Do your baby's legs look a little bowed? Or do they move around abnormally when they walk? Sometimes these can be signs of a condition called rickets, which is caused by the bones not developing properly in babies. Don't worry, we'll talk about this in more detail.
What are Rickets?
Simply put, Rickets is a condition that affects your child's bones, that is, their growth. What happens is that the child's bones become soft and weak. Then the bones can easily bend, bend, and sometimes even break. Like untempered clay, they easily change shape.
The main cause is vitamin D deficiency.
The main reason for the development of Rickets is the deficiency of the nutrient called Vitamin D. Now you are wondering what happens to this Vitamin D. Vitamin D helps our body absorb other important nutrients called Calcium and Phosphorus. This Calcium and Phosphorus are the most important things for strong and healthy bones. So, when there is not enough Vitamin D in the body, the child is not able to absorb Calcium and Phosphorus properly. Then the bones do not grow strong.
Where does this vitamin D come from?
There are two main ways our little ones get vitamin D: sunlight and food.
Sunlight: Did you know that when our skin is exposed to sunlight, it produces vitamin D from within the skin. Isn't that amazing? However, in some countries, especially in areas with little sunlight, people don't get enough vitamin D this way. In Sri Lanka, we have plenty of sunlight, but sometimes we may not expose our little ones to the sun enough, especially in the morning. A little sunlight is very important.
Food: Some fatty fish and fish oils naturally contain vitamin D. But these foods are rare. In many countries, people consume fortified foods with vitamin D. For example:
- Milk and milk products
- Types of infant formula
- Some cereals
- Orange juice
But remember, rickets is a rare but treatable condition. If you have any concerns about your child's vitamin D intake, be sure to talk to your pediatrician.
What are the symptoms of Rickets?
Rickets causes a child's bones to become weak and brittle, causing them to bend, become crooked, and take on an unusual shape. Let's take a look at what these symptoms are:
- Bowed legs: This is the most common symptom. The legs appear bent outwards, like a bow.
- Bone pain: The child may say that their bones hurt, or may show pain when touched.
- Dental problems: These can include delayed teething, cavities, and weakening of tooth enamel.
- Growth delays: Children may not grow taller or gain weight as quickly as other children their age.
- Muscle weakness: The child may lose interest and energy in standing, walking, and playing. The child may appear lethargic.
- Seizures: In some severe cases, if the calcium level in the blood drops too low, these can occur. However, this is a rare occurrence.
- Rib end swelling: The area where the ribs connect to the middle breastbone (sternum) may become swollen and look like a knot. This is also called a "rachitic rosary."
- Abnormal curvature of the spine or changes in the shape of the skull: You may see a sideways curvature of the spine (scoliosis), or a flattening or abnormal protrusion of the head.
- Weak muscle tone: The child's body may feel loose instead of stiff.
- Wide knees and ankles (in toddlers) or wide wrists (in crawling babies): These joints may appear larger and wider than in other children.
If you think your child has one or more of these symptoms, it's best to see a doctor as soon as possible.
What are the causes of rickets?
There are several main factors that can contribute to the development of rickets. Let's look at each one.
Vitamin D deficiency
This is the most common cause of rickets. We also call this nutritional rickets. As I mentioned earlier, vitamin D is essential for the child's bones to absorb calcium and phosphorus. These nutrients are what bones need to grow strong and healthy. So, if a child does not get enough vitamin D from the foods they eat, a vitamin D deficiency can occur. The following factors can cause this:
- If the child cannot digest milk and dairy products (Lactose intolerant): Then the calcium and vitamin D obtained from milk may be reduced.
- If you eat a completely vegetarian or vegan diet: Because vitamin D is mostly found in animal foods.
- If you are exclusively breastfed (especially for more than 6 months): Breast milk is slightly low in vitamin D. Therefore, doctors recommend giving vitamin D supplements to breastfed babies.
- If you have a medical condition that limits your body's absorption of vitamin D: For example, Crohn's disease, celiac disease, or intestinal diseases such as ulcerative colitis.
In addition, insufficient sun exposure and low calcium intake in the child's diet can also cause vitamin D deficiency.
