Rickets is a condition that affects bone development in children. It causes the bones to become soft and malformed, which can lead to bone deformities.
Rickets in adults is known as osteomalacia or soft bones.
The most common cause of rickets is a lack of vitamin D and calcium. Vitamin D comes largely from sunlight on our skin but is also in some foods such as oily fish and eggs. Vitamin D is essential for a child to form strong and healthy bones.
In rare cases, children can be born with a genetic form of rickets. It can also develop if another condition affects how vitamins and minerals are absorbed by the body.
Read more about the causes of rickets.
Rickets causes the bones to become painful, soft and weak. This leads to deformities of the skeleton, such as bowed legs, curvature of the spine and thickening of the ankles, wrists and knees.
Children with rickets are also more likely to fracture their bones.
Read more about the symptoms of rickets.
When to seek medical advice
If your child has any symptoms of rickets, such as bone pain, delayed growth or skeletal problems, take them to your GP for a check-up.
Read more about how rickets is diagnosed.
Rickets can easily be prevented by eating a diet that includes vitamin D and calcium and spending some time in sunlight. The hands and face only need to be exposed to the sunlight a few times a week during spring and summer to provide enough vitamin D.
In some cases, vitamin D supplements may be recommended to reduce the risk of rickets.
Read more information about preventing rickets, including a list vitamin D and calcium sources.
Rickets can be successfully treated in most children by ensuring they eat foods that contain calcium and vitamin D or take vitamin and mineral supplements.
If your child has problems absorbing vitamins and minerals, they may need a higher dose or a yearly vitamin D injection.
Read more about how rickets is treated.
Who is affected?
Rickets was common in the past during Victorian times, but mostly disappeared in the Western world during the 1940s thanks to the fortification with vitamin D of foods such as margarine and cereal.
However, there has been and increase in cases of rickets in the UK in recent years.
The number of rickets cases is still relatively small but studies have shown that a significant number of people in the UK have low levels of vitamin D in their blood.
Any child whose diet does not contain enough vitamin D or calcium can develop rickets, but the condition is more common in children with dark skin (as this means more sunlight is needed to get enough vitamin D), children born prematurely, and children taking medication that interferes with vitamin D.
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Rickets causes a child's bones to become soft, weak and malformed, which can lead to bone deformities.
The signs and symptoms of rickets include:
- Pain – the bones affected by rickets are often sore and painful, so the child may be reluctant to walk or may tire easily.
- Skeletal deformities – these include soft skull bones, bowed legs, curvature of the spine, and thickening of the ankles, wrists and knees. The breastbone can also stick out, which is sometimes called "pigeon chest".
- Fragile bones – the bones become weaker and more prone to fractures.
- Poor growth and development – the skeleton does not grow and develop properly so the child will be shorter than average.
- Dental problems – these include weak tooth enamel, delay in teeth coming through and increased risk of cavities.
As your child gets older, the symptoms of rickets may also include:
- waddling when walking
- bent bones
- muscle weakness and pain
These symptoms can also affect adults who have soft bones (osteomalacia).
Occasionally, rickets can cause low levels of calcium in the blood. This is known as hypocalcaemia and it can make the symptoms of rickets worse. It can also cause muscle cramps, twitching, tingling in the hands and feet, and fits
When to seek medical advice
If your child has any symptoms of rickets, such as bone pain, delayed growth, muscle weakness or skeletal problems, take them to your GP for a check-up.
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Rickets usually occurs because of a lack of vitamin D or calcium. It can also be caused by a genetic defect or another health condition.
Lack of vitamin D and calcium
The most common cause of rickets is a lack of vitamin D or calcium in a child’s diet. Both are essential for children to develop strong and healthy bones. The main sources of vitamin D are:
- Sunlight – your skin produces vitamin D when it is exposed to the sun. We get most of our vitamin D this way.
- Food – vitamin D is also found in foods such as oily fish, eggs and fortified breakfast cereals.
Calcium is commonly found in dairy products (such as milk, cheese and yoghurt) and green vegetables (such as broccoli and cabbage).
Over time, vitamin D deficiency causes rickets in children and osteomalacia (soft bones) in adults.
Who's at risk?
Any child who does not get enough vitamin D or calcium can develop rickets, but there are certain groups of children who are more at risk.
Rickets is more common in children of Asian, African-Caribbean and Middle Eastern origin because their skin is darker and needs more sunlight to get enough vitamin D.
Babies born prematurely are also at risk of developing rickets because the foetus builds up stores of vitamin D while in the womb. As the amount of vitamin D in breast milk varies, the Department of Health recommends that all pregnant and breastfeeding women should take a daily supplement of 10 micrograms (mcg) of vitamin D.
This ensures that the mother’s vitamin D requirements are met and that adequate foetal stores are built up for early infancy.
Rare forms of rickets can also be inherited (passed on from a parent to a child).
Hypophosphatemic rickets is a genetic disorder in which the kidneys and bones deal abnormally with phosphate (calcium phosphate is what makes bones and teeth hard). This leaves too little phosphate in the blood and bones, leading to weak and soft bones.
Other types of genetic rickets affect special proteins in the body that are used by vitamin D.
Occasionally, rickets develops in children with rare forms of kidney, liver and intestinal conditions. These can affect the absorption and metabolism of vitamins and minerals.
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If rickets is suspected, your GP may carry out a number of tests including a physical examination, an X-ray and blood tests.
These are described in more detail below:
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- Physical examination – this will check for any obvious problems with your child’s skeleton, such as bone pain and tenderness.
- Medical history – your GP will discuss your child’s medical history, diet, family history and any medication they are currently taking.
