What is Rickets in Children

Rickets is a bone disease. If a child has rickets, his or her bones do not develop normally. They may become weak or soft. This condition can also cause bowed legs and other unusual bone growth.

Rickets can develop when your child does not have enough vitamins and minerals that support normal and healthy bone growth. Rickets is mostly related to low levels of vitamin D, but a lack of phosphorus and calcium can also affect normal bone growth.

What are the causes?

This condition is caused by a lack of vitamin D. In rare cases, rickets can be passed down through families (inherited).

What increases the risk?

The following factors may make your child more likely to develop this condition:

• Age. Children 2 years or younger are at greatest risk because this is when bones grow the fastest.
• Being given only breast milk (exclusive breastfeeding) for a long time without a vitamin D supplement.
• Having a diet that does not have enough vitamin D or calcium. This includes diets that do not include beef, fish, eggs, or dairy products.
• Lack of exposure to the sun. Sunlight helps the body make vitamin D.
• Having dark skin. The darker your child’s skin, the less vitamin D it produces when it is exposed to the sun.
• Having a medical condition that affects the liver, kidneys, or intestines.
• Living in certain parts of the world where adequate food is a problem, or living in the the northern hemisphere where sunlight exposure is weak.
• Certain medicines that affect the body’s ability to absorb vitamin D.

What are the signs or symptoms?

Symptoms of rickets may include:

• Slow growth (failure to thrive).
• Delayed development. This may include inability to walk at the right age.
• Short stature.
• Bone pain or tenderness.
• Bowed legs.
• Widened ankles or wrists.
• Broken bones.
• Misshapen skull.
• Bumps in the rib cage.
• Poor posture, such as stooping.
• Muscle cramps or weakness.
• Dental problems, including frequent cavities.

How is this diagnosed?

This condition may be diagnosed based on:

• Your child’s symptoms.
• Your child’s medical history.
• A physical exam.
• Blood tests.
• X-rays.

How is this treated?

Your child’s treatment depends on the cause of rickets and how severe it is. Treatment may include:

• Vitamin D supplements.
• Calcium supplements.
• Braces or surgery. These may be needed for severe bone deformities.

For rickets that is inherited, treatment may also include the use of hormones to correct the deficiency. This treatment is usually supervised by a specialist (endocrinologist).

Follow these instructions at home:

Eating and drinking

• Feed your child foods that are high in vitamin D and calcium as told by your child’s health care provider.
  • Foods high in vitamin D include:
    • Fatty fish, such as tuna, salmon, and mackerel.
    • Eggs.
    • Cheese.
    • Beef liver.
    • Foods and drinks that have had vitamin D added (fortified). Check the labels. These include milk, some breakfast cereals, and some brands of orange juice, yogurt, margarine, and soy drinks.
  • Foods that are high in calcium include:
    • Dairy products, including milk, yogurt, cheese, and ice cream.
    • Fish that is canned with bones, such as sardines or salmon.
    • Dark green vegetables such as kale, collard greens, spinach, or bok choy.
    • Foods and drinks that have had calcium added (fortified). Check the labels. These include some breakfast cereals, some brands of orange juice, and soy, rice, or almond drinks.

If your child has a brace:

• Have your child wear the brace as told by your child’s health care provider. Remove it only as told by your child’s health care provider.
• Loosen the brace if your child’s fingers or toes tingle, become numb, or turn cold and blue.
• Keep the brace clean.
• If the brace is not waterproof:
  • Do not let it get wet.
  • Cover it with a watertight covering when your child takes a bath or a shower.

General instructions

• Give over-the-counter and prescription medicines and supplements only as told by your child’s health care provider.
• Ask the health care provider about how much sun exposure your child should have without wearing sunscreen. Sunscreen protects your child’s skin from the sun’s harmful rays, but it also prevents your child’s skin from absorbing vitamin D.
• Keep all follow-up visits as told by your child’s health care provider. This is important.

Contact a health care provider if your child:

• Has symptoms that get worse.
• Has worsening bone pain.
• Has difficulty walking or is delayed in walking.

Get help right away if your child:

• Has severe pain that does not get better with treatment.
• Has a new deformity of a bone.

Summary

• Rickets is a bone disease. It may make your child’s bones weak, soft, or not develop normally.
• Rickets can develop when your child does not have enough vitamins and minerals that support normal and healthy bone growth.
• This condition is caused by a lack of vitamin D. In rare cases, rickets can be passed down through families (inherited).
• Your child’s treatment depends on cause of rickets and how severe it is. Treatment may include vitamin D supplements. Your child might also need to take calcium supplements.