All About Rickets and it’s Treatment

Rickets is a disease of the bones occurring in infants and children, majorly caused by a prolonged deficiency of vitamin D, leading to softer, weaker bones that bend into abnormal shapes and are prone to fracture. Most of the afflicted children have bowed legs because the bones take a bowed shape. Rickets is common in children from 3 months to 18 months.

Who are vulnerable to rickets?

1. Infants and children: They are at the highest risk for rickets.
2. Malnutrition: Children from a poverty-stricken background, facing famine or starvation in early childhood are at high risk of widespread malnutrition.
3. Dark skin: Children with dark skin are more susceptible to rickets, even if they get adequate sunlight. Melanin, the pigment responsible for the darkening of the skin competes with vitamin D. Hence dark-skinned children have difficulty making vitamin D from sunlight. They need to get vitamin D from their diet.
4. Calcium deficient: In countries with sufficient sunlight, the cause can also be a lack of calcium from the diet.
5. Vegetarian or Vegan: Vegetarian Children, who can't get vitamin D from sunlight is vulnerable to rickets unless the milk they drink is fortified with vitamin D. This is because milk naturally contains calcium but doesn't have vitamin D. Fish, eggs, poultry contain vitamin D. Children raised as Vegans and children who are lactose intolerant may not be able to get both calcium and vitamin D from their diet.
6. Genetic: Rickets can be due to a genetic disorder where the kidneys cannot control phosphate excretion through urine, resulting in low phosphate levels.
7. Medical conditions: Some children are born with or develop certain medical conditions like celiac disease, inflammatory bowel disease, kidney problems or other ailments that prevent absorption of vitamin D.
8. Vitamin D deficiency in mother's pregnancy: Children born to women who were severely deficient in vitamin D when they were pregnant with them are at risk of developing rickets soon after birth.
9. Premature birth: Babies born prematurely are at a higher risk because they have lesser time to receive vitamin D from their mother's womb.
10. Medications: Certain types of medicines used to treat seizures or anti-retroviral medications to treat HIV infections seem to interfere with the body's ability to absorb vitamin D.
11. Exclusively breastfed: Children solely breastfed may be at risk as breast milk doesn't contain vitamin D. They should be supplemented with vitamin D drops.

Symptoms:

• Stunted growth
• Abnormal curvature of the spine
• Dental problems
• Seizures
• Bone deformities
• Weak bones that fracture easily

What happens if left untreated? 

• Failure to grow
• Physical deformities of limbs or spine
• Dental defects like delayed teething along with weak tooth enamel or malformed tooth.
• Can develop seizures in severe rickets with low calcium levels.

Diagnosis: 

• The doctor does a complete physical examination and assesses medical history and nutrition status.
• Notes any apparent signs of deformity of limbs and skull.
• If there is no evident deformity or seizure, x-rays of long bones and ribs are taken.
• Lab tests of vitamin D, phosphates, electrolytes, and parathyroid hormone are conducted.
• The tests reveal the cause of rickets, and treatment is charted accordingly.

Treatment can involve:

• Exposure to the sun for a few minutes a day
• Intake of foods rich in vitamin D and calcium
• Supplementing with Vitamin D and calcium
• If a medical condition has caused rickets treatment of the underlying disease is done
• Corrective surgery may be advised in cases of children with deformed bones or spine. Braces may be recommended until the bones become more robust. Children with genetic rickets may need unique formulation of vitamin D and calcium supplements.

Outcome:

• Regular follow-ups are needed to check the progress.
• When diagnosed early, children with rickets caused by nutritional deficiencies show excellent results within a matter of a few weeks to months.
• Children with bow-legs due to long-standing rickets also sometimes recover without surgical intervention.
• In children with an advanced stage of rickets, some of the damage can be life-long.

Prevention:

1. Sunlight: Exposure to sunlight for about 10 to 15 minutes is usually enough. However, children who have dark skin and children who stay in Northern latitudes or areas that receive sparse sunlight may not get enough vitamin D from sunlight.
2. Food: Ensure that your children eat food like egg, fish, meat that contain vitamin D or eat food fortified with vitamin D. If using fortified foods, check labels to verify the vitamin D content in them.
3. Pregnancy: if pregnant, ask your doctor about supplementing with vitamin D.
4. Supplement for infants: If your baby is exclusively breastfed, supplement with vitamin D drops under a doctor's guidance. Suppose your baby is on formula check if it is fortified with a safe and sufficient vitamin D quantity.
5. Finance: If you are concerned about the finance for treatment of rickets, most doctors of any discipline, be it nutritionists, Endocrinologists, pediatricians, or General Physicians in Mumbai, Delhi, Chennai. Most of the healthcare providers in almost every city in India all over India accept Bajaj Health EMI Card so that patients can pay in easy installments.