The investigation was triggered after a report of two cases of rickets, both of which were associated with the use of a commercial alternative milk. The six children with rickets were all male, aged 8 to 21 months, and received breast milk until age 8 to 21 months. Two children were exposed to 6 and 21 hours of sunlight per week, one child did not receive much sunlight, and two children received minimal sunlight. Sun exposure was unknown for one child. According to the report, rickets is not always easy to recognize in infants and toddlers because its early symptoms mimic other conditions.
Infants often present with seizures and high fevers associated with a secondary infection.
If the child is treated for infection and no blood is drawn, there will be no indication of the low calcium levels indicative of rickets. While cheese and other dairy products are an important source of nutrition, they don't contain vitamin D and many parents are unaware of that. Milk and adult breakfast cereals have some vitamin D, but the primary source for toddlers is vitamin D-fortified milk. The three children with protein-energy malnutrition, one of them with kwashiorkor, were aged 6 to 22 months at the time of diagnosis. The child with kwashiorkor drank a rice beverage with low protein content.