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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      • Outdated tetracycline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 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.
  • 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

    Rickets. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated April 15, 2016. Accessed May 13, 2016.Vitamin D deficiency in children (infancy through adolescence). EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. 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: http://familydoctor.org/familydoctor/en/diseases-conditions/rickets.html. 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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