Study to Assess the Use of a Simple Lab Test to Screen for Rickets in Children
Condition: Rickets
MeSH terms: Rickets
Study type: Observational

Summary: 
      Some experts recommend that all breastfed babies receive supplemental vitamin D. The purpose
      of this study is to determine the rate of vitamin D use in breastfed babies, the
      recommendations of pediatricians regarding vitamin D, and the impact on these recommendations
      on parental choice of vitamin D. In addition, in preparation for a large study to see how
      many breastfed children who don't receive supplemental vitamin D have rickets, in this study
      we will determine if a simple blood test, an alkaline phosphatase level, could be used to
      screen for rickets. Parents of children 6-23 months old are eligible to complete feeding
      surveys and children 6-15 months old who were breastfed for at least the first six months of
      life and didn't routinely receive vitamin D are eligible for alkaline phosphatase levels. We
      postulate that most breastfed babies don't receive supplemental vitamin D, and that alkaline
      phosphatase levels will only be abnormal in a few babies who will have evidence on x-ray of
      rickets.
    

Detailed description: 
      The Puget Sound Pediatric Research Network (PSPRN) is a practice-based research network of
      pediatricians in the Puget Sound area and at the University of Washington and Children's
      Hospital and Regional Medical Center. The network has extensive experience in conducting
      large studies on contentious issues that are pertinent to children, their parents, and
      primary care providers. In 2004, vitamin D supplementation was recommended for all
      exclusively breastfed infants. This recommendation was based on sporadic reports over the
      last 30 years of vitamin D deficient rickets in infants and toddlers who have been
      exclusively breastfed. The recommendation has been controversial because it might undermine
      efforts to promote breastfeeding, and because the prevalence of rickets in these patients is
      unknown. PSPRN proposes to conduct a preliminary study to determine the feasibility of a
      larger planned project by the network to determine the prevalence of rickets in breastfed
      infants and toddlers who do not receive supplemental vitamin D. Systematic surveys will be
      conducted in PSPRN practices to determine current levels and trends in vitamin D
      supplementation. Current practices of PSPRN pediatricians regarding supplementation, and
      their effect on parents, will also be assessed. The utility of a serum alkaline phosphatase
      level as a screening test for vitamin D deficient rickets will be determined in the proposed
      study by obtaining levels on approximately 300 patients, 6-15 months old, seen by PSPRN
      practitioners, who have been breastfed. In addition to assessing possible methodologies for
      the larger project, the preliminary study is designed to yield standalone results with
      important implications.
    

Time perspective: Cross-Sectional
Sampling method: Non-Probability Sample
Study population: 
        breastfed children
      
Keywords: breastfeeding; vitamin D supplementation; rickets