Overview
Rickets is a condition in children characterized by the softening and weakening of bones due to an extreme and prolonged deficiency of vitamin D. This deficiency makes it challenging for the child's body to maintain proper calcium and phosphorus levels in bones, leading to rickets. Rickets can be caused by insufficient vitamin D intake or issues with vitamin D absorption. It can lead to delayed growth, delayed motor skills, pain in the spine, pelvis, and legs, muscle weakness, and skeletal deformities if left untreated. Including vitamin D-rich foods in the diet or taking vitamin D supplements can usually resolve the bone problems associated with rickets.
Understanding the disease
Symptoms
Symptoms of rickets may include delayed growth, delayed motor skills, pain in the spine, pelvis, and legs, muscle weakness, bowed legs or knock knees, thickened wrists and ankles, breastbone projection, weakness in the legs, ankles, and feet, loss of muscle bulk, high foot arches, curled toes (hammertoes), decreased ability to run, difficulty lifting the foot at the ankle (footdrop), awkward or higher than normal step (gait), frequent tripping or falling, and decreased sensation or a loss of feeling in the legs and feet.
Risk Factors
The risk factors for developing rickets include: dark skin, mother's vitamin D deficiency during pregnancy, living in northern latitudes, being born prematurely, and taking certain medications such as anti-seizure medications and antiretroviral medications used to treat HIV infections.
Development
Rickets can develop due to an extreme and prolonged vitamin D deficiency, which can occur when the body doesn't get enough vitamin D from sunlight, diet, or both. In some cases, inherited disorders related to low levels of phosphorus may also contribute to rickets. The lack of vitamin D makes it difficult for the body to maintain proper calcium and phosphorus levels in bones, leading to softening and weakening of the bones, particularly in areas of growing tissue at the ends of the bones (growth plates). Skeletal deformities such as bowed legs, knock knees, thickened wrists and ankles, and breastbone projection may result from rickets. These deformities can cause delayed growth, delayed motor skill development, pain in the spine, pelvis, and legs, and muscle weakness. Factors that can increase a child's risk of developing rickets include dark skin, a mother's vitamin D deficiency during pregnancy, living in northern latitudes, being born prematurely, and taking certain medications. To prevent rickets, it is essential to ensure that children receive enough vitamin D through sunlight exposure or dietary sources such as fatty fish, fish oil, egg yolks, infant formula, cereal, bread, and fortified milk and orange juice. It is important to note that due to skin cancer concerns, infants and young children should avoid direct sun exposure and use sunscreen and protective clothing when necessary.
Assessment and Diagnosis
Triage
You should see a doctor if your child develops bone pain, muscle weakness, or obvious skeletal deformities. These symptoms can indicate rickets, a condition caused by a prolonged and extreme vitamin D deficiency. Early diagnosis and treatment can help prevent complications such as failure to grow, an abnormally curved spine, bone deformities, dental defects, and seizures.
Diagnosis
To diagnose rickets, a doctor will typically conduct a physical examination of the child's bones, paying attention to the skull, legs, chest, wrists, and ankles. Abnormalities in these areas may indicate rickets. X-rays of the affected bones can also reveal bone deformities. Blood and urine tests can confirm the diagnosis of rickets and monitor the progress of treatment.
Management and Treatment
Complications
Potential complications of rickets can include:
- Failure to grow: Rickets can cause delayed growth and may result in a child not reaching their full growth potential.
- Abnormally curved spine: The softening of bones can lead to an abnormal curvature of the spine, which may cause back pain and posture problems.
- Bone deformities: Prolonged vitamin D deficiency can result in skeletal deformities, such as bowed legs, knock knees, thickened wrists and ankles, and breastbone projection.
- Dental defects: Rickets can lead to dental problems, including tooth decay and enamel defects.
- Seizures: In severe cases of vitamin D deficiency, it can cause seizures or other neurological issues.
Prevention
Rickets can be prevented by ensuring that children have adequate levels of vitamin D and calcium in their diet. Exposure to sunlight is the best natural source of vitamin D, but it should be limited for infants and young children due to skin cancer concerns and the need for sunscreen. Dark-skinned individuals and those living in northern latitudes may also need to rely on fortified foods or supplements. Include vitamin D-rich foods in your child's diet, such as fatty fish, egg yolks, and fortified cereal, bread, and milk. Infant formula and some orange juice brands are also fortified with vitamin D. It is essential to consult with a healthcare professional for appropriate guidance on vitamin D and calcium intake based on your child's specific needs and circumstances.
Home Remedies
It is important to consult with a healthcare professional for appropriate treatment and management of rickets.
Treatment
To treat rickets, the primary focus is to correct the deficiency of vitamin D and ensure proper calcium and phosphorus levels in the body. This can be achieved by incorporating foods rich in vitamin D, such as fatty fish, fortified cereal, bread, and orange juice, into the child's diet. In some cases, vitamin D or calcium supplements may be recommended. If rickets is caused by an underlying medical condition, additional medications or treatments may be necessary. In cases where skeletal deformities are present, physical therapy, braces, or even surgery may be required to correct the deformities and alleviate pain. It's essential to consult a doctor if your child displays symptoms of rickets, such as delayed growth, bone pain, muscle weakness, or skeletal deformities. Early diagnosis and treatment can help prevent complications and ensure proper bone development. Remember that prevention is key. Ensure your child spends time in the sun, as sunlight is the best natural source of vitamin D. However, due to skin cancer concerns and the importance of protecting young children, make sure they use sunscreen or protective clothing when in direct sunlight.