Definition

Rickets is disease resulting from a vitamin D shortage in children. It causes bones to soften and weaken.

Rickets

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Causes

Rickets results when there is a vitamin D or calcium shortage in 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.

    • Vitamin D controls how calcium is absorbed in the body. It also controls levels of calcium and phosphate in bone. Vitamin D is absorbed in the intestines from food. Vitamin D is also produced by the skin during exposure to sunlight.

    Most often, rickets is caused by a shortage of vitamin D. This can result from:

        
  • Not enough vitamin D in the diet. In children, this may be related to:     
  • Not drinking enough vitamin D-fortified milk
  • Not giving enough vitamin D supplements to children being breastfed or to children who are lactose intolerant
  • Lack of exposure to sunlight

    • Less often, rickets can be caused by other disorders that affect vitamin D absorption, processing, or action in the body 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
  • Diseases of the small intestines with malabsorption
  • Disorders of the liver or pancreas disease
  • Cancer
  • Certain drugs, such as:     
  • Certain seizure medications, such as phenytoin or phenobarbital
  • Acetazolamide
  • Ammonium chloride
  • Disodium etidronate
  • Fluoride treatment
  • Toxicity or poisoning from:     
  • Cadmium
  • Lead
  • Aluminum
  • Outdated tetracycline

    • Risk Factors

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

        
  • Lack of sun exposure
  • Age in children: 6 to 24 months    
  • 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
  • Family history of rickets
  • Race: Black, especially in association with breastfeeding
  • Certain chronic illnesses that result in loss of or poor absorption of calcium

    • Symptoms

    Symptoms may include:

        
  • Bone pain and tenderness
  • Skeletal and/or skull deformities
  • Bow legs or knock knees
  • Deformity or curvature of the spine
  • Pigeon chest—a chest that protrudes
  • Impaired growth, resulting in short stature
  • Bone fractures
  • Dental deformities
  • Delayed tooth formation
  • Defects in teeth
  • Increased cavities
  • Loss of appetite or weight loss
  • Difficulty sleeping
  • Poor muscle development and tone
  • Muscle weakness
  • Delayed walking

    • Diagnosis

    The doctor will ask about your child's symptoms and medical history. A physical exam will be done.

        
  • Your child's bodily fluid and bone may be tested. This can be done with:     
  • Blood tests
  • Urine tests
  • Bone biopsy —when other tests are not conclusive
  • Pictures may be taken of structures inside your child's body. This can be done with an x-ray.

    • Treatment

    Treatment attempts to:

        
  • Correct the underlying cause
  • Relieve or reverse symptoms

    • Treating the Underlying Cause

    Treatment of the underlying cause may include:

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

    • Treating Symptoms

    Treatment to relieve or correct symptoms may include:

        
  • Wearing braces to reduce or prevent bony deformities
  • In severe cases, surgery to correct bony deformities

    • Prevention

    To help prevent rickets, your child should:

        
  • Drink vitamin D-fortified milk.
  • Consume enough vitamin D, calcium, and other minerals. If you think your child's diet may be deficient, 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 supplementation 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. Children not getting at least 400 units of vitamin D from their diet may also need supplements. Talk to the doctor to make sure your child is meeting the nutritional requirements for vitamin D.