Rosh Pediatrics Practice Exam

What is the most appropriate intervention for a 9-month-old boy who is suspected of having rickets given his dietary history?

1. Formula feeding instead of breastfeeding

2. Increase calcium in diet

3. Increase phosphorus in diet

4. Supplement breastfeeding with cholecalciferol

The correct answer is: Supplement breastfeeding with cholecalciferol

The most appropriate intervention for a 9-month-old boy suspected of having rickets, particularly in the context of his dietary history, is to supplement breastfeeding with cholecalciferol, which is vitamin D3. Rickets is commonly associated with vitamin D deficiency, as it is essential for calcium and phosphorus metabolism, both of which are crucial for bone mineralization. At this age, if the child is breastfeeding and not receiving adequate sunlight exposure or dietary sources of vitamin D, he may not be getting sufficient amounts of this vitamin to support proper bone development. Cholecalciferol supplementation provides the necessary vitamin D that helps the body absorb calcium and phosphorus effectively, thereby addressing the underlying deficiency that may be causing rickets. The other options may not adequately address the fundamental issue of vitamin D deficiency causing rickets. While increasing calcium or phosphorus in the diet can be beneficial, without adequate vitamin D, the body may not be able to utilize these minerals effectively, and simply switching to formula feeding may not specifically target the vitamin D deficiency that is likely present in a breastfeeding infant.