Rickets – Sign & Symptoms, Cause & Treatment

What is rickets?

• Rickets is the weakening & softening of bone in children.
• It occurs due to deficiency of vitamin D or inability of vitamin D action on mineral metabolism in body.
• In this disease, mineralization of growth plate /physis (growing area found at end of bone) is poor.
• Vitamin d helps in absorption of calcium & phosphorus from food. Insufficient amount of Vitamin D in body will affect absorption of calcium & vitamin d so deposition of calcium in bone will be affected leading to insufficient mineralization of bone.
• Some genetic / inherited disorder also can also lead to insufficient mineralization in bone.

What are the common signs & symptoms of Rickets?

Rickets occurs in young children, so it mainly affects bony growth & development. In this problem, a child can have

• Delayed & slow bone growth
• Delayed motor milestone
• Muscle weakness & cramp
• Pain and tenderness in the bone of spine, pelvis & leg
• Short stature
• Fracture with trivial trauma
• Rachitic rosary in chest wall– Enlargement of the costochondral junction
• Harrison sulcus- the prominence of lower rib margin
• Swelling in wrist, knee
• Deformity of limb-like bow leg, genu valgus, femur, radius deformity, etc.
• Dental problem like- delayed tooth formation, dental abscess, dental cavity, Defect in a tooth etc.

What Causes Rickets?

Rickets occurs due to deficiency of vitamin D, Calcium & phosphorus.

Vitamin D came to body through food & sunlight exposure.

Causes:

• Lack of sunlight exposure: if your child don’t get sufficient sun exposure then most likely, he is going to have vitamin D deficiency.
• Insufficient amount of vitamin D in food: Vitamin D don’t found in most of vegetarian food item. Vit D are being added to dairy product.
• Problem with absorption in intestine: In diseases like coeliac disease, inflammatory bowel diseases & cystic fibrosis, vitamin D absorption from intestine is poor.
• Liver disease: Vitamin D will not formed in body if liver is diseased
• Kidney disease: In kidney disease, Vitamin D activation will not happen along with less  retention of calcium & phosphorus.

Some genetic causes (vitamin D resistant): Vitamin D will not be able to act on bone & intestine because of some genetic disease.

How to diagnose the Rickets?

• Rickets can be identified by clinical examination of the child.
• X-ray of deformed limbs is required to see the impact of vitamin D on bone.
• Low level of Vitamin D, calcium, phosphorus in blood will confirm the diagnosis of Rickets.
• In familial & genetic causes, Vitamin D levels may be normal or increased. So other investigation, including parathyroid hormone, creatinine, 24-hour urine assessment, is required.

What is the Prevention?

Sun exposure:

Sun Exposure is the best way to get sufficient Vitamin D in the body. 10-15 minute exposure to sunlight in noon time is sufficient for vitamin D formation through Skin. But you are dark skinned or sun exposure is not sufficient, then your body will not get sufficient Vitamin D. In this circumstances, you need to take supplement.

Food :

Most of the vegetable food is lacking in Vitamin D. Infant formula, Bread, Milk, Juices are fortified with vitamin D but you need to check that it is fortified with Vitamin D or not.

Supplement:

Vitamin D is available at most of the medical counter for sale. It is available in drop, syrup, capsule and sachet. Recommended supplement for infant is 400IU in a day. But if child is deficient in vitamin D then they should be given loading dose as recommended by doctor.

What are the risk factors?

• Dark skin
• Wearing sunscreen outdoor
• On lactose-free diet / strict plant-based diet,
• Spend a lot of time indoors/ don’t get enough exposure to sunlight.
• Don’t eat enough foods containing vitamin D, calcium, or phosphorus.
• Breastfeed without vitamin D supplement.
• Illness like celiac disease, kidney disease & liver problem, that prevents your body from making or absorbing vitamin D.
• Premature born & infant born to Vitamin D deficient mother
• Hereditary metabolic disease
• Live in a place with a high level of air pollution.

What is Rickets treated?

• Treatment of Rickets is vitamin D, Calcium, phosphorus supplement.
• Paediatrician / paediatric orthopaedic surgeon decides the dose.
• In confirm cases of rickets, we need to give high dose of vitamin D.
• Vitamin D get stored in liver.
• Overdose may harm to child so proper consultation is advised.
• Mild to moderate limb deformity will be corrected spontaneously.
• Moderate to severe deformity may need bracing and orthopaedic surgery.
• In rare cases of phosphorus deficiency rickets, we need to supplement phosphorus along with calcium & vitamin D.