Genetics
This is a rare condition. However, some genetic disorders can interfere with a child's ability to absorb phosphorus or vitamin D. There are other genetic conditions that affect specific proteins that are used by the body to make vitamin D. These are called hypophosphatemic rickets.
Other underlying health conditions
Rickets can also be caused by other diseases. Children with certain rare conditions, especially those involving the liver, kidneys, intestines, and lungs, may have difficulty absorbing vitamin D and phosphorus.
Who is at higher risk of developing rickets?
Actually, any child can develop nutritional rickets. However, some groups are at a slightly higher risk. Let's take a look at who they are:
- Babies who are exclusively breastfed (especially for more than 6 months): As I mentioned before, babies who are exclusively breastfed should be given a vitamin D supplement.
- Babies and young children between 6 months and 24 months (2 years): Age is a very important risk factor for developing rickets. This is when children are growing rapidly.
- Premature babies: The baby stores vitamin D while in the womb, especially in the last three months. So, if the baby is born prematurely, the amount of vitamin D stored is low.
- Children with dark skin: Due to the increased production of melanin in the skin, the time it takes for the skin to produce vitamin D from sunlight increases.
- Children who don't get enough direct sunlight: Sunlight coming through windows blocks some of the vitamin D-producing ultraviolet B (UVB) rays. So it's a good idea to take your child outside and spend 10-15 minutes in the bright sunlight, around 9-10 am (but not in the midday sun).
So if your little one belongs to one of these groups, it's a good idea to be a little more careful about vitamin D.
What happens if rickets is not treated? (Complications)
Although rickets is a treatable disease, it is important to treat it as soon as possible. If left untreated, even mild rickets can cause long-term problems that can affect bone development. Possible complications include:
- Bone fractures: Bones are weak and can break easily.
- Chronic pain: There may be ongoing pain in the bones.
- Skeletal deformities: The shape of the bones may be permanently changed. For example, bowed legs or a bent back may remain.
- Dental problems: delayed teething, weakened tooth enamel, increased risk of cavities.
- Stunting: The child's height may be stunted.
That's why it's important to see a doctor as soon as you notice the symptoms of rickets. If identified early, these complications can be largely prevented.
How do doctors diagnose rickets?
Your pediatrician will first ask you about your family's health history and your child's symptoms. They will also ask about your child's general health, diet, and exposure to sunlight. Then, the doctor will do a physical exam. However, they may need to do a few more tests to confirm the diagnosis.
What tests are used?
Your child's doctor may do one or more of these tests:
- X-rays: These can clearly show the specific changes of rickets, such as cupping, fraying, and bowing of the bones.
- Blood tests: These can check vitamin D, calcium, and phosphorus levels, as well as levels of an enzyme called alkaline phosphatase (ALP) (which is elevated in rickets) and parathyroid hormone (PTH).
- Urine tests: This can also give an idea of the amount of calcium and phosphorus excreted from the body.
How is Rickets treated?
Rickets is often caused by a deficiency of vitamin D. So, nutritional rickets is treated as follows:
- Supplementing with Vitamin D and Calcium: Treatment begins with increasing the child's intake of Vitamin D and Calcium. The child should be given foods rich in Vitamin D and Calcium, such as cereals, milk, cheese, yogurt, egg yolks, and oily fish. The pediatrician will also prescribe daily doses of Vitamin D (usually Vitamin D3) and Calcium supplements.
- Sunlight: Since your baby's skin naturally produces vitamin D when exposed to sunlight, your doctor may recommend taking your baby outside for a while and exposing him to sunlight. Morning sunlight is best.
- Bracing or Surgery: Most of the time, a child's bones will straighten out on their own over time with vitamin D and calcium. However, if there are some severe deformities, braces may be needed to correct the bent shape of the bones. Very rarely, corrective surgery may be necessary.
Just think, just as a small plant withers without water, bones become weak without vitamin D. Just as a plant grows back healthy when given water and nutrition, a child's bones become strong again when given vitamin D and calcium.
If your child has rickets due to a genetic disease or another health condition, your pediatrician will refer you to a specialist, such as a pediatric endocrinologist or nephrologist.
When should I see a doctor?
If your child has any of these symptoms, see a pediatrician without delay :
- If you have a medical condition or disease that prevents the body from using vitamin D.
