Caring for children with rickets

What is rickets?

Rickets is a skeletal disorder that’s caused by a lack of vitamin D, calcium, or phosphate. These nutrients are important for the development of strong, healthy bones. People with rickets may have weak and soft bones, stunted growth, and, in severe cases, skeletal deformities.

Vitamin D helps your body absorb calcium and phosphate from your intestines. You can get vitamin D from various food products, including milk, eggs, and fish. Your body also produces the vitamin when you’re exposed to sunlight.

A vitamin D deficiency makes it difficult for your body to maintain sufficient levels of calcium and phosphate. When this occurs, your body produces hormones that cause calcium and phosphate to be released from your bones. When your bones lack these minerals, they become weak and soft.

Rickets is most common in children who are between 6 and 36 months old. Children are at the highest risk of rickets because they’re still growing. Children might not get enough vitamin D if they live in a region with little sunlight, follow a vegetarian diet, or don’t drink milk products. In some cases, the condition is hereditary.

Rickets is rare in the United States. Rickets used to be more common, but it mostly disappeared in developed countries during the 1940s due to the introduction of fortified foods, such as cereals with added vitamin D.

Who is at risk for developing rickets?

Risk factors for rickets include the following:

Age

Rickets is most common in children who are between 6 and 36 months old. During this time period, children usually experience rapid growth. This is when their bodies need the most calcium and phosphate to strengthen and develop their bones.

Diet

You have a higher risk of developing rickets if you eat a vegetarian diet that doesn’t include fish, eggs, or milk. You’re also at an increased risk if you have trouble digesting milk or have an allergy to milk sugar (lactose). Infants who are only fed breast milk can become deficient in vitamin D as well. Breast milk doesn’t contain enough vitamin D to prevent rickets.

Skin color

Children of African, Pacific Islander, and Middle Eastern descent are at the highest risk for rickets because they have dark skin. Dark skin doesn’t react as strongly to sunlight as lighter skin does, so it produces less vitamin D.

Geographic location

Our bodies produce more vitamin D when they’re exposed to sunshine, so you’re more at risk for rickets if you live in an area with little sunlight. You’re also at a higher risk if you work indoors during daylight hours.

Genes

One form of rickets can be inherited. This means that the disorder is passed down through your genes. This type of rickets, called hereditary rickets, prevents your kidneys from absorbing phosphate.

What are the symptoms of rickets?

Symptoms of rickets include:

• pain or tenderness in the bones of the arms, legs, pelvis, or spine
• stunted growth and short stature
• bone fractures
• muscle cramps
• teeth deformities, such as:
  • delayed tooth formation
  • holes in the enamel
  • abscesses
  • defects in the tooth structure
  • an increased number of cavities
• skeletal deformities, including:
  • an oddly shaped skull
  • bowlegs, or legs that bow out
  • bumps in the ribcage
  • a protruding breastbone
  • a curved spine
  • pelvic deformities

Call your doctor right away if your child is showing signs of rickets. If the disorder isn’t treated during a child’s growth period, the child may end up with a very short stature as an adult. Deformities can also become permanent if the disorder goes untreated.

How is rickets diagnosed?

Your doctor may be able to diagnose rickets by performing a physical examination. They will check for tenderness or pain in the bones by lightly pressing on them. Your doctor may also order certain tests to help make a rickets diagnosis, including:

• blood tests to measure the levels of calcium and phosphate in the blood
• bone X-rays to check for bone deformities

In rare cases, a bone biopsy will be performed. This involves the removal of a very small section of bone, which will be sent to a laboratory for analysis.

How is rickets treated?

Treatment for rickets focuses on replacing the missing vitamin or mineral in the body. This will eliminate most of the symptoms associated with rickets. If your child has a vitamin D deficiency, your doctor will likely want them to increase their exposure to sunlight, if possible. They will also encourage them to consume food products high in vitamin D, such as fish, liver, milk, and eggs.

Calcium and vitamin D supplements can also be used to treat rickets. Ask your doctor about the correct dosage, as it can vary based on the size of your child. Too much vitamin D or calcium can be unsafe.

If skeletal deformities are present, your child may need braces to position their bones correctly as they grow. In severe cases, your child may need corrective surgery.

For hereditary rickets, a combination of phosphate supplements and high levels of a special form of vitamin D are required to treat the disease.

What can be expected after treatment for rickets?

Increasing vitamin D, calcium, and phosphate levels will help correct the disorder. Most children with rickets see improvements in about one week.

Skeletal deformities will often improve or disappear over time if rickets is corrected while the child is still young. However, skeletal deformities can become permanent if the disorder isn’t treated during a child’s growth period.

How can rickets be prevented?

The best way to prevent rickets is to eat a diet that includes adequate amounts of calcium, phosphorous, and vitamin D. People with kidney disorders should have their calcium and phosphate levels monitored on a regular basis by their doctors.

Rickets can also be prevented with moderate sun exposure. According to the National Health Service of England (NHS), you only need to expose your hands and face to sunlight a few times a week during the spring and summer months to prevent rickets.

Most adults get enough exposure to sunlight. It’s important to note that too much sunlight can damage your skin, and sunscreen should be applied to prevent burns and skin damage. Sometimes, the use of sunscreen can prevent your skin from producing vitamin D, so it’s beneficial to eat foods that contain vitamin D or to take vitamin D supplements. These preventive measures can significantly lower your risk of developing rickets.