An 18-month-old child who was exclusively breastfed and never received complementary feeds presents with bowing of legs, craniotabes, and rachitic rosary. Serum calcium is 8.0 mg/dL, phosphorus is 2.5 mg/dL, alkaline phosphatase is markedly elevated. Which of the following is the single best initial intervention?
- A Oral vitamin C 100 mg daily
- B Dietary restriction of phosphorus
- C Oral vitamin D 60,000 IU weekly for 6 weeks plus calcium supplementation ✓
- D Orthopedic referral for leg bracing
Correct answer: C. Oral vitamin D 60,000 IU weekly for 6 weeks plus calcium supplementation
Explanation
This child has nutritional rickets from vitamin D deficiency compounded by dietary calcium deficiency due to prolonged exclusive breastfeeding without complementary feeds or vitamin D supplementation. Stoss therapy (high-dose oral vitamin D 60,000 IU weekly for 6 weeks or a single large dose) along with adequate dietary calcium supplementation is the recommended initial treatment. Elevated alkaline phosphatase and low serum phosphorus are key biochemical markers. Orthopedic correction is considered only after biochemical healing.
Reference: Ghai Essential Pediatrics, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.