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Key words: Hypotonia, Iron deficiency anaemia, Vitamin D deficiency rickets

Prolonged and exclusive breastfeeding without vitamin D supplements is a main determinant of vitamin D deficiency rickets in children of immigrants living in Italy. Dark skin may be an adjunctive factor for the development of rickets. Early signs and symptoms of vitamin D deficiency rickets may be misleading mimicking a myopathy. In children with vitamin D deficiency rickets low doses of vitamin D are efficacious and cost-effective, and there is no indication to the administration of vitamin D active metabolites or very high doses of vitamin D in this form of rickets. Paediatricians should check if the administration of vitamin D supplements is regularly performed by parents mainly in children with an increased risk of vitamin D deficiency.