Throughout life, we can face various situations, illnesses, and problems that frighten us just by hearing their names. For this reason, knowledge about these subjects brings us clarity to find solutions or the best treatment. One of these childhood scares is rickets.

What is Rickets?

Rickets is a skeletal disorder caused by a lack of vitamin D or calcium. Vitamin D is largely obtained through skin exposure to sunlight, but it is also found in some foods, such as fish oil and eggs. Calcium, on the other hand, is found in foods like milk and its derivatives. Children with rickets may have weak and soft bones, stunted growth and, in severe cases, skeletal deformities. Rickets mainly affects children, but adults can develop it as well. In most cases, the child has suffered from severe and long-term malnutrition, usually during early childhood. In rare cases, a child can be born with a genetic form of rickets.

Causes of Rickets

There are several causes of rickets, including:

  • Lack of vitamin D – The human body needs vitamin D to absorb calcium from the intestine. Ultraviolet light (sunlight) helps skin cells convert vitamin D from an inactive to an active state. If there isn’t enough vitamin D, the calcium obtained from food is not properly absorbed, causing hypocalcemia (low calcium levels in the blood). Hypocalcemia results in deformities of bones and teeth, as well as neuromuscular problems (nerve and muscle issues). The body also produces vitamin D when exposed to sunlight. A vitamin D deficiency makes it harder for the body to maintain sufficient levels of calcium and phosphate. When this happens, the body produces hormones that cause calcium and phosphate to be released from the bones. When the bones have lower amounts of these minerals, they become weak and sensitive
  • Genetic defect – Hypophosphatemic rickets is a rare genetic defect that prevents the kidneys from processing phosphates properly. Low phosphate levels in the blood lead to weak and soft bones.
  • Diseases – Some kidney, liver, and intestinal diseases can interfere with how the body absorbs and metabolizes minerals and vitamins, resulting in rickets.

Who is at Risk of Developing Rickets?

Some factors can make the development of rickets more likely. These include:

  • Age – Rickets is most common in children between 6 and 36 months of age. During this period, children usually experience rapid growth. This is when their bodies need more calcium and phosphate to strengthen and develop their bones.
  • Diet – There is a higher risk of developing rickets if the child follows a vegetarian diet that does not include fish, eggs, or milk. There is also an increased risk if they have trouble digesting milk or are allergic to milk sugar (lactose). Babies who are exclusively breastfed can also become deficient in vitamin D. Breast milk does not contain enough vitamin D to prevent rickets.
  • Skin color – Children of African descent are at higher risk for rickets because they have darker skin. Dark skin does not react to sunlight as strongly as lighter skin does, so it produces less vitamin D.
  • Geographical location – The body produces more vitamin D when exposed to sunlight, so there is a greater risk of rickets if the child lives in an area with little sunlight. Adults are also at greater risk if they work indoors during the day.
  • Poverty – Rickets is more likely to occur among children who are poor because access to adequate nutrition can be limited.
  • Malnutrition – Rickets is more common in regions of the world where severe drought and famine occur.

Symptoms of Rickets

Symptoms of rickets include:

  • Bone pain in the arms, legs, pelvis, and spine
  • Delayed growth
  • Bone fracture
  • Muscle cramps

What Are the Complications of Rickets?

If left untreated, rickets can cause:

  • Short stature
  • Skeletal deformities, including:
  • Bowed legs
  • Bump on the breastbone
  • Thick wrists and ankles
  • Curved spine
  • Dental deformities
  • Seizures
  • Respiratory problems
  • Heart muscle weakness – (this complication is rare)

How Is Rickets Diagnosed?

Rickets can be diagnosed in the following ways:

  • Blood tests – measures the levels of calcium and phosphorus in the blood.
  • Arterial blood gases – checks the acidity of the blood.
  • X-ray – this test can reveal calcium loss in the bones, or changes in the structure or shape of the bones.
  • Bone biopsy – In rare cases, a bone biopsy will be performed. This involves removing a very small section of bone, which will be sent to a laboratory for analysis.
  • Physical exams – bowed legs, softer bones, and delayed closure of the fontanelles (soft spots on the skull) will also be checked; however, these exams are not reliable enough to be used to finalize a diagnosis.

How Is Rickets Treated?

Treatment for rickets focuses on increasing the child’s intake of calcium, phosphorus, and vitamin D. This will eliminate most of the symptoms associated with rickets. Other treatments include:

  • Vitamin D supplementation (ergocalciferol or cholecalciferol)
  • Sunlight exposure,
  • Annual vitamin D injection (if there is a problem absorbing the vitamin, such as with intestinal or liver diseases)

It is important to ask the doctor about the correct dosage, as it may vary according to the child’s size and age. Too much vitamin D or calcium can be unsafe.

Treatment for Genetic Rickets

If the child has this condition, it will be necessary to combine phosphate medications and a special vitamin D supplement. Other medical conditions – if the rickets has an underlying medical cause, such as kidney disease, that disease needs to be treated and managed.

Other Complications

If skeletal deformities are present, the child may need braces to position the bones correctly as they grow. In severe cases, corrective surgery may be needed.

What to Expect After Rickets Treatment?

Increasing vitamin D, calcium, and phosphate levels will help correct the disorder. Most children with rickets see improvements in about a week. Skeletal deformities generally will improve or disappear over time if rickets is corrected while the child is still young. However, skeletal deformities can become permanent if the disorder is not treated during the child’s growth period.

How to Prevent Rickets?

There are several measures that can be taken to help prevent rickets. Simple measures that are essential for the child’s quality of life.

Diet

A balanced and healthy diet should provide the necessary amounts of Vitamin D and calcium. Foods rich in vitamin D include:

  • Eggs
  • Butter
  • Fortified milk and juices
  • Oily fish, including mackerel, salmon, and sardines
  • Soy-based products
  • Fortified breakfast cereals.

Foods rich in calcium include:

  • Dairy products, such as milk, cheese, cottage cheese, and yogurt
  • Soybeans
  • Green vegetables, such as broccoli and kale
  • Sardines
  • Nuts
  • Tofu

Sunlight

Estimating the exact vitamin D needs of each person is very difficult, because it is hard to measure the amount of vitamin that is synthesized in the skin through sunlight. In countries that are not close to the tropics and where sunlight intensity is lower, it is important to provide supplemental vitamin D intake to prevent rickets. In areas with plenty of sunlight, the best way to prevent rickets is to expose children to the sun. It is recommended to take 15 to 20 minutes of sun a day, preferably in the morning. Arms and legs should be exposed, as the amount of vitamin D absorbed is proportional to the amount of skin exposed. To obtain vitamin D it is important not to use sunscreen, as sunscreen inhibits vitamin D absorption. A protection factor of 8 inhibits 95% of the vitamin concentration, so a higher factor than this practically eliminates the substance’s production. Although sunlight exposure is a good source of vitamin D, it is important not to overdo it, excessive sun exposure can lead to burns and eventually skin cancer. See Also: Childhood Anemia – How to Fight It? Photos: Nevit Dilmen