Rickets is a common nutritional disease in children, commonly found in infants and young children. In child health clinics or consultations, parents often ask, “Is rickets the child’s excessive sweating and hair loss rings on the head and occipital area?” “Which calcium tablets are good to take to prevent rickets?” “Is rickets diagnosed when hair or urine calcium tests have been done and the results are abnormal?” It can be said that there is no disease that has attracted so much attention and concern from parents as rickets. At present, there are many misconceptions about the diagnosis, prevention and treatment of rickets in children, and the phenomenon of “calcium and D supplementation” is overheated. In the middle of June, I attended the 5th National Symposium on the Prevention and Treatment of Rickets in Children held in Dalian, and now I would like to introduce the new concept of prevention and treatment of rickets in children to the parents. I. Is it calcium or vitamin D supplementation to prevent rickets? Infant rickets is mainly caused by vitamin D deficiency. Breast-fed or formula-fed infants, as well as young children who eat 400 ml of milk every day, are generally not calcium deficient and do not need additional calcium supplementation. And the vitamin D in food certainly cannot meet the normal physiological needs of children. Sunlight can increase the synthesis of vitamin D in the skin, but for various reasons, infants and children often do not get enough sunlight, especially in the winter and spring seasons, including the rainy summer season in the south. However, the current practice of adding vitamin D to all kinds of children’s food has raised concerns among experts that one cannot judge the intake of vitamin D, and the other is that it can easily cause vitamin D poisoning in children. Foreign countries have only added vitamin D to formula to prevent rickets in children and achieved good results. It is important to choose a vitamin D preparation that is well packaged and shielded from light to prevent rickets. Since vitamin D is very easy to decompose when it sees light, it is difficult to guarantee the vitamin D content of concentrated cod liver oil drops and some preparations with poorly shielded packaging. Experts believe that this is an important reason why rickets prevention is not effective in our children. Some children have insufficient calcium intake and should start by improving their dietary structure. Calcium is high in milk and soy products, and more of these foods should be eaten. At present, there are many varieties of calcium preparations on the market. You can refer to the amount of calcium elements in calcium preparations, taste, absorption rate and price to buy. The absorption rate of calcium in general calcium preparations is between 25% and 35%, and it is impossible to absorb more than 90% of calcium. Excessive calcium supplementation not only causes waste, but also affects the absorption of other nutrients such as iron and zinc, which is detrimental to the health of children. Therefore, it should be taken under the guidance of a doctor. Second, can hair or urine calcium test diagnose rickets? Can blood calcium and blood phosphorus tests diagnose rickets early? Doing hair or urine calcium tests to diagnose rickets is absolutely not credible and has been completely rejected by the medical profession. The results of a single urine calcium test are unreliable, and a 24-hour urine calcium test has some value. The diagnosis of rickets should be based on a comprehensive judgment of medical history, clinical manifestations and laboratory and x-ray examinations. In the early stage of rickets, blood calcium and blood phosphorus generally do not decrease, and only when severe, blood calcium and blood phosphorus will decrease, therefore, blood calcium and blood phosphorus determination, also have little value for the early diagnosis of rickets. Determination of blood alkaline phosphatase level or bone alkaline phosphatase activity and taking wrist x-ray with molybdenum target is a reliable method for early rickets. Third, is excessive sweating and occipital baldness at the back of the head rickets? One of the clinical manifestations of rickets is excessive sweating, but parents are often unsure of how to determine excessive sweating in children. When a child wakes up, the sympathetic nerves are excited and the metabolism is high; when the child goes to sleep, the body enters the basal metabolism, but the child’s plant nervous function is not well developed and can only gradually transition from the high metabolism to the basal metabolism, so a large amount of heat energy in the body will still be released in the form of sweating. If a child’s sweating disappears gradually 1 to 2 hours after going to sleep, it can be considered normal. As the head sweats a lot, the child often swings his head while sleeping, and hair loss rings appear on the occipital area. Therefore, children who sweat a lot and have occipital baldness are not always rickets. Children with rickets often sweat all night, and after changing clothes in the first half of the night, their clothes are still wet in the second half of the night, and their sweating has a sour smell. In addition to excessive sweating, bone marrow changes are an important feature in children with rickets. Children with rickets at different ages have different skeletal changes, for example, neonatal rickets often has an enlarged fontanel, children with rickets within one year old have mainly head and chest changes, and after standing and walking have mainly lower limb changes. IV. Is high dose or low dose used to treat rickets? The traditional method of treating rickets with large doses of vitamin D has been questioned by many experts, such as intramuscular injection of 300,000 or 600,000 units of vitamin D once every other month. This method may cause vitamin D toxicity and cause serious effects such as calcium deposition in internal organs and organ damage. Even if vitamin D toxicity does not occur, high doses of vitamin D have a suppressive effect on the immune system, making children less resistant. Therefore, the trend will be to treat rickets with small doses of vitamin D, such as 31,200 units of vitamin D taken orally daily. but for those who cannot adhere to long-term medication treatment, or whose other diseases affect vitamin D absorption, the high-dose treatment method can be considered.