- Blood tests – your GP may arrange for your child to have some blood tests to measure calcium, phosphorous and vitamin D levels.
- X-ray – your child may also have some X-rays and sometimes a bone densitometry scan (DEXA scan), which is a special type of X-ray that measures the calcium content in the bones.
Most cases of rickets are caused by a vitamin D and calcium deficiency. Therefore, rickets is usually treated by increasing a person's intake of vitamin D and calcium.
Vitamin D and calcium can be increased by:
- eating more foods rich in calcium and vitamin D
- taking daily calcium and vitamin D supplements
- having a vitamin D injection each year (this is only necessary if the child cannot take the supplements by mouth or has intestinal or liver disease)
Sunlight also contains vitamin D, so you may be advised to increase the amount of time your child spends outside.
Read more about sunlight and foods that are rich in calcium and vitamin D.
Your GP will advise you about how much vitamin D and calcium your child will need to take. This will depend on their age and the cause of the rickets. If your child has problems absorbing vitamins, they may need a higher dose.
When rickets occurs as a complication of another medical condition, treating the underlying condition will often cure the rickets. For example, people who have kidney disease and rickets may require dialysis (treatment that replicates many of the kidneys' functions).
If your child has a bone deformity caused by rickets, such as bowed legs or curvature of the spine, your GP may suggest treatment to correct it. This might be a brace to support the affected area of your child’s body as their bones grow, or they may need surgery.
People with genetic forms of rickets need slightly different treatment.
For hypophosphatemic rickets (where a genetic defect causes abnormalities in the way the kidneys and bones deal with phosphate), a combination of phosphate supplements and a special form of vitamin D is required.
Children with other types of genetic rickets need very large amounts of a special type of vitamin D treatment.
It is very unusual to get side effects from vitamin D, calcium or phosphate supplements if they are given in the correct dose.
However, if the dose of vitamin D or calcium is too high, it can raise calcium levels in the blood. This can result in a condition called hypercalcaemia. Symptoms of hypercalcaemia include:
- passing a lot of urine
- feeling thirsty
- reduced appetite
- nausea, abdominal pain, constipation and vomiting
- dizziness and headaches
- bone pain
See your GP immediately if you or your child has any of these symptoms.
If you have osteomalacia (the adult form of rickets that causes soft bones), treatment with supplements will usually cure the condition. However, it may be several months before any bone pain and muscle weakness is relieved.
You should continue taking vitamin D supplements regularly to prevent the condition returning.
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The information on this page has been adapted by NHS Wales from original content supplied by NHS Choices.
There are several steps you can take to help prevent rickets developing. These include ensuring that your child has a healthy, balanced diet and spends some time outside in the sun.
Make sure your child has a healthy, balanced diet that contains plenty of calcium and vitamin D.
Sources of vitamin D include:
- oily fish, such as salmon, sardines and mackerel
- margarine with added vitamin D
- breakfast cereals with added vitamin D
Sources of calcium include:
- dairy products, such as milk, cheese and yoghurt
- green vegetables, such as broccoli and spinach
- soya beans and tofu
- fish where you eat the bones, such as sardines and pilchards
If you have a restricted diet – for example if you are vegetarian or vegan – you may not be getting essential vitamins and minerals and may need to take a vitamin supplement (see below).
Sunlight is a good source of vitamin D and is where most of our vitamin D comes from. The vitamin forms under the skin as a result of sun exposure.
In the UK, about 10-15 minutes of exposure on the hands and face when the sun is at its strongest (between 11am and 3pm) a few times a week during the spring and summer is enough for most people.
You won't get vitamin D from the sun if you wear sunscreen, but you should apply sunscreen with a sun protection factor (SPF) of at least 15 if you are outside for longer than 10-15 minutes. This will help protect your skin from sun damage.
Babies and young children have very sensitive skin that burns easily so they need to use stronger sunscreen and keep covered up when out in the sun.
In the UK, our skin isn't able to make vitamin D from sun during the winter (November to March) as the sunlight isn't strong enough. However, we can get vitamin D from our body's stores and from food sources during this period.
Read more about staying safe the sun.
Most people can get all the vitamin D they need through their diet and by getting a little sun.
However, certain groups of people have an increased risk of developing a vitamin D deficiency and may need to take supplements to avoid getting rickets and osteomalacia (the adult form of rickets). These at-risk groups are discussed below.
Pregnant and breastfeeding women
The Department of Health recommends that all pregnant and breastfeeding women should take a daily supplement of 10 micrograms (mcg) of vitamin D.
In the UK, the Department of Health recommends the use of vitamin drops for all babies and young children aged six months to five years (or from one month if their mother has not taken vitamin D supplements throughout pregnancy).
However, the Department of Health says infants who are fed infant formula will not need vitamin drops until they are receiving less than 500ml of infant formula a day, as these products contain added vitamin D.
It is important that children in high-risk groups take vitamin D supplements. These include children who do not get enough vitamin D from their diet and those with certain medical conditions such as kidney disease. Your GP can advise you about how much vitamin supplementation is needed.
Other at-risk groups
Other people who have an increased risk of developing a vitamin D deficiency and who may need to take supplements include:
- elderly people
- people of Asian, African-Caribbean and Middle Eastern origin
- people who always cover up all their skin when they are outside
- people not exposed to much sun
- people who do not eat meat or oily fish
Some families are eligible for free vitamin supplements from the government’s Healthy Start scheme. See the Healthy Start website or call the helpline on 0845 607 6823 to find out whether you qualify.
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Last Updated: 27/08/2014 11:08:24