What is rickets in children?

Rickets is a disorder that affects children and leads to the weakening and softening of bones, making them susceptible to deformities. Rickets usually occurs when a child does not receive enough vitamin D, an essential element for absorbing minerals such as calcium and phosphorus needed by growing bones. Rickets can also result from very low levels of calcium or phosphorus in the body [3].

Children's bones are constantly developing and require a delicate balance of hormones and minerals to remain strong. When this balance is disrupted, bones can become weak and deformed. Vitamin D, calcium, and phosphorus are vital elements for bone growth and remodeling [2].

Causes of Rickets

There are several primary causes of rickets, most notably:

• Dietary Vitamin D deficiency: This occurs when a child does not get enough vitamin D from food or sunlight exposure. Children with darker skin, those who spend little time outdoors, those who use sunscreen consistently, those following a strict vegan diet, or breastfed infants without vitamin D supplementation may be at higher risk [3].
• Problems absorbing or using vitamin D: The body may be unable to synthesize or use vitamin D effectively due to certain medical conditions, such as celiac disease [3].
• Hereditary Rickets: There is a genetic form of rickets known as X-linked hypophosphatemia (XLH). This condition is characterized by low levels of phosphate in the blood, leading to skeletal deformities. Phosphate is an essential mineral for the normal growth of bones and teeth. Without sufficient amounts of phosphate, bones can weaken or soften, leading to rickets in growing children [1].
• Chronic kidney disease: Chronic kidney disease can lead to an imbalance in bone minerals, as damaged kidneys cannot properly regulate levels of hormones and minerals such as calcium and phosphorus, which negatively impacts bone health [2].

Symptoms of Rickets

Symptoms of rickets vary and can range from mild to severe. Common symptoms include:

• Bone pain or softening: The child may feel bone pain or be sensitive to touch [3].
• Impaired growth: Children with rickets may grow more slowly than their peers [1].
• Bone deformities: These can include bowed legs (bowlegs) because the bones are too weak to support weight, or dental deformities [1].
• Dental problems: These may include dental deformities or abscesses resulting from bacterial infection [1].
• Delayed walking: Children may have difficulty walking or be delayed in learning to walk.

Diagnosis and Treatment

Diagnosis of rickets is based on clinical examination, medical and family history, blood tests to measure levels of calcium, phosphorus, and vitamin D, as well as imaging tests such as X-rays which reveal bone deformities [3].

Treatment aims to correct the mineral and vitamin deficiency. For nutritional rickets, treatment usually involves replacing the deficient vitamin D, calcium, or phosphorus in the diet through supplements [3]. In cases of hereditary rickets or rickets related to kidney disease, treatment may require a more complex approach involving special medications or management of the underlying conditions [2].

Prevention of Rickets

Nutritional rickets can be prevented by following some guidelines:

• Sun exposure: Encourage children to spend sufficient time outdoors, while taking care to protect against harmful sun exposure.
• A diet rich in vitamin D and calcium: Include foods rich in vitamin D such as fatty fish (salmon), fortified milk, fortified breakfast cereals, and eggs. Include calcium sources such as dairy products and green leafy vegetables.
• Vitamin D supplements: The doctor may recommend vitamin D supplements for breastfed infants or for children who do not get enough vitamin D from other sources [3].

It is important to consult a doctor upon noticing any symptoms of rickets to ensure proper diagnosis and treatment. You can learn more about Rickets in Children: Vitamin D Deficiency and Its Effect on Bone Growth (Arabic).

Medical references

• Rickets
• X-linked hypophosphatemia
• Mineral & Bone Disorder in Chronic Kidney Disease