Rickets is caused by a vitamin D, calcium, or phosphorous shortage 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:
- 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
- Malabsorption-related diseases of the small intestine
- Liver or pancreatic diseases
- Certain medications
- Poisoning from:
- Outdated tetracycline
Rickets is more common in children aged 6-24 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 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
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 attempts to:
- Relieve or reverse symptoms and improve bone changes
- Correct the underlying cause
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
To help reduce your child's chance of rickets:
- 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.
This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.
Edits to original content made by Denver Health.
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Healthy Children—American Academy of Pediatrics http://www.healthychildren.org
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