12 weeks after start of treatment

• Check - Serum U&E’s, Calcium, Phosphate, Alkaline Phosphatase, PTH.
• Ensure dietetic review carried out.
• Expect improvement in biochemistry and motor milestones.
• Reduce Vitamin D dose to maintenance (as multivitamins or combined with Calcium (see combination products).
• Expect improvements in x-ray appearance.
• Discharge to GP on Vitamin D supplement – to continue until at least the age of 5yrs, preferably until the child stops growing.

Consider alternative diagnoses and referral to Metabolic Bone Clinic or Endocrine Clinic.

Remember

• • In young infants and older adolescents, the classic findings of rickets (x-ray changes and bony deformities) may be absent despite profound Vitamin D deficiency.
• Other siblings and parents, especially mother, may also be Vitamin D deficient and vitamin D supplementation (400 units/600 units) may be beneficial for the whole family.
• Iron deficiency anaemia often accompanies Vitamin D deficiency.