Rickets

Children's bones can become soft and weak, a condition called rickets. This usually happens because their bodies don't get enough vitamin D for a long time. Sometimes, rare, inherited conditions can also cause rickets.

Vitamin D is important because it helps the body use calcium and phosphorus from food. These minerals are crucial building blocks for strong bones. When a child doesn't get enough vitamin D, their body struggles to keep enough calcium and phosphorus in their bones, leading to rickets.

Most cases of rickets can be fixed by adding vitamin D and/or calcium to a child's diet. This helps their bodies build strong bones again. But if rickets is caused by another health issue, doctors might need to give extra medication or other treatments. Sometimes, if rickets causes unusual bone shapes, surgery might be needed to correct them.

In rare cases, rickets might be linked to problems with phosphorus, another important mineral in bones. If this is the cause, doctors might prescribe special medications to address the phosphorus deficiency.

Rickets is a condition that affects bone development in children. It happens when their bodies don't get enough vitamin D, which is crucial for strong bones. This lack of vitamin D causes the bones to become soft and weak.

The early signs of rickets can be subtle. They often include:

• Slower growth: The child might not be growing as quickly as other children of the same age.
• Delayed motor skills: Learning to sit, crawl, walk, or other physical milestones may take longer than usual.
• Pain in the spine, hips, and legs: The child might complain of aches and discomfort in these areas.
• Muscle weakness: The child might seem less strong and have trouble with movements.

Because rickets affects the areas where bones grow (called growth plates), it can lead to noticeable changes in the child's skeleton. These changes can include:

• Bowed legs or knock-knees: The legs may bend outward or inward, creating unusual shapes.
• Thickened wrists and ankles: The bones in these areas may become abnormally wide.
• Protruding breastbone (pectus carinatum): The breastbone might stick out noticeably.

These signs and symptoms can vary from child to child, and some children might not show all of them. If you notice any of these issues in a child, it's important to talk to a doctor right away. Early diagnosis and treatment are crucial for preventing long-term problems.

Children need vitamin D to properly use calcium and phosphorus from the foods they eat. If a child doesn't get enough vitamin D, or their body can't use it well, a condition called rickets can develop. Sometimes, not having enough calcium, or a combination of not enough calcium and vitamin D, can also lead to rickets. This is because calcium and vitamin D work together in the body.

Factors that can increase a child's risk of rickets are varied and often related to vitamin D levels.

• Skin tone: People with darker skin have more melanin, a pigment that reduces their skin's ability to make vitamin D from sunlight. This means they need to get more vitamin D from other sources, like food or supplements.

• Mom's vitamin D levels: If a pregnant woman doesn't have enough vitamin D, her baby might be born with rickets or develop it shortly after birth. A severe vitamin D deficiency in the mother can significantly impact the baby's vitamin D stores.

• Limited sunlight: Children living in areas with less sunshine, often in higher latitudes, have less opportunity to produce vitamin D naturally. This is because sunlight is essential for the body to make vitamin D.

• Prematurity: Babies born early often have lower vitamin D levels because they haven't had as much time to get vitamin D from their mother during pregnancy. This is especially important for premature babies, as their bodies are still developing and may not have the same ability to produce vitamin D as full-term babies.

• Certain medications: Some medicines, like those used to treat seizures or HIV, can make it harder for the body to use vitamin D effectively. This means that even if a child gets enough vitamin D from other sources, these medications can interfere with its absorption and use.

• Breastfeeding alone: Breast milk contains some vitamin D, but often not enough to fully prevent rickets. Babies who are exclusively breastfed should be given vitamin D supplements, typically in liquid form (drops), to ensure they get the necessary amount.

If rickets isn't treated, it can cause serious problems. Untreated rickets can prevent children from growing normally. It can also lead to a curved spine, misshapen bones, and problems with teeth. In severe cases, it might even cause seizures. These issues can significantly impact a child's overall health and development.

Sunlight is a great way to get vitamin D. Most people need just 10 to 15 minutes of sun exposure around midday to get enough during warmer months. However, if you have darker skin, if it's winter, or if you live far north, you might not get enough vitamin D from the sun alone. This is because your skin needs more time in the sun to produce enough vitamin D, or the sun's rays are weaker in those situations.

Sun safety is especially important for babies and young children. Because of the risk of skin cancer, it's crucial to limit their sun exposure, especially during peak sun hours, and always use sunscreen and protective clothing.

To ensure your child gets enough vitamin D, you can give them foods that naturally contain it or have vitamin D added. Good sources include:

• Fatty fish: Salmon and tuna are excellent choices.
• Fish oil: This is a concentrated source.
• Egg yolks: A small amount of vitamin D is found in egg yolks.
• Fortified foods: Look for these in the grocery store, as manufacturers add vitamin D to some foods. Examples include:
  • Infant formula
  • Breakfast cereals
  • Bread
  • Milk (but not all dairy products like yogurt and cheese)
  • Orange juice

Always check the nutrition labels on food packages to see how much vitamin D each food provides.

If you're pregnant, talk to your doctor about possibly taking a vitamin D supplement. This is especially important because your body needs extra vitamin D during pregnancy to support your baby's development.

The recommended daily amount of vitamin D for infants is 400 IU. Since breast milk doesn't have a lot of vitamin D, babies who are only breastfed need to take a vitamin D supplement daily. Some formula-fed babies might also need a supplement if their formula doesn't provide enough. Always talk to your pediatrician about the best vitamin D intake for your child.

During a physical exam, a doctor will check your child's bones for any unusual shapes or sizes. They will carefully feel the bones to look for any problems.

X-rays can show if there are any bone shape issues. Blood and urine tests can help diagnose rickets and track how well treatment is working.

Doctors will pay special attention to these areas:

• Skull: Babies with rickets sometimes have skull bones that are softer than normal. They might also have delays in the closing of the soft spots on the top of the head (called fontanels). This is a sign that the bones aren't growing and hardening normally.

• Legs: While some slight bowing of the legs is normal in toddlers, rickets can cause the legs to bow out more than usual. This can make the legs look like they are curved inward.

• Chest: In some children with rickets, the rib cage can become flattened, and the breastbone might stick out more than normal. This can affect how the chest looks and develops.

• Wrists and ankles: Children with rickets often have wrists and ankles that are bigger or wider than usual. This is another sign that the bones aren't growing and hardening as expected.

Rickets treatment often involves vitamin D and calcium supplements. A doctor will tell you the right amount for your child. It's important to follow these instructions carefully, as too much vitamin D can be dangerous.

To track your child's progress, the doctor will use X-rays and blood tests. These tests help them see how the bones are developing and if the treatment is working.

In some rare cases, a child might have a genetic problem that causes low phosphorus levels. If this is the case, the doctor may prescribe special supplements and/or medicines.

If your child has bowed legs or spinal problems, the doctor might recommend special braces. These braces help guide the bones into the correct position as they grow. More significant skeletal problems might require surgery to correct them.