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Encyclopaedia


Rickets

Introduction

Rickets is a condition that affects bone development in children. It causes the bones to become soft and weak, which can lead to bone deformities.

Rickets in adults is known as osteomalacia or soft bones.

Rickets can cause bone pain, poor growth and 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.

What causes rickets?

A lack of vitamin D or calcium is the most common cause of rickets. Vitamin D largely comes from exposing the skin to sunlight, but it's also found in some foods, such as oily fish and eggs. Vitamin D is essential for the formation of strong and healthy bones in children.

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.

Who is affected?

Rickets was common in the past, but it mostly disappeared in the Western world during the 20th century after foods like margarine and cereal were fortified with vitamin D.

However, in recent years, there has been an increase in cases of rickets in the UK. 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 they need more sunlight to get enough vitamin D), as well as children born prematurely or taking medication that interferes with vitamin D.

Treating rickets

For mosr children, rickets can be successfully treated by ensuring they eat foods that contain calcium and vitamin D or by taking vitamin 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.

Preventing rickets

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 for 15 minutes 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.

When to seek medical advice

Take your child to see your GP if they have any of the signs and symptoms of rickets.

Your GP will carry out a physical examination to check for any obvious problems. They may also discuss your child's medical history, diet, family history and any medication they're taking.

A blood test to measure calcium, phosphorous and vitamin D levels can usually confirm a diagnosis of rickets, although your child may also have some X-rays or possibly a bone density scan (DEXA scan). This is a special type of X-ray that ,ensures the calcium content in bones.

Read more about how rickets is diagnosed.

 

 

 

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Symptoms

Rickets causes a child's bones to become soft and weak, 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; the child's walk may look different (waddling).
  • Skeletal deformities – thickening of the ankles, wrists and knees, bowed legs, soft skull bones and, rarely, bending of the spine.
  • Fragile bones – in severe cases, 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 – including weak tooth enamel, delay in teeth coming through and increased risk of cavities.

These symptoms can also affect adults who have soft bones (osteomalacia).

Some children with rickets may also have low levels of calcium in their blood (hypocalcaemia). This can make the symptoms of rickets worse and can also cause muscle cramps, twitching, tingling in the hands and feet, and fits

When to seek medical advice

If your child has any signs and 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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Causes

Rickets usually occurs because of a lack of vitamin D or calcium, although 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 or calcium deficiency will cause 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.

For example, 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 they build up stores of vitamin D while they're in the womb. Babies who are exclusively breastfed, especially for longer than six months, may also be at risk of vitamin D deficiency.

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 adequate foetal stores are built up for early infancy.

Genetic defect

Rare forms of rickets can also occur in some inherited (genetic) disorders. For example, hypophosphatemic rickets is a genetic disorder where the kidneys and bones deal abnormally with phosphate.

Phosphate binds to calcium and 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.

Underlying conditions

Occasionally, rickets develops in children with rare forms of kidney, liver and intestinal conditions. These can affect the absorption of vitamins and minerals.

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Treatment

As most cases of rickets are caused by a vitamin D and calcium deficiency, it 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.

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.

Treating complications and related conditons

When rickets occurs as a complication of another medical condition, treating the underlying condition will often cure the rickets.

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 may include surgery.

Genetic rickets

A combination of phosphate supplements and a special form of vitamin D is required for the treatment of hypophosphatemic rickets, where a genetic defect causes abnormalities in the way the kidneys and bones deal with phosphate.

Children with other types of genetic rickets need very large amounts of a special type of vitamin D treatment.

Supplement side effects

It is very unusual to get side effects from vitamin D, calcium or phosphate supplements if they are given in the correct dose. Your doctor will advise you about how much supplement is needed, for how long, and the monitoring of treatment.

If the dose of vitamin D or calcium is too high or the treatment is ocntinued for too long or isn't carefully monitored, 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.

 

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Prevention

There are several steps you can take to help prevent rickets. These include ensuring that your child has a healthy, balanced diet and spends some time outside in the sun.

Diet

If you're breastfeeding your baby, take a daily supplement of 10 micrograms (µg) of vitamin D.

For older children, make sure their diet contains plenty of foods rich in calcium and vitamin D.

Sources of vitamin D include:

  • oily fish, such as salmon, sardines and mackerel
  • eggs
  • fortified fat spreads
  • fortified breakfast cereals

Sources of calcium include:

  • dairy products, such as milk, cheese and yoghurt
  • green vegetables, such as broccoli and cabbage
  • soya beans and tofu
  • nuts
  • 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 vitamin supplements.

Sunlight

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 be covered up when out in the sun.

In the UK, your skin isn't able to make vitamin D from sun during the winter (November to March) as the sunlight isn't strong enough. However, you can get vitamin D from your body's stores and from food sources during this period.

Read more about staying safe the sun.

Supplements

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 to reduce the risk of their child developing rickets.

Babies and children

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.

For breastfed infants, vitamin drops are recommended from one month if their mother hasn't taken vitamin D supplements throughout pregnancy.

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 (those aged 65 years or over)
  • 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

Healthy Start

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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The information on this page has been adapted by NHS Wales from original content supplied by NHS Choices.
Last Updated: 29/01/2016 14:13:53

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