الفهرس 
Gross motor developmental milestonesOnly 14 pages are availabe for public view
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Abstract
Breast-fed infants are generally protected from vitamin D deficiency and rickets during the first few months of life because vitamin D and its metabolites cross the placenta. But this protection doesn’t last long as it is well recognized that breast milk normally contains insufficient concentrations of vitamin D. Therefore, if food fortification or adequate sunlight exposure is not given to the child, vitamin D deficiency is inevitable.
In majority of children in developing countries, majority of children continue to take predominantly breast feeds beyond 6 months of age and complimentary feeds are inadequate, resulting in nutritional deficiency. Rickets has been reported to delay walking; this is reversible if the disease is not too advanced. Several factors that have been shown to be important in the pathogenesis of rickets at this age include continued exclusive breast-feeding, depleting mother’s vitamin D reserves, in, lack of sunlight exposure and dark pigmented skin. This age group encompasses the age when the child normally starts walking and hence any aberration from normal skeletal development may delay the process of walking, Other causes of delayed walking include neuromotor and muscular affections, congenital abnormalities, trauma and infections etc.
Our work was planned to study the vitamin D status in infants with delayed walking.
This study involved 40 infants subdivided into 2 groups: cases group included 30 infants subdivided into 21 males and 9 females. And control group included 10 infants subdivided into 7 males and 3 females.
The infants were collected from different hospitals in Alexandria through the period from January to August 2014.
The mothers were interviewed for obtaining history of their infants as regard dietetic history to stress on type of feeding and exclusive milk feeding duration, sun exposure, vitamin D & Ca supplementation, motor developmental history and socioeconomic status.
Physical examination of the studied infants was done with particular stress on signs of rickets and anthropometric measurement.
Laboratory investigations were done to all the studied infants including:
1- Estimation of serum calcium
2- Estimation of serum 25 hydroxy vitamin D
Analysis of the data collected revealed that:
40% of the of the studied infants with delayed walking had insufficient or marginal vitamin D status while 10% had vitamin D deficiency.
About 30% of the studied infants with delayed walking had rickets
There was a significant correlation between vitamin D status of the studied infants of cases group and their anthropometric measurements (weight &length), socioeconomic status, motor developmental history.
Exclusive milk feeding duration for more than 6 months affect vitamin D status.
About 30% of the studied infants with delayed walking had
hypocalcaemia There was a significant difference between cases and control groups as regard their anthropometric measurements (weight &length), exclusive milk feeding duration, presence of signs of rickets and motor developmental history.
There was a significant difference between cases and control groups as regard serum 25 hydroxy vitamin D.
There was no significant correlation between vitamin D status of the studied infants of cases group and their age, sex,history of sun exposure and vitamin D & Ca supplementation.
There was no significant difference between cases and control as regard age, sex, socioeconomic status and dietetic history.
There was no significant difference between cases and control as regard history of sun exposure, vitamin D & Ca supplementation and serum calcium.
Conclusion
from the above mentioned study, it is concluded that:
1- Vitamin D deficiency represents one of causes of delayed motor development especially delayed walking in infants and affect weight and length of these infants.
2- Vitamin D deficiency positively related to type of feeding and occur if exclusive milk feeding duration is more than 6 months.
3- Vitamin D deficiency is prevalent among infants of families with low socioeconomic class.