Nutritional rickets in immigrant and refugee children

Area of Science:

• Pediatrics
• Public Health
• Nutritional Science

Background:

• Immigrant and refugee children face unique public health challenges, including increased prevalence of diseases rare in host nations.
• Nutritional rickets, a condition caused by vitamin D and/or calcium deficiency, is increasingly observed in high-income countries, particularly among immigrant children.
• Risk factors include dark skin pigmentation, sun avoidance, cultural practices, and dietary habits common in specific ethnic groups.

Purpose of the Study:

• To highlight the rising incidence of nutritional rickets in immigrant and refugee children in high-income countries.
• To emphasize the preventable nature of nutritional rickets and advocate for public health interventions.
• To recommend screening and supplementation strategies for at-risk pediatric populations.

Main Methods:

• Review of the prevalence and risk factors associated with nutritional rickets in immigrant children.
• Clinical assessment and radiographic confirmation of nutritional rickets in children under 5 years.
• Analysis of vitamin D and calcium requirements for prevention.

Main Results:

• Nutritional rickets is increasingly prevalent in children from the Middle East, Africa, and South Asia residing in high-income countries.
• Key risk factors include vitamin D deficiency, inadequate calcium intake, dark skin, sun avoidance, and prolonged breastfeeding without supplementation.
• The condition can lead to severe consequences including stunted growth, bone deformities, seizures, and even death.

Conclusions:

• Screening immigrant and refugee children under 5 from specific ethnic groups for nutritional rickets is recommended.
• Universal vitamin D supplementation (400 IU/d for infants, 600 IU/d thereafter) and adequate calcium intake (500 mg/d) are effective preventive measures.
• Public health policies should incorporate screening for micronutrient deficiencies and vitamin D supplementation for all refugee children upon arrival.