Rickets, the childhood disease that caused an epidemic of bowed legs and curved spines during the Victorian era, is making a shocking comeback in 21st-century Britain.
Rickets results from a severe deficiency of vitamin D, which helps the body absorb calcium. Rickets was historically considered a disease of poverty among children who toiled in factories during the Industrial Revolution.
Last month, Britain's chief medical officer Sally Davies proposed the country give free vitamins to all children under five.
Most people get vitamin D from the sun, oily fish, eggs or dairy products. Rickets largely disappeared from Britain in the 1950s, when the country embarked on mass programs to give children cod liver oil. But the number of reported cases of rickets in hospitalised children has increased from 183 cases in 1995 to 762 cases in 2011. With no official surveillance system, experts said the actual number is probably even higher.
"Children come in with bendy legs, swollen wrists and sometimes swollen ribs," said Dr Mitch Blair, an officer for health promotion at the Royal College of Paediatrics and Child Health.
Blair cited several reasons for the rise in rickets cases, including children spending more time playing indoors, the stringent use of sunscreen and religious beliefs that mean skin is covered.
In the US, doctors say there has also been a rise in rickets, though there are no solid national figures to confirm it.
"Kids with rickets are children who don't have exposure to safe places to play and (who) stop drinking milk as soon as they're weaned," said Dr Laura Tosi, an orthopedic surgeon in Washington, DC.
"If the vitamin D deficiency is ongoing for a long time, these kids come in with horrific bowing of the legs and I have to think about breaking the bones to straighten them," she said.