Rickets is disease that affects the bones. It causes them to soften and weaken.
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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:
- Malabsorption -related diseases of the small intestine
- Liver or pancreatic diseases
- Certain medications
- Outdated tetracycline
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 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
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:
- Blood tests
Urine tests may also help to find causes.
Treatment attempts to:
- Relieve or reverse symptoms
- Improve bone changes
- Correct the underlying cause
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
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.
Eat Right—Academy of Nutrition and Dietetics http://www.eatright.org
Healthy Children—American Academy of Pediatrics http://www.healthychildren.org
Health Canada http://www.hc-sc.gc.ca
The Hospital for Sick Children—About Kids Health http://www.aboutkidshealth.ca
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.
- Reviewer: Michael Woods, MD
- Review Date: 05/2018
- Update Date: 07/12/2018