Lahey Health is now part of Beth Israel Lahey Health

by Alan R

Definition

Rickets is disease that affects the bones. It causes them to soften and weaken.

Rickets
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Causes

Rickets is caused by a vitamin D , calcium, or phosphorous 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
  • The body’s cells do not respond properly 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 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
  • Malabsorption -related diseases of the small intestine
  • Liver or pancreatic diseases
  • Cancer
  • Certain medications
  • Poisoning from:
    • Cadmium
    • Lead
    • Aluminum
    • Outdated tetracycline

Risk Factors

Rickets is more common in:

  • Children aged 6-24 months
  • Children with darker skin

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

  • Lack of sun exposure
  • 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
  • Vegetarian diet
  • Family history of rickets
  • Certain chronic illnesses that result in loss of or poor absorption of calcium or phosphorous
  • Drugs that affect vitamin D, calcium, or phosphorous absorption or use

Symptoms

Symptoms may include:

  • Muscle weakness
  • Bow legs or knock knees
  • Bone pain and tenderness
  • Skeletal and/or skull deformities
  • Deformity or curvature of the spine— scoliosis
  • Pigeon chest—a chest that protrudes
  • Dental deformities
  • Delayed tooth formation
  • Defects in teeth
  • Loss of appetite or weight loss
  • Difficulty sleeping
  • Delayed walking
  • Seizures

Diagnosis

You will be asked about your child's symptoms and medical history. A physical exam will be done. The doctor may suspect rickets if deformities are present.

The diagnosis may be confirmed with:

Urine tests may also help to find causes.

Treatment

Treatment attempts to:

  • Relieve or reverse symptoms
  • Improve bone changes
  • Correct the underlying cause

Treating Symptoms

Treatment to relieve or correct symptoms and bone changes may include:

  • Adding biologically active vitamin D, calcium, and/or phosphate
  • Wearing braces to reduce or prevent bony deformities
  • Surgery to correct bony deformities (in severe cases)

Treating the Underlying Cause

Treatment of the underlying cause may include:

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

Prevention

To help reduce your child's chance of rickets:

  • Encourage your child to:
    • Drink vitamin D-fortified milk.
    • Eat vitamin D , calcium, and other minerals. Children can be picky eaters. If you think your child needs more nutrients, talk to their doctor. They may recommend other sources of vitamins and minerals.
  • Allow some exposure to sunlight. Fifteen minutes a day is usually enough. Any longer than that requires sun protection. Excess exposure can lead to sunburns and increased risk for skin cancer.
  • 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.
  • Children with dark skin are at increased risk for rickets. They may need more sun exposure and dietary supplements with vitamin D.
  • Some babies (breastfed or bottle fed) may need a supplement starting within the first few days of life. Talk to the doctor to make sure your child is meeting nutrition needs.

RESOURCES

Eat Right—Academy of Nutrition and Dietetics  http://www.eatright.org 

Healthy Children—American Academy of Pediatrics  http://www.healthychildren.org 

CANADIAN RESOURCES

Health Canada  http://www.hc-sc.gc.ca 

The Hospital for Sick Children—About Kids Health  http://www.aboutkidshealth.ca 

References

Rickets. EBSCO DynaMed website. Available at:  https://www.dynamed.com/topics/dmp~AN~T114165/Rickets  . Updated April 15, 2016. Accessed May 13, 2016.

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 radiation: a hazard to children and adolescents. Pediatrics. 2011;127(3):e791-e817.

Grant WB, Boucher BJ. Requirements for Vitamin D across the life span. Biol Res Nurs. 2011;13(2):120-133.

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. Pediatrics. 2008;122(5):1142-1152.

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