Rickets In Children Symptoms, Causes, Risks, And Treatment

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Softening and weakening of the bones is called rickets, and it is commonly seen in children. Prolonged or severe vitamin D deficiency is the primary cause of impaired bone mineralization in children. Calcium and phosphorus deficiencies can also lead to rickety bones since these nutrients are required for bone mineralization.

Vitamin D and calcium supplements help correct bone deformities due to rickets. However, children with severe deformities may require bracing and surgeries.

Read this post to know more about the signs, risk factors, treatment, and prevention of rickets in children.

Signs And Symptoms Of Rickets

The signs and symptoms of rickets include the following (1).

  • Pain in legs, pelvis, and spine
  • Growth delay
  • Delay in motor skills
  • Weak muscles
  • Knock knees
  • Bowed legs
  • Thick or wide ankles and wrists
  • Projected sternum (breastbone)
  • Craniotabes (soft and thin skull bones)
  • Skull bossing (protuberance of the skull), especially of the frontal bones
  • Bent or abnormally curved spine
  • Increased fractures, such as greenstick fracture where bone bends and cracks instead of breaking completely

Skeletal deformities in rickets occur due to softening of the growing tissue (growth plate) located at the end of the bones. It can further lead to pain and weakness that could make it difficult to walk, stand, or do other activities. Children with rickets-related skeletal deformities often develop an abnormal gait and posture.

Older children have fused growth plates, indicating the growth is complete. When they experience rickets, they tend to develop softening and bowing of the bones.

Seek medical care if your child has any of the above mentioned skeletal deformities or other symptoms suggestive of rickets.

Causes And Risk Factors For Rickets

A deficiency of vitamin D, calcium, or phosphorus is the primary cause of rickets.

Calcium and phosphorus are required for optimal bone growth. Vitamin D is essential to absorb these minerals from the food. A lack of enough vitamin D in the diet, lack of sun exposure, or issues with vitamin D usage in the body could result in rickets in children (2).

Medical conditions, such as inflammatory bowel disease, kidney issues, cystic fibrosis, and celiac disease, may interfere with vitamin D absorption in the body. A combination of calcium and vitamin D deficiency could also lead to rickets.

The following factors may increase the risk of rickets in children (3).

  1. Premature birth increases the risk of vitamin D deficiency since the baby could have received inadequate vitamin D during intrauterine life.
  1. Exclusive breastfeeding could cause vitamin D deficiency since breast milk does not contain enough vitamin D. Exclusively breastfed babies should receive vitamin D drops to prevent rickets.
  1. Maternal vitamin D deficiency during pregnancy could cause babies to be born with rickets or develop rickets in early infancy.
  1. Medications, such as antiretroviral (HIV) drugs and anti-seizure drugs, may interfere with vitamin D use by the body.
  1. Nutrient (dietary) deficiencies of calcium, phosphorus, and vitamin D.
  1. Adolescents during pubertal growth spurts could develop vitamin and mineral deficiency.
  1. Residents of northern latitudes or other areas with low sunlight could have a higher risk.
  1. Individuals with dark skin could have a higher risk if they don’t receive adequate sunlight. Dark skin has high melanin pigment and requires more sunlight exposure to make vitamin D from sunlight.

Complications Of Rickets

If left untreated, rickets may result in the following complications in children (3).

  • Growth failure
  • Bone deformations, such as  bow legs and abnormally curved spine
  • Dental defects
  • Seizures
  • Fractures
  • Muscles spasms
  • Intellectual disabilities

Hypocalcemia (low calcium in the blood) due to vitamin D deficiency could result in seizures (hypocalcemic seizures) and intellectual disabilities in children with rickets.

Prevention Of Rickets

Prevention of vitamin D, calcium, and phosphorus deficiencies helps avoid rickets. The following precautions could help prevent nutritional deficiencies and rickets in children (4).

  1. Sun exposure: The best vitamin D source is 10 to 15 minutes of sunlight exposure during midday or morning, depending on the season and the region you reside. Children with sensitive skin, certain skin diseases, and skin cancer risk should avoid sun exposure since sunlight may worsen these conditions.
  1. Vitamin D-, phosphorus-, and calcium-rich diet: Vitamin D and calcium-rich foods, such as fish (salmon, tuna), eggs, broccoli, kale, fish oils, and dairy products, should be included in a child’s diet. Some of the good sources of phosphorus are meat, dairy products, seeds, nuts, and lentils. You may also pick foods fortified with these nutrients. A few examples include fortified milk (including plant-based milk), cereals, and bread.
  1. Vitamin and mineral supplements: Children with low levels of vitamin D, phosphorus, and calcium could consume supplements after doctor consultation to prevent rickets. Infant formula contains enough vitamin D for babies. Breastfed infants will require vitamin D drops.

Low levels of vitamin D and calcium could also interfere with a child’s cognitive development. Therefore, timely prevention is essential to prevent rickets and other complications.

Diagnosis Of Rickets

Doctors examine the bones to identify skeletal abnormalities and other signs of rickets. Usually, the delay in closure of soft spots (fontanelle), bowed legs, protruded breastbone, curved spine, and thick wrist or ankles are noted on physical examination.

The following tests are ordered for further evaluation and diagnosis of rickets (5).

  • X-rays to look for bone abnormalities.
  • Blood tests to determine calcium, phosphorus, and vitamin D levels.
  • Urinalysis can also be used to identify mineral and vitamin deficiencies.
  • Bone density scan (DEXA scan) measures the bone mineral density (BMD) to determine bone loss.

These tests are also performed during follow up visits to know the progress of treatments. Doctors may order additional tests to determine underlying conditions if required.

Treatment For Rickets

Vitamin D and calcium supplements are prescribed for most children with rickets. You must follow the recommended dose to avoid toxicities (6). Phosphorus supplements and medications are given if the rickets is caused by inherited disorders that cause low phosphorus levels.

Special bracing and surgeries are required to correct bone deformities in some children. Severe deformations require surgery and rehabilitation therapies.

Guided growth surgeries are one of the surgery methods that have replaced corrective osteotomies (cutting and reshaping the bones). In this type of surgery, a tension-band plate (guided growth plate) is placed on the deformed bone through a minimally invasive procedure to reshape the bone.

The prevalence of rickets in children has reduced in recent times, but it could still occur due to vitamin and mineral deficiencies. Meeting the nutrient requirements could prevent rickets in many children. Inherited or other medical conditions causing phosphorus, calcium, or vitamin D deficiency may require supplements and other medications to prevent rickets.

References:

1. Symptoms; Rickets and Osteomalacia; National Health Service
2. Rickets: What It Is and How It’s Treated; The American Academy of Family Physicians
3. Rickets; St. Clair Hospital
4. Rickets; The Royal Children’s Hospital Melbourne
5. Rickets;; Golisano Children’s Hospital; The University of Rochester Medical Center
6. What Is Rickets?; Familydoctor; The American Academy of Family Physicians

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