Definition

Rickets is disease that affects the bones. It causes them to soften and weaken.

Rickets

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Causes

Rickets is caused by a vitamin D, calcium, or phosphorous shortage a child's body. This may occur when:

    
  • The supply of vitamin D from diet or sun exposure is too low
  • The way the body processes vitamin D is not typical
  • Tissue does not respond to the action of vitamin D
  • There is not enough calcium or phosphorous in the diet or it cannot be absorbed
  • Less often, rickets can be caused by other disorders that affect vitamin D absorption or calcium metabolism such as:

        
  • Kidney problems:     
  • A hereditary disorder of the kidney called vitamin D-resistant rickets
  • Renal tubular acidosis—a non-hereditary kidney disorder that causes bone calcium to dissolve
  • Chronic kidney failure
  • Long-term kidney dialysis
  • Malabsorption-related diseases of the small intestine
  • Liver or pancreatic diseases
  • Cancer
  • Certain medications
  • Poisoning from:     
  • Cadmium
  • Lead
  • Aluminum
  • Outdated tetracycline
  • Risk Factors

    Rickets is more common in children aged 6-24 months. It is also more common in children of African American descent.

    Factors that may increase your child's chances of getting rickets include:

        
  • Lack of sun exposure or having dark skin
  • Babies who are breastfed—breast milk is low in vitamin D
  • Babies who do not drink enough formula that is fortified with vitamin D
  • Children who do not drink enough vitamin D-fortified milk
  • Lactose intolerance with low intake of vitamin D-fortified milk
  • Vegetarian diet
  • Family history of rickets
  • Certain chronic illnesses that result in loss of or poor absorption of calcium or phosphorous
  • Drugs that affect vitamin D, calcium, or phosphorous
  • Symptoms

    Symptoms may include:

        
  • Muscle weakness
  • Bow legs or knock knees
  • Bone pain and tenderness
  • Skeletal and/or skull deformities
  • Deformity or curvature of the spine—scoliosis
  • Pigeon chest—a chest that protrudes
  • Dental deformities
  • Delayed tooth formation
  • Defects in teeth
  • Loss of appetite or weight loss
  • Difficulty sleeping
  • Delayed walking
  • Seizures
  • Diagnosis

    You will be asked about your child's symptoms and medical history. A physical exam will be done.

    Your child's bodily fluids and bone may be tested. This can be done with:

        
  • Blood tests
  • Urine tests
  • Bone biopsy
  • Pictures may be taken of structures inside your child's body. This can be done with an x-ray.

    Treatment

    Treatment attempts to:

        
  • Relieve or reverse symptoms and improve bone changes
  • Correct the underlying cause
  • Treating Symptoms

    Treatment to relieve or correct symptoms and bone changes:

        
  • Involves biologically active vitamin D, calcium, and/or phosphate
  • May include:    
  • Wearing braces to reduce or prevent bony deformities
  • In severe cases, surgery to correct bony deformities
  • Treating the Underlying Cause

    Treatment of the underlying cause may include:

        
  • Adding the following to your child's diet:     
  • Supplements of vitamin D, calcium, and other minerals
  • Vitamin D-fortified dairy products
  • Foods high in vitamin D, such as fatty fish, egg yolk, and green vegetables
  • Foods high in calcium
  • Adequate, but not excessive, exposure to sunlight
  • Avoiding medication that may be causing poor calcium, phosphorous, or vitamin D absorption
  • Treating underlying illnesses
  • Prevention

    To help reduce your child's chance of rickets:

        
  • Drink vitamin D-fortified milk.
  • Consume enough vitamin D, calcium, and other minerals. If you think your child's diet may be lacking, talk with the doctor about other sources of vitamins and minerals.
  • Get sufficient, but not excessive, exposure to sunlight. Fifteen minutes a day is usually enough. Any longer than that requires sun protection with clothing or sunscreens, especially in fair-skinned infants and children. Children with dark skin are at increased risk for rickets and may need more sun exposure and dietary supplements with vitamin D.
  • Breastfed babies and bottle-fed babies who do not get enough vitamin-D fortified formula may need to be given a supplement starting within the first few days of life. Talk to the doctor to make sure your child is meeting the nutritional requirements for vitamin D.