deficiency or hypophosphatemia. You did not tell me the phosphate level in blood of your child. The hypo-phosphatemic form of rickets is resistant to vitamin D supplement. As X-ray is normal, this is a remote possibility in your child. Alkaline phosphatase is very commonly found to be high in growing child. But it is also high in rickets. With treatment, ALP (alkaline phosphatase) comes to within reference range. I suggest you continue with the Vitamin D and Calcium supplementation and get a phosphate level in your child's blood. Do not worry if minor deformities are present. Because these deformities will disappear as the child grows. But if the child cannot walk properly despite having a normal X-ray, and normal phosphate level, then consult with an orthopedic consultant. He will help your child by suggesting some good orthoses. I suggest you do a repeat PTH (parathyroid hormone) test and to do a serum phosphate level. Also, continue the Calcium and Vitamin D supplementation. I hope this helps. Thank you and take care. Regards.