Rickets is a disease of the growing child arising from defective mineralisation of the growth plate and osteoid. It is usually associated with abnormal serum calcium and/or phosphate levels. Rickets results in skeletal deformities and short stature. Nutritional rickets arises from deficiency of vitamin D and/or calcium, or both these nutrients. It also arises from mutations in genes involved in vitamin D metabolism or it’s biological actions at the receptor level. Fibroblast growth factor 23 (FGF23), which is primarily produced by osteocytes, plays an important role in regulating serum phosphate via its actions on renal sodium dependent phosphate cotransporters and synthesis/degradation of 1,25-dihydroxyvitamin D. In causes of rickets associated with high plasma FGF23 levels, there is increase in renal phosphate wastage and reduced gastrointestinal absorption of phosphate.

In the interactive workshop, the logical approach to establishing the diagnosis based on history, clinical examination, biochemical, radiological and genetic testing shall be discussed. Treatment of nutritional rickets as well as those caused by genetic causes will also be discussed.

• General Sick day management rules
• Frequency of glucose and ketones testing during illness
• Management of hyperglycemia and ketonemia during illness.
• Management during infections associated with hypoglycemia and poor oral intake.
• Use of IV insulin during illness

• Review and discuss existing tools and recommendations to diagnose and treat obesity in children
• Enhance well child visit anticipatory guidance with stronger focus on nutrition, physical activity and importance of health weight
• Understand how clinicians and nutritionists can work together to combat obesity.
• Discuss ways the primary care provider can refer patient to pediatric endocrinologist
• Initiate discussion with parents on childhood obesity: Do’s and Don’ts
• Empower families to set goals and make habit changes for healthy living