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  • Definition

    Rickets is disease resulting from a vitamin D, calcium, or phosphate shortage in children. It causes bones to soften and weaken.
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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      • Outdated tetracycline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 or having dark skin
    • 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
  • Symptoms

    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

    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:
    • Relieve or reverse symptoms and improve bone changes
    • Correct the underlying cause
    Treating Symptoms
    Treatment to relieve or correct symptoms and bone changes:
    • Involves biologically active vitamin D, calcium, and/or phosphate
    • May include:
      • Wearing braces to reduce or prevent bony deformities
      • In severe cases, surgery to correct bony deformities
    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

    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.

    Eat Right—Academy of Nutrition and Dietetics

    Healthy Children—American Academy of Pediatrics


    Health Canada

    The Hospital for Sick Children—About Kids Health


    Rickets. EBSCO DynaMed website. Available at: Updated April 15, 2016. Accessed May 13, 2016.Vitamin D deficiency in children (infancy through adolescence). EBSCO DynaMed website. Available at: Updated February 3, 2015. Accessed May 13, 2016.

    Rickets: what it is and how it's treated. Family Doctor—American Academy of Family Physicians website. Available at: 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):e791-817.

    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;122:1142-1152.

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