Written by Medicover Team and Medically Reviewed by Dr Vempati Satya Surya Prasanthi, Pediatrician

Rickets in Children: Causes, Symptoms, and Prevention

Rickets is a condition that affects bone development in children, leading to soft and weakened bones. A deficiency in vitamin D, calcium, or phosphate primarily causes this disease. While once considered rare in developed countries, rickets is making a resurgence, emphasising the need for awareness and preventive measures. In this article, we will delve into the causes, symptoms, and prevention strategies for rickets in children.

Types of Rickets

What are the Causes of Rickets in Children?

Early detection of rickets and ensuring proper vitamin D, calcium, and phosphate intake can help support healthy bone growth in children.

Vitamin D Deficiency

The most common cause of rickets is a deficiency in vitamin D. This vital nutrient is essential for the absorption of calcium and phosphate from the gastrointestinal tract, which is crucial for healthy bone formation. The skin can synthesise vitamin D upon exposure to sunlight, and it can also be obtained from dietary sources such as fortified milk, fatty fish, and egg yolks.

Calcium and Phosphate Deficiency

While vitamin D deficiency is the leading cause, insufficient calcium and phosphate intake can also contribute to rickets. These minerals are critical for the development and maintenance of strong bones. Inadequate dietary intake or conditions that affect their absorption can result in deficiencies.

Genetic Factors

Certain genetic disorders can predispose children to rickets. For example, hypophosphatemic rickets, a rare inherited disorder, is characterised by low blood phosphate levels. This condition affects the kidneys' ability to process phosphate, leading to weakened bones.

Inherited types

Conditions like X‑linked hypophosphatemia cause the kidneys to lose phosphate, weakening bones. A new injectable drug (burosumab) is now available for these cases.

Chronic Diseases

Chronic diseases such as celiac disease, inflammatory bowel disease, and kidney disorders can interfere with the absorption of vitamin D and minerals, thereby increasing the risk of developing rickets.

Symptoms of Rickets in Kids

Recognising the signs of rickets early is important for effective treatment. The symptoms of rickets can vary, but common indications include:

Bone Pain and Tenderness

Children with rickets often feel pain or soreness in their bones, particularly in the legs, pelvis, and spine. This discomfort can be severe enough to affect their mobility and daily activities.

Skeletal Deformities

Rickets can cause a range of skeletal deformities, including bowed legs, thickened wrists and ankles, and a protruding breastbone. These deformities result from the softening of bones and can become more pronounced as the child grows.

Delayed Growth and Development

Children with rickets may exhibit delayed growth and development. They may be shorter in stature than their peers and might experience delays in reaching developmental milestones such as sitting, crawling, and walking.

Dental Problems

Rickets can also affect dental development, leading to delayed tooth eruption, enamel defects, and an increased risk of cavities.

Muscle Weakness

Muscle weakness is another common symptom of rickets. Children may have difficulty standing, walking, or engaging in physical activities due to weakened muscles.

How is Rickets Diagnosed in Children?

Accurate diagnosis of rickets in children involves a combination of physical examination, lab tests, and imaging to evaluate bone health and nutrient levels.

Physical Examination

A thorough physical examination by a healthcare provider can help identify the signs of rickets. This includes assessing the child's growth, skeletal deformities, and any reported symptoms of bone pain or tenderness.

Blood Tests

Blood tests are essential for diagnosing rickets. These tests measure the levels of calcium, phosphate, and vitamin D in the blood. Abnormally low levels of these nutrients can indicate rickets.

X-rays

X-rays of the affected bones can reveal characteristic changes associated with rickets, such as bone softening, deformities, and growth plate abnormalities.

Bone Density Scan

In some cases, a bone density scan (DEXA scan) may be performed to assess bone strength and density. This can provide additional information about the severity of rickets.

Treatment of Rickets in Children

The treatment of rickets in child aims to correct the underlying nutritional deficiencies and manage any complications resulting from the condition. Key treatment strategies include:

Vitamin D and Calcium Supplements

The main treatment for rickets in child is giving vitamin D and calcium supplements. These help the child’s bones grow strong and healthy. The dosage and duration of supplementation depend on the severity of the deficiency and the child's individual needs.

Dietary Modifications

To manage rickets, it's important to get enough vitamin D, calcium, and phosphate through your diet. Foods rich in these nutrients, such as fortified dairy products, fatty fish, leafy greens, and nuts, should be included in the child's diet.

Sunlight Exposure

Encouraging regular, safe exposure to sunlight can help boost the body's production of vitamin D. Spending time outdoors, particularly during peak sunlight hours, can significantly contribute to improving vitamin D levels.

Physical Therapy

Physical therapy can help children with rickets by making their muscles stronger and helping them move better. Regular exercises improve strength and coordination, allowing them to regain their physical abilities over time.

Surgical Intervention

In severe cases of rickets with significant skeletal deformities, surgical intervention may be necessary. Orthopedic surgery can correct bone abnormalities and improve the child's overall function and quality of life.

Potential Complications of Rickets in Children

Untreated rickets can lead to long‑term issues:

How to Prevent Rickets in Children?

Prevention is always better than a cure, and several strategies can help reduce the risk of rickets in children:

Adequate Nutrient Intake

Children must receive adequate amounts of vitamin D, calcium, and phosphate in their diet. Breastfed infants may need vitamin D supplements, as breast milk alone may not provide sufficient amounts of the nutrient.

Regular Sunlight Exposure

Encouraging children to spend time outdoors and ensuring they get regular exposure to sunlight can help maintain healthy vitamin D levels. However, it is essential to balance sun exposure with skin protection to prevent sunburn and skin damage.

Fortified Foods

Incorporating fortified foods into the child's diet can help meet their nutritional needs. Many cereals, dairy products, and plant-based milk alternatives are fortified with vitamin D and calcium.

Routine Health Check-ups

Regular health check-ups with a pediatrician can help monitor the child's growth and development and identify any early signs of nutritional deficiencies. Early intervention can prevent the progression of rickets.

Conclusion

Rickets is a preventable and treatable condition that requires awareness and proactive measures. Understanding the causes, recognizing the symptoms, and implementing preventive strategies can help ensure that children develop strong, healthy bones. By addressing nutritional deficiencies and promoting a balanced diet, sunlight exposure, and regular health check-ups, we can significantly reduce the incidence of rickets and support the overall well-being of our children.

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