What is Rickets and how is it diagnosed in Children?

Q1) What is Rickets?
A1) Rickets is a condition affecting the bone development in children. It causes bone pain, poor growth and soft, weak bones that can lead to bone deformities. Rickets is most common in children ages 6 to 24 months. This is because their bones grow rapidly during this period.

Q2) What are the signs and symptoms of Rickets?
A2) Rickets results in weak bones and can lead to:

  • Bone deformities – thickening of the ankles, wrists and knees, bowed legs, soft skull bones and, rarely, bending of the spine
  • Bone pain – the bones affected by rickets can painful, so the child may be reluctant to walk or may tire easily; the child's walk may walk is a different posture (waddling)
  • Dental problems – it can cause weak tooth enamel, delay in teeth coming out and increased risk of cavities
  • Poor growth and development – if the skeleton does not grow and develop properly, the child will be shorter than his expected height potential
  • Fragile bones – in severe cases, the bones become weaker and more prone to fractures

Q3) What causes Rickets?
A3) The most common cause of rickets is a deficiency of vitamin D, Calcium or Phosphorous. Exposure to sunlight is the most important source of Vitamin D largely in our body. It is also present in oily fish and eggs. Vitamin D is essential for the formation of strong and healthy bones in children. Children with an underlying disease such as fat malabsorption, liver disease, renal insufficiency can also develop Rickets.

In rare cases, children can be born with a genetic form of rickets, which can cause a fall in the levels of Vitamin D or Calcium in our body.

Q4) What are the clinical features of Rickets?
A4) Children with Rickets can have the following physical features:

  • Craniotabes (softening of skull bones, usually evident on palpation of cranial sutures in first 3 months of age)
  • Swelling of wrists and ankles
  • Delayed fontanelle closure (normally closed by age 2 y)
  • Delayed tooth eruption (no incisors by age 10 months, no molars by age 18 months)
  • Leg deformity (knock knees, bow legs, windswept deformity)
  • Rachitic rosary (enlarged costochondral joints)
  • Frontal bossing
  • Bone pain, restlessness, and irritability

Severe forms if left untreated can lead to :

  • Hypocalcemic seizure and tetany
  • Hypocalcemic dilated cardiomyopathy (heart failure, arrhythmia, cardiac arrest, death)
  • Failure to thrive and poor linear growth
  • Delayed gross motor development with muscle weakness
  • Raised intracranial pressure

Q5) How do you diagnosed Rickets?
A5) Rickets is diagnosed by Blood tests done for Calcium, Phosphorus, Vitamin D and any other underlying cause that your Endocrinologist may suspect. Serum PTH, ALP, and urinary phosphorus levels may be tested in some special conditions.

An Xray of the limbs may also be done to assess the signs of rickets in bones and the bone density.

Q6) Is playing in the Sun enough to maintain Vitamin D levels in children?
A6) Playing outdoors alone may not be enough to maintain Vitamin D levels in the body as exposure can be affected by environmental factors such as latitude, altitude, season, time of day, cloud cover, and air quality.

Personal factors such as occupation, lifestyle, culture such as clothing, and preference which may modify time spent outdoors and/or the surface area of skin exposed to sunlight also affects the Vitamin D levels.

Finally, the dose-response of circulating 25OHD to cutaneous UVB exposure is dependent on skin pigmentation, age, body composition and genetic factors play a major role too.

Q6) How is Rickets treated?
A6) Once the correct diagnosed is made the treatment is with oral medication. Nutritional Rickets is treated with Vitamin D and calcium supplementation, calculated according to age. Rickets due to underlying medical conditions require treatment of the disease causing it. Early diagnosis and treatment result in favorable outcomes.