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RicketsBy Mayo Clinic staff
Original Article: http://www.mayoclinic.com/health/rickets/DS00813
Rickets is the softening and weakening of bones in children, usually because of an extreme and prolonged vitamin D deficiency.
Vitamin D promotes the absorption of calcium and phosphorus from the gastrointestinal tract. A deficiency of vitamin D makes it difficult to maintain proper calcium and phosphorus levels in bones, which can cause rickets.
If a vitamin D or calcium deficiency causes rickets, adding vitamin D or calcium to the diet generally corrects any resulting bone problems for your child. Rickets due to a genetic condition may require additional medications or other treatment. Some skeletal deformities caused by rickets may need corrective surgery.
Signs and symptoms of rickets may include:
- Delayed growth
- Pain in the spine, pelvis and legs
- Muscle weakness
Because rickets softens the growth plates at the ends of a child's bones, it can cause skeletal deformities such as:
- Bowed legs
- Abnormally curved spine
- Thickened wrists and ankles
- Breastbone projection
When to see a doctor
Talk to your doctor if your child develops bone pain, muscle weakness or obvious skeletal deformities.
Your body needs vitamin D to absorb calcium and phosphorus from food. Rickets can occur if your child's body doesn't get enough vitamin D or if his or her body has problems using vitamin D properly.
Lack of vitamin D
You receive vitamin D from two sources:
- Sunlight. Your skin produces vitamin D when it's exposed to sunlight. But children in developed countries now tend to spend less time outdoors. They're also more likely to use sunscreen, which blocks the rays that trigger the skin's production of vitamin D.
- Food. Fish oils, fatty fish and egg yolks contain vitamin D. Vitamin D also has been added to some foods, such as milk, cereal and some fruit juices. Children who don't eat enough of these fortified foods can develop a vitamin D deficiency.
Problems with absorption
Some children are born with or develop medical conditions that affect the way their bodies absorb vitamin D. Some examples include:
- Celiac disease
- Inflammatory bowel disease
- Cystic fibrosis
- Kidney problems
- Age. Children 6 to 24 months old are most at risk of rickets because their skeletons are growing so rapidly.
- Dark skin. Dark skin doesn't react as strongly to sunshine as does lighter colored skin, so it produces less vitamin D.
- Northern latitudes. Children who live in geographical locations where there is less sunshine are at higher risk of rickets.
- Premature birth. Babies born before their due dates are more likely to develop rickets.
- Anti-seizure medications. Certain types of anti-seizure medications appear to interfere with the body's ability to use vitamin D.
- Exclusively breast-fed. Breast milk doesn't contain enough vitamin D to prevent rickets. The American Academy of Pediatrics recommends vitamin D drops for breast-fed babies.
If left untreated, rickets may lead to:
- Failure to grow
- Skeletal deformities
- Bone fractures
- Dental defects
- Breathing problems and pneumonia
Preparing for your appointment
You'll likely start by seeing your family doctor or a pediatrician. Depending on the cause of your child's symptoms, you may be referred to a specialist.
What you can do
Before your appointment, you may want to write a list that answers the following questions:
- What symptoms have you noticed and when did they start?
- What types of food and drink does your child usually consume?
- How often does your child play outdoors?
- Does your child always wear sunscreen?
- What medications and supplements does your child take?
What to expect from your doctor
During the exam, the doctor will gently press on your child's bones, checking for abnormalities. He or she will pay particular attention to your child's:
- Skull. Babies who have rickets often have softer skull bones and may experience a delay in the closure of the soft spots (fontanels).
- Legs. While even healthy toddlers are a little bowlegged, an exaggerated bowing of the legs is common with rickets.
- Chest. Some children with rickets develop abnormalities in their rib cages, which may flatten and cause their breastbones to protrude.
- Wrists and ankles. Children who have rickets often have wrists and ankles that are larger or thicker than normal.
Tests and diagnosis
X-rays of the affected bones can reveal bone deformities. Blood and urine tests can confirm a diagnosis of rickets and also monitor the progress of treatment.
Treatments and drugs
Most cases of rickets can be treated with vitamin D and calcium supplements. Follow your doctor's directions as to dosage, which may vary by the size of your child. Too much vitamin D can be dangerous.
Surgical and other procedures
For some cases of bowlegs or spinal deformities, your doctor may suggest special bracing to position your child's body appropriately as the bones grow. More severe skeletal deformities may require surgery.
Most adolescents and adults receive much of their necessary vitamin D from exposure to sunlight. Infants and young children, however, need to avoid direct sun entirely or be especially careful by always wearing sunscreen.
Make sure your child is consuming foods that contain vitamin D naturally — fatty fish, fish oil and egg yolks — or that have been fortified with vitamin D, such as:
- Infant formula
- Orange juice
Because human milk contains only a small amount of vitamin D, the American Academy of Pediatrics recommends that all breast-fed infants receive 400 international units (IU) of oral vitamin D daily beginning the first few days of life.
- Greenbaum LA. Rickets. In: Kleigman RM, et al. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa.: Saunders Elsevier; 2007. http://www.mdconsult.com/das/book/body/214433730-7/0/1608/132.html#4-u1.0-B978-1-4160-2450-7..50050-5--cesec3_919. Accessed Aug. 13, 2010.
- Rickets: What it is and how it's treated. American Academy of Family Physicians. http://familydoctor.org/online/famdocen/home/children/parents/special/bone/902.html. Accessed Aug. 13, 2010.
- Rauch F. Etiology and treatment of hypocalcemic rickets in children. http://www.uptodate.com/home/index.html. Accessed Aug. 13, 2010.
- Rauch F. Overview of rickets in children. http://www.uptodate.com/home/index.html. Accessed Aug. 16, 2010.
- Drezner MK. Osteomalacia and rickets. In: Goldman L, et al. Cecil Medicine. 23rd ed. Philadelphia, Pa.: Saunders Elsevier; 2007. http://www.mdconsult.com/das/book/body/214808326-3/0/1492/956.html#4-u1.0-B978-1-4160-2805-5..50270-6--cesec7_12061. Accessed Aug. 16, 2010.
- Dietary supplement fact sheet: Vitamin D. Office of Dietary Supplements. National Institutes of Health. http://ods.od.nih.gov/factsheets/vitamind.asp. Accessed Aug. 16, 2010.
- Prevention of rickets and vitamin D deficiency in infants, children and adolescents. Rockville, Md.: Agency for Healthcare Research and Quality. http://www.guideline.gov/content.aspx?id=13540&search=vitamin+d. Accessed Aug. 17, 2010.
- Taylor JA, et al. Use of supplemental vitamin D among infants breastfed for prolonged periods. Pediatrics. 2010;125:105.
- Sunburn: Treatment and prevention. American Academy of Pediatrics. http://www.healthychildren.org/English/safety-prevention/at-play/pages/Sunburn-Treatment-And-Prevention.aspx. Accessed Aug. 17, 2010.