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Recent publications have again drawn attention to long bone fractures in newborn infants with severe vitamin D deficiency due to maternal subnutrition.  This is a reminder of the complete dependence of an infant on maternal nutrition; the bones that fracture in early infancy are formed during gestation.

This review covers previous reports of congenital rickets including the difficulties in diagnosis, not least because there may be none of the usual radiological hallmarks of rickets.  It also outlines ways of making a retrospective diagnosis of vitamin D deficiency after the infant’s biochemical findings have become normal.

It is likely that similar considerations apply to vitamin C deficiency.  Although overt scurvy is uncommon it is clear that vitamin C subnutrition is widespread even in Western countries.  Vitamin C has many roles but among them is its requirement in the formation of collagen.  Thus it is not surprising that fractures and intracranial bleeding are well-recognised features of vitamin C deficiency.

Maternal subnutrition of vitamin D and vitamin C are important conditions in the wide differential diagnosis of unexplained fractures and fracture-like lesions in infancy.