Pediatrics
The primary cause of rickets is the lack of vitamin D, calcium, or phosphorus during early childhood. There are two ways by which deficiency of vitamin D can occur in the body. It can be either due to external factors or internal factors. External factors include sunlight and diet.
Sunlight is the easiest source of vitamin D production in your body. When your skin is exposed to sunlight, a chemical reaction takes place which releases vitamin D. Dark-skinned children with excessive melanin or children who wear full coverage clothes may develop vitamin D deficiency due to lack of sufficient exposure to sunlight. Lack of vitamin D can also occur in developing countries where proper diet is not available for young children due to poverty or shortage of resources.
Internal factors include medical or genetic conditions which disrupt the normal absorption of vitamin D and calcium from the diet. These diseases include celiac disease, cystic fibrosis, inflammatory bowel disease, kidney diseases, etc. Rickets, due to internal factors, is comparatively rare.
Rickets is often observed in children between the age range of 6 to 36 months. During this stage, children require high levels of calcium and phosphorus for the growth and development of bones. Lack of vitamin D or these minerals can put children at increased risk for rickets during this growing age. Dark-skinned individuals may develop rickets due to high levels of melanin in their skin. Apart from these factors, living in northern latitudes with less sunlight, premature birth, lack of vitamin D during pregnancy, hereditary diseases, and certain medications may also increase the risk of rickets.
The prevalence of rickets is low in the United States due to the inclusion of vitamin D sources in diet supplies for young children. Among reported cases, exclusive breastfeeding was found as one of the major causes. The incidence of rickets is higher in developing countries.
The common signs and symptoms of rickets include stunted growth, pain or tenderness in bones, bone fractures, skeletal deformities, delayed motor function, and weak muscles. The affected children often feel pain or tenderness in the bones of the spine, arms, legs, or pelvis. Skeletal deformities may present as an odd-shaped skull, bowlegs, visible bumps in the rib cage, curved spine, etc. These children also develop multiple issues with their teeth, including holes or cavities in teeth, tooth abscesses, abnormal tooth formation, and delayed eruption.
Diagnosis of rickets is usually made on the basis of their clinical presentation. Before beginning a physical examination, your doctor may require a brief history of your living condition, dietary factors, sunlight exposure, presence of a medical condition, etc. Physical examination is done to look for noticeable skeletal deformities in the skull, spine, arms, legs, or other regions. Pain or tenderness is also noted by palpation. Your doctor will require blood and urine tests to confirm the diagnosis of rickets by checking vitamin D, calcium, and phosphate levels. X-rays of the affected bones will be taken to look for possible deformities.
Rickets should be differentiated from a few other conditions with similar symptoms. These conditions include osteochondrodysplasias, Blount's disease, and hypophosphatasia.
Treatment of rickets begins with fulfilling the lack of vitamin D and necessary minerals. If a child has vitamin D deficiency, they will be suggested to spend more time outside during the morning or late afternoon. Sunlight exposure is the easiest way to fulfill vitamin D deficiency. Your doctor would also recommend dietary modifications. Diet needs to include food products rich in vitamin D, such as liver, fish, milk, eggs, etc.
If sunlight and diet alone are not enough, your doctor may also include vitamin D or calcium supplements to promote the growth of healthy bones. Some bone deformities or fractures may require braces or external fixation for a certain period to support the weakened bones. Severe bone deformities or fractures may require surgery.
Medication
There are no medications required for the treatment of rickets. Mineral and vitamin D supplements are prescribed in limited dosages to fulfill the deficiency of these substances.
Prognosis of rickets is really good in children who receive a timely diagnosis and suitable treatment. Majority of the cases improve within the first few weeks of treatment. Bone deformities may become permanent if rickets is left untreated.
Sunlight exposure is the best way to prevent rickets, but it should be done in moderation. Around 15 to 20 minutes of morning or late afternoon sunlight every day is enough for the normal growth and development of bones. Diet should also include rich sources of vitamin D and necessary minerals. If you are pregnant but have vitamin D or calcium deficiency, consult your doctor to start dietary supplements. Children who are exclusively breastfed also need vitamin D drops because breast milk is insufficient to provide a sufficient amount. These preventive measures can lower the risk of rickets.
Our clinical experts continually monitor the health and medical content posted on CURA4U, and we update our blogs and articles when new information becomes available. Last reviewed by Dr.Saad Zia on May 27, 2023.
An Overview of Rickets in Children - ScienceDirect
https://www.sciencedirect.com/science/article/pii/S2468024920311657
Rickets - OrthoInfo - AAOS
Rickets is a developmental disorder caused by vitamin D, calcium, or phosphorus deficiency. Vitamin D is essential because it helps absorb calcium and phosphate from your diet. These minerals are necessary for the proper growth and development of bones. With a lack of vitamin D, adequate absorption of calcium and phosphorus is diminished. This results in weak and soft bones. Rickets is common in children because their bones are still going through development. Adding vitamin D to the diet can reduce the complications associated with rickets.