Although there are no data from national surveys, vitamin D deficiency is  common in many parts of sub Saharan Africa, usually starting during the second half of the first year. For children who were born premature, the deficiency is diagnosed
much earlier.

Clinical Features

  • Children present with poor growth
  • Delayed or regressed milestones
  • Recurrent pneumonias
  • Widening of the wrists
  • Prominence of costo-chondral junctions (rickety rosary)


  • X-ray wrist – cupping of radius and ulna
  • Serum calcium, phosphate
  • Alkaline phosphatase
  • Urine to exclude renal causes


  • Give vitamin D2 at 2,000–5,000 IU per day for 6–12 weeks or D3 at 0.05μg/ kg/day.
  • Supplements of calcium and phosphate will also be beneficial. Advise parents
    to expose their children to sunshine as a preventive measure against rickets.


  • Children should be exposed to sunlight with minimal clothing for 30 minutes a day.
  • For infants born preterm, supplementation with vitamin D at a dose of 4,000 IU/day is recommended.
  • In addition, there should be provision for calcium and phosphate in the diet, which is usually adequate from milk for the infant and
    young child.