All you need to know about rickets

Rickets is an easily preventable condition involving the bones, which is commonly seen in small children and infants. It is linked to the deficiency of Vitamin D, calcium and phosphorus, all of which can be managed with lifestyle modification and by taking prescribed supplements. In this blog, by the experts from one of the best hospitals in India, we have elaborated on what rickets means, its, causes, symptoms, risk factors and everything you need to know. 

What is Rickets?

Rickets is a skeletal disorder seen in kids, which is linked to the lowered levels of Vitamin D, calcium and phosphorus in the body, as a result of which the kid’s bones become soft and weak. This can stunt the child’s growth and lead to abnormalities in the skeletal structure. 

When the vitamin D levels in the body drop, it makes it difficult for the body to regulate normal calcium and phosphorus levels. When this happens, our body starts draining these two from the bones resulting in pain, discomfort and even scoliosis. The problem is very common in kids who are growing at a fast pace but do not get enough Vitamin D to support their development. 

Rickets can also affect adults and in such cases, it is often referred to as osteomalacia. However, unlike kids, who are at a growing stage, adults are done with this growing phase, and as such the problem is not as severe as in the case of kids, however, it can lead to pain management and increased vulnerability to fractures. 

What are the different types of Rickets?

Rickets can be broadly classified into the following types depending on the underlying cause and how it manifests. These are: 

• Nutritional rickets: Despite being highly preventable, it is the most common type of rickets, caused by a lack of Vitamin D in the diet. 
• Inherited rickets: This is a result of certain genetic defects, passed down through generations, that prevent the body from absorbing enough Vitamin D.
• Hypophosphatemic rickets: It is a result of an underlying genetic condition due to which the kidneys excrete excessive amounts of phosphorus, leading to its deficiency in the body.
• Renal rickets: The problem is particularly seen in people with kidney diseases and disorders, affecting their ability to regulate normal calcium and phosphorus levels in the body.  

How does Rickets manifest?

Rickets is a progressive condition, which means that it develops slowly and gradually. At first, the symptoms are not significant, however as time passes by, it can result in the following:

• Stunted growth resulting in short height
• Easy susceptibility to fractures
• Weakening or softening of bones
• Persistent pain in limbs, pelvis and spine
• Dental problems such as deformed teeth, increased cavities and abscesses
• Deformities like bowed legs and scoliosis
• Having a very prominent forehead

What are the different causes of Rickets?

Vitamin D plays a very crucial role in the body as it helps to absorb calcium from the food that we consume. Vitamin D is primarily obtained via various sources like diet and sunlight. So, if you are wondering what causes Rickets, the answer is simple, either you are not taking enough Vitamin D in your diet or do not get enough sunlight. In some cases, the problem may even be genetic, linked to underlying conditions that cause our body to excrete calcium and phosphorus in excess. 

Is your child at a risk of developing Rickets?

There are certain factors that can increase your child’s risk of developing Rickets. These are:

• Age of the child: Rickets commonly affect children lying in the age group of 6 to 36 months as this is a stage of rapid growth when their body is in dire need of calcium and phosphorus. 
• Diet that lacks Vitamin D: Foods like fish, eggs, and milk are the best sources of Vitamin D. However, if your child takes a vegetarian diet which lacks foods like these, the risks of developing Rickets are higher. 
• Tone of your child's skin: Rickets is commonly seen in kids with a darker skin tone due to the excess amounts of melanin in their body. Dark skin is not as sensitive to sunlight as lighter skin and hence does not produce as much Vitamin D.
• Staying indoors: The best way for a child to get sunlight is by playing outdoors, however, if your child does not go out much and tends to stay indoors, the risks are higher. 
• Lactose intolerance: If your child is lactose intolerant and cannot take milk as a part of their daily diet, they won’t get enough Vitamin D. 
• Faulty genetics: Rickets can be inherited, which means that it can be passed down from the parents to the child. This is commonly referred to as inherited rickets. 
• Geographical factors: The risks of developing Rickets are higher in geographical areas that get a limited amount of sunlight. 

How is the diagnosis made?

If your child is presenting with any of the symptoms, it does not necessarily mean that they have rickets. The conclusion can be made only after proper diagnosis. With includes a physical examination to assess the symptoms and child’s overall health, evaluation of the child’s medical history, blood analysis and imaging tests like X-rays and bone scans.

How is Rickets treated/prevented?

In the majority of cases, when diagnosed early, Rickets can be cured completely with proper care and guidance. The same measures that are used to treat Rickets also help to prevent it and all these primarily focus on getting enough Vitamin D. 

• Increase exposure to the Sun: Nearly 90 per cent of Vitamin D that we need, we get it from the Sun. Our skin contains a substance called 7-dehydrocholesterol, which on coming in contact with direct sunlight converts into Vitamin D. Hence it is important to make sure that your little one goes out and spends time in the sun.
• Make your little one drink milk: Some kids can be very fussy or cranky when it comes to drinking milk, however, it is important to make them take at least a glass or even two on a daily basis. If your child is lactose intolerant, you can speak to their doctor about supplements. 
• Taking more fish: Fish is a good source of Vitamin D3 which can be easily absorbed by our body. Try to include fatty fish in your diet or at take fish oil supplements. Consult a specialist to know what is the ideal dose for your little one. 
• Be mindful of what you eat: If you are a vegetarian and cannot include fish and meat in your diet, don’t worry as there are many vegetarian options that can help you balance the right Vitamin D levels. These include fortified cereals, fortified orange juice, raw kale, almonds, and broccoli.

Things to keep in mind

While you are focusing on improving Vitamin D levels by making changes in your regular diets chart and habits, it is important to understand that excessive Vitamin D is also not good for you and can lead to toxicity. There are certain things that you need to keep in mind. These are:

• Make sure that you do not get more than 10,000 IU/day 
• While going out in the sun, take necessary measures to prevent the risks of sunburn.
• Do not take any supplements without consulting a specialist
• Do not force your little one to take milk if they are intolerant.