Missed doses, missed milestones: a case report of nutritional rickets in a high-risk infant

Introduction: Nutritional hypocalcemic rickets, though uncommon in developed countries, remains a relevant concern in at-risk populations. Case-report: We report the case of a 13-month-old female migrant infant who presented with growth failure, delayed psychomotor development, and classic signs of rickets, including craniotabes, a rachitic rosary, limb deformities, and bone pain. Contributing factors included the absence of vitamin D supplementation, an inadequate diet, and cow’s milk protein allergy. Biochemical evaluation revealed low serum levels of vitamin D and phosphorus, as well as elevated parathyroid hormone and markedly increased alkaline phosphatase, supporting the diagnosis. Radiographic findings showed osteopenia and skeletal abnormalities. After six months of treatment with high-dose vitamin D and calcium supplementation, there was significant improvement in growth, motor development, and radiological. Discussion: This case underscores the importance of ensuring universal access to healthcare, adherence to supplementation guidelines, and appropriate nutritional education to prevent rickets and its long-term complications.