Rickets

Definition

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

Rickets

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Causes    TOP

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    • Outdated tetracycline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    TOP

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    TOP

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    TOP

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    TOP

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    TOP

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:

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

References:

Rickets. EBSCO DynaMed website. Available at: http://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:
...(Click grey area to select URL)
Updated February 3, 2015. Accessed May 13, 2016.
Rickets. American Academy of Family Physicians Family Doctor website. Available at:
...(Click grey area to select URL)
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.
Last reviewed May 2018 by Michael Woods, MD
Last Updated: 7/12/2018

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