What is rickets?
Rickets is a disorder that affects the bones, causing them to soften and break easily. It is most common in children.
This condition is a relative or absolute deficiency in vitamin D, which causes a decrease in ossification. It is almost exclusively seen in children younger than 2 years of age.
What are the symptoms of rickets?
Rickets can cause delayed growth, pain in the bones of the spine, pelvis and legs, and muscle weakness.
It can also cause problems with your child’s teeth, such as cavities and problems with teeth structure.
What are the causes?
A lack of vitamin D causes most cases of rickets, but this disorder can also run in families. Vitamin D helps the bones absorb calcium and phosphorus from food.
When your child does not get enough vitamin D, his or her bones do not get the necessary nutrients that make bones strong.
Who is at risk?
Children ages 6 months to 24 months are at the highest risk of rickets because their bones are growing very rapidly during this period. Your child may also be at risk if he or she:
- Has dark skin
- Doesn’t get moderate exposure to sunlight or wears sunscreen at all times when outside
- Doesn’t eat enough foods containing vitamin D, calcium or phosphorus
- Breastfeeds without a vitamin D supplement
How can my doctor tell if my child has rickets?
Your doctor will ask about your family health history and your child’s health and diet. Your child will need a full physical exam. Blood tests and X-rays of the arms or legs can also help your doctor determine if your child has rickets.
How does rickets appear radiographically?
Bone density is overall decreased.
More specific signs include loss of the zone of provisional calcification within the metaphysis of long bones; this leads to metaphyseal irregularity, cupping, and fraying with an associated widened physis.
These changes are seen best in the distal radius, which is the reason that radiographs of the wrists are ordered to evaluate rickets. Another classic appearance is the “rachitic rosary,” which is enlargement of the costochondral junctions in the chest.
How can I keep my child from getting nutritional rickets?
Be sure your child gets enough vitamin D and calcium. If you breastfeed your baby, your doctor will prescribe a vitamin supplement that includes vitamin D (because human milk only has a small amount of vitamin D).
If your baby gets less than 16 ounces of formula per day, he or she will also need extra vitamin D. If you have an older child who has rickets, offer him or her vitamin-D fortified foods (such as breakfast cereals and orange juice) and foods that are high in calcium (such as milk, cheese, and salad greens). Do not give your child vitamin supplements unless they are recommended by your doctor.
Your doctor can tell you about how much time in the sun is safe for your child. Remember that infants and babies should be protected from direct sunlight.
How is rickets treated?
Treatment depends on the type of rickets your child has. Rickets caused by nutritional deficiencies is treated with vitamin D and calcium. Your child’s pain and muscle weakness will probably get better within a few weeks of treatment. If your child has inherited rickets or has an illness causing the problem, you may need to see a doctor who specializes in rickets.
If your child has bone deformities caused by rickets, he or she may need braces or surgery to correct the problem.
Questions to your Doctor
- What is the likely cause of my child’s rickets?
- What is the best treatment option?
- Does my child need a vitamin D or calcium supplement?
- What can I do at home to make sure my child gets enough vitamin D?
- Is it safe to let my child have monitored time in the sun without sunscreen?
- What are the complications of rickets? Is my child at risk for any long-term problems?
- Rickets: Not a Disease of the Past by LS Nield, M.D., P Mahajan, M.D., M.P.H., A Joshi, M.D., and D Kamat, M.D., PH.D.( 08/15/06,http://www.aafp.org/afp/20060815/619.html )