Expert Advice -- Rickets: You Are What You Eat

I am writing for my aunt who's grandson has been diagnosed with rickets. We would like more information please. What is it? What causes it? What is the treatment for it?

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ABOUT THE EXPERT

Robert Steele

Robert W. Steele, MD, is a board certified pediatrician at St. John's Regional Health Center in Springfield, MO. He graduated from medical... Read more

The bones in children grow from the ends which are called growth plates. As new bone replaces the cartilage in these growth plates, the bones become longer, and the child gets bigger. Rickets is a disease in which there is interference with this process. Therefore, rickets is a hindrance of new bone formation in children.

What Are the Symptoms of Rickets?

Most children with rickets have few if any symptoms. Some experience pain and deformities of the bones which may cause the child to "walk funny". Rickets cause the ends of bones to become widened, and this widening is most apparent at the ends of the longest bones such as the wrists and knees. Other who have had long-standing rickets may eventually have their body calcium drop low enough to cause seizures or severe contractions of muscles called tetany.

When Do Rickets Occur?

While technically it could occur at anytime during childhood, it is usually apparent during times of rapid bone growth. Therefore, children under the age of two, and teenagers going through their growth spurt are generally more at risk.

What Causes Rickets?

The formation of bone is dependent upon a number of things the most important of which are calcium and vitamin D. So, probably the easiest way to remember the causes of rickets is putting them into three categories:

  1. The child is not getting enough calcium and/or Vitamin D. Calcium and vitamin D are received primarily through the diet. However, a significant amount of vitamin D is made by the body by means of sunlight shining on the skin.
  2. The child is getting enough calcium and Vitamin D, but for some reason, the body isn't using it correctly, so it gets waste.
  3. The child is getting enough calcium and Vitamin D but the body is losing it in some way.

While there are many causes of rickets that involve steps #2 and #3, they are mainly due to other medical reasons such as cystic fibrosis, kidney damage, and rare hereditary disorders. These medical conditions often have other symptoms to suggest they may be causing the rickets. Therefore, let me focus on step #1 because it is the step that parents can be the most instrumental in preventing rickets.

Next page: Who's at risk?

Who's At Risk for Not Getting Enough Calcium and/or Vitamin D?

Premature Infants
A large amount of calcium is transferred to the infant during that last trimester of pregnancy. If pregnancy is cut short, these special babies begin life with a lower than normal amount of calcium. Throw in the fact that these babies often have difficulties feeding and may be on medications that cause calcium to be lost in the urine, and you can see why they are at risk for rickets.

Adolescents on Strange Diets
What teenager doesn't have peculiar eating habits? But while many adolescents do not eat very healthy diets, they usually get enough calcium and vitamin D to prevent rickets. Teenage girls already on average do not take the recommended daily amount of calcium to help prevent future osteoporosis. However, there may be certain girls and boys who eliminate all sources of calcium (milk, cheese, etc.) in the name of losing weight. It is this situation that puts them at risk for rickets.

The Exclusively Breast-fed Infant
Rickets can occur in infants who are exclusively breast because the amount of vitamin D in breastmilk may be inadequate to prevent it. Rickets usually do not occur in these children because most babies get some amount of regular sunlight. Therefore, the babies most at risk are those with darker skin who live in large northern cities. It is estimated that African-Americans require 6 times more ultraviolet light than Caucasians to make the same amount of vitamin D due to melanin in their skin not allowing as much sunlight to penetrate. Those babies that live in cold climates will be bundled more thus exposing less skin to the sun, and the tall buildings and smog of big cities also decreases the amount of sunlight exposure.

What Can Be Done to Lower the Risk of Rickets?
The best preventative measure is to ensure an adequate amount of calcium and vitamin D in the diet. Infant formulas and cereals have adequate vitamin D. Most milk is also fortified with vitamin D. For the exclusively breast fed infant, getting a little bit of sunlight each day is usually enough to prevent rickets. Supplementation with vitamin D drops in breastfed infants is generally not needed unless the risk factors above exist. Therefore, the decision about these drops is generally made on a case-by-case basis by the doctor.

I am sorry to hear of your aunt's grandson. When rickets is caused by lack of enough calcium or vitamin D in the diet, simple supplementation of these is two is enough to correct the problem. And once correction has taken place, usually no long-standing effects occur. However, there are other medical conditions and medications that can also cause rickets which may make correction more difficult.

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