- Symptoms of rickets, especially if you see things like wide wrists, ankles, or knees, bowed legs, difficulty walking, and stunted growth.
- If the child often says that their bones hurt or shows pain when touched.
If you see things like this, it's wise to see a doctor without delay.
Can Rickets be prevented?
Yes, absolutely! There are things we can do to prevent nutritional rickets.
"If you are exclusively breastfeeding your baby, you should give them vitamin D supplement drops every day. This is because breast milk does not contain enough vitamin D for your baby's growing bones. Most babies need about 400 International Units (IU) of vitamin D3 per day. But it's best to ask your pediatrician about the exact dosage your baby needs. "
"To prevent nutritional rickets in older children, it is important to give them a variety of foods rich in vitamin D. Some types of fish (especially salmon, trout, and sardines) are rich in vitamin D. Also, many foods are fortified with vitamin D. Milk, orange juice, and some cereals are fortified with vitamin D. Your child's doctor may also recommend taking a vitamin D supplement."
"Also, doctors recommend exposing your child to some sunlight. Since the skin produces vitamin D when exposed to sunlight, that's another way to get this important nutrient. However, the amount of vitamin D we get from sunlight can vary depending on factors such as our region, climate, skin color, and the use of sunscreen. Many children may not be able to get enough vitamin D from sunlight alone."
"However, rickets, which is caused by a genetic condition, cannot be prevented. If you are pregnant or planning to become pregnant and have a family history of rickets, you may want to consider talking to a genetic counselor. They may also recommend genetic testing."
How long will my child have rickets?
Nutritional rickets can be treated in a few weeks or months, depending on the severity of the child's condition. Most symptoms – for example, bone pain and muscle weakness – should improve within a few weeks of starting treatment. Vitamin D deficiency should also improve within six to eight weeks. If your child has any bowing or curvature of the bones, it may take several months, or even a year, to improve. This may go away on its own, or it may require braces or surgery.
"If your child's rickets is caused by a non-nutritional health condition, vitamin D deficiency can be treated. However, even if it is treated, the underlying condition can be lifelong. Your pediatrician (and other specialists, if needed) will help you and your child manage and live with the condition."
What is the outlook/prognosis for children with rickets?
The outlook for children with nutritional rickets is usually very good. With treatment, their condition usually resolves completely within a few weeks or months. Most children who are treated for nutritional rickets make a full recovery and grow into healthy adults.
"If there are other causes of rickets, the outlook will depend on the specific disease or condition your child has. However, in many cases, children with rickets like this can live full, healthy lives with specialist medical care."
What is the difference between Rickets and Osteomalacia?
Osteomalacia is a condition similar to Rickets in adults. Simply put, Rickets is a softening of the bones in children, while Osteomalacia is a softening of the bones in adults. The main cause of both is vitamin D deficiency. Rickets affects the developing bones of children, so it causes characteristic symptoms such as bowed legs. Adults do not have this specific symptom (bowed legs) because their bones are fully developed. However, they also have bone pain, and their weakened, brittle bones can break easily.
You are not alone, get help.
If you notice that your child's legs are bowed or his wrists are wide, see a pediatrician right away. They can check to see if it's rickets. This may sound scary, but it's a treatable condition. In the meantime, ask your doctor about support groups that help children with rickets and their families. Connecting with others who have had similar experiences can be a great source of encouragement for you and your child. It can also help you learn new, better ways to manage your child's condition.
The most important message to take home
So, Mom and Dad, Rickets is not something to be afraid of, but it is not something to take lightly either.
- Vitamin D is essential for the development of strong bones in children.
- Rickets can be prevented by exposure to sunlight (especially in the morning), eating foods rich in vitamin D (such as fish, milk, egg yolks), and, if necessary, taking vitamin D supplements as directed by a doctor.
- It is very important to consult a doctor before giving vitamin D drops to exclusively breastfed babies (especially those over 6 months old).
- If you notice symptoms such as bowed legs, delayed walking, bone pain, and poor growth, be sure to see a pediatrician.
Remember, early detection and proper treatment can give your child a healthy, strong future. Your little one's smile is our greatest joy!
` Rickets, vitamin D, calcium, childhood bones, bone development, breastfeeding, sunlight
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