Rickets is disease that affects the bones. It causes them to soften and weaken.
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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 lowThe way the body processes vitamin D is not typicalTissue 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
A hereditary disorder of the kidney called vitamin D-resistant ricketsRenal tubular acidosis—a non-hereditary kidney disorder that causes bone calcium to dissolve
dialysisMalabsorption-related diseases of the small intestine
Liver or pancreatic diseasesCancer
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 skinBabies who are breastfed—breast milk is low in vitamin DBabies who do not drink enough formula that is fortified with vitamin DChildren who do not drink enough vitamin D-fortified milkLactose intolerance with low intake of vitamin D-fortified milkVegetarian dietFamily history of ricketsCertain chronic illnesses that result in loss of or poor absorption of calcium or phosphorousDrugs that affect vitamin D, calcium, or phosphorous
Symptoms may include: Muscle weaknessBow legs or knock kneesBone pain and tendernessSkeletal and/or skull deformitiesDeformity or curvature of the spine—scoliosisPigeon chest—a chest that protrudesDental deformitiesDelayed tooth formationDefects in teethLoss of appetite or weight lossDifficulty sleepingDelayed walkingSeizures
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 testsUrine tests
Pictures may be taken of structures inside your child's body. This can be done with an
Treatment attempts to: Relieve or reverse symptoms and improve bone changesCorrect the underlying cause
Treatment to relieve or correct symptoms and bone changes: Involves biologically active vitamin D, calcium, and/or phosphateMay include: Wearing braces to reduce or prevent bony deformitiesIn severe cases, surgery to correct bony deformities
Treatment of the underlying cause may include:
Adding the following to your child's diet:
Supplements of vitamin D, calcium, and other mineralsVitamin D-fortified dairy productsFoods high in vitamin D, such as fatty fish, egg yolk, and green vegetablesFoods high in calciumAdequate, but not excessive, exposure to sunlightAvoiding medication that may be causing poor calcium, phosphorous, or vitamin D absorptionTreating underlying illnesses
To help reduce your child's chance of rickets: Drink vitamin D-fortified milk.
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.
Vitamin D deficiency in children (infancy through adolescence). EBSCO DynaMed website. Available at:
http://www.ebscohost.com/dynamed. Updated February 3, 2015. Accessed May 13, 2016.
Rickets. American Academy of Family Physicians Family Doctor website. Available at:
http://familydoctor.org/familydoctor/en/diseases-conditions/rickets.html. Updated April 2014. Accessed May 13, 2016.
Balk SJ, Council on Environmental Health; Section on Dermatology. Ultraviolet
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Grant WB, Boucher BJ. Requirements for Vitamin D across the life span.
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Wagner CL, Greer FR, American Academy of Pediatrics Section on Breastfeeding, American Academy of Pediatrics Committee on Nutrition. Prevention of rickets and vitamin D deficiency in infants, children, and adolescents.
Last reviewed May 2016 by Michael Woods, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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