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by Alan R

Rickets

Definition

Rickets is disease resulting from a vitamin D , calcium, or phosphate shortage in children. It causes bones to soften and weaken.
Rickets
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Causes

Rickets results when there is 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
  • Tissue does not respond 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
  • Diseases of the small intestines with malabsorption
  • Disorders of the liver or pancreas disease
  • Cancer
  • Certain medications
  • Toxicity or poisoning from:
    • Cadmium
    • Lead
    • Aluminum
    • Outdated tetracycline

Risk Factors

Rickets is more common in children age 6 to 24 months. It is also more common in children of African American descent.
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
  • Family history of rickets
  • Certain chronic illnesses that result in loss of or poor absorption of calcium

Symptoms

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

Diagnosis

You will be asked about your child's symptoms and medical history. A physical exam will be done.
Your child's bodily fluids and bone may be tested. This can be done with:
  • Blood tests
  • Urine tests
  • Bone biopsy
Pictures may be taken of structures inside your child's body. This can be done with an x-ray .

Treatment

Treatment attempts to:
  • Correct the underlying cause
  • Relieve or reverse symptoms

Treating the Underlying Cause

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

Treating Symptoms

Treatment to relieve or correct symptoms may include:
  • Wearing braces to reduce or prevent bony deformities
  • In severe cases, surgery to correct bony deformities

Prevention

To help prevent rickets, your child should:
  • Drink vitamin D-fortified milk.
  • Consume enough vitamin D , calcium, and other minerals. If you think your child's diet may be lacking, talk with the doctor about other sources of vitamins and minerals.
  • Get sufficient, but not excessive, exposure to sunlight. Fifteen minutes a day is usually enough. Any longer than that requires sun protection with clothing or sunscreens, especially in fair-skinned infants and children. Children with dark skin are at increased risk for rickets and may need more sun exposure and dietary supplements with vitamin D.
  • 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.

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

Balk SJ; Council on Environmental Health; Section on Dermatology. Ultraviolet radiation: a hazard to children and adolescents. Pediatrics. 2011;127(3):e791-817.
Grant WB, Boucher BJ. Requirements for Vitamin D across the life span. Biol Res Nurs. 2011;13(2):120-133.
Rickets: what it is and how it's treated. Family Doctor—American Academy of Family Physicians website. Available at: http://familydoctor.org/familydoctor/en/diseases-conditions/rickets.html. Updated April 2014. Accessed June 29, 2015.
Vitamin D deficiency in children (infancy through adolescence). EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated February 3, 2015. Accessed June 29, 2015.
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;122:1142-1152.

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