When it comes to the topic of children’s calcium, many parents are particularly concerned about, afraid of their babies lack of calcium, especially when the baby appeared sweating, late teething, walking late, ribs turned out and so on, it is thought that their babies lack of calcium, began to give the baby calcium. First, how to determine the baby “calcium deficiency”? Often referred to as “calcium deficiency” in medicine known as rickets, nutritional rickets is due to children’s vitamin D deficiency or insufficient intake, resulting in chondrocyte differentiation disorders, growth plate calcification and chondrocyte-like calcification disorders. The diagnosis of nutritional rickets requires a combination of medical history, physical examination, biochemical tests, and x-rays. The history includes including whether vitamin D supplementation, regular outdoor activities, adequate daily calcium intake, and the presence of symptoms of rickets, etc. Physical examination is usually performed by a doctor who specializes in examining children for characteristic signs of rickets, such as infantile cranial softness, bead-like changes in the ribs, and the presence of inward or outward turning of the legs beyond the normal range. If there are suspicious symptoms, the level of vitamin D in the blood can also be tested by biochemical examination and judged according to the reference standard. An X-ray of the wrist can further confirm the diagnosis. Diagnostic criteria for vitamin D deficiency: Serum 25 hydroxyvitamin D3: <30 nmol/L, deficiency; 30~50 nmol/L, insufficiency; >50 nmol/L, sufficiency; and >250 nmol/l for toxicity. Calcium intake standard: Note: Children after 1 year of age consume less than 300 ml of calcium per day, which can lead to rickets, regardless of whether the organism is vitamin D deficient or not. Second, the symptoms of nutritional rickets Nutritional rickets patients are often prone to limb and pelvic deformities, bone pain, as well as muscle weakness and other manifestations. There is a risk of fracture in rickets confirmed by x-rays of the wrist. Skeletal symptoms of rickets: 1) Swelling of the wrist and ankle joints; 2) Delayed closure of the fontanel (normally closes by 2 years of age); 3) Delayed eruption of the teeth (no incisors erupting by 10 months of age, no molars erupting by 18 months of age); 4) Deformities of the legs (inward turning of the knee, outward turning of the knee, wind erosion deformity); 5) String ribs; 6) Frontal elevation; 7) Cranial tenderness (usually evident on palpation of the bone sutures in the first three months); 8) Bone pain and pain, and musculoskeletal pain. ); 8, bone pain, restlessness, irritability. III.PREVENTION AND TREATMENT OF NUTRITIONAL RICKETS 1. PREVENTIVE DOSE OF VITAMIN D To prevent vitamin D deficiency, the daily intake of vitamin D in infants should be 400 IU/d (10 μg/d), whether breastfed, mixed, or artificially fed. for children older than 12 months of age, and adults, vitamin D requirements are met by diet or nutrient supplements at a minimum of 600 IU/d ( 15 μg/d). 2. Vitamin D and Calcium Dosage for Treatment of Nutritional Rickets The minimum dose of vitamin D is 2000 IU/d (50 μg) for at least 3 months; calcium, 500 mg/d, should be routinely used in conjunction with vitamin D, either by dietary intake or by supplementation. Oral therapy is still generally recommended for more rapid restoration of 25-OHD levels. For routine treatment, D2 and D3 are equally effective. When used in high doses as a single agent, vitamin D3 is recommended because it has a longer half-life than vitamin D2. Vitamin D treatment should be continued for at least 12 weeks, and some children may be treated for longer. Dosage of vitamin D therapy for nutritional rickets IV. How to recognize risk factors for rickets in children? Vitamin D deficiency should be avoided in women of childbearing age with a daily intake of 600 IU of vitamin D. Pregnant women should likewise consume 600 IU/d of vitamin D, preferably in conjunction with other supplements such as iron and folic acid. For infants, in addition to a daily intake of 400 IU of vitamin D, complementary foods should be added no later than 26 weeks of age, including calcium-rich foods such as sesame seeds and soy products. At least 500 mg/d of calcium intake should be ensured during childhood and adolescence. V. Risk factors for nutritional rickets and osteomalacia 1. Maternal factors Vitamin D deficiency; dark skin pigmentation; generalized skin covering; high latitudes in winter/spring; other causes of restricted sunlight such as indoor living predominantly, disability, air pollution, cloud cover, etc.; low-calcium diets; poverty, malnutrition, and special dietary habits. Infant/childhood factors Vitamin D deficiency in newborns due to mothers; lack of vitamin D supplementation in infancy; lack of appropriate complementary foods after 6 months of age; high latitudes in winter/spring; low vitamin D diets; low-calcium diets; poverty, malnutrition, special dietary habits.