Rickets in Children: Causes, Symptoms, and Prevention
Understanding the causes and symptoms of rickets in children is essential for any parent or caregiver, as this condition—once thought to be a relic of the past—continues to affect pediatric bone health in many parts of the world. Characterized by the softening and weakening of bones, rickets typically occurs when a child’s body lacks sufficient Vitamin D, calcium, or phosphate. Because these nutrients are the building blocks of a strong skeletal system, a deficiency during the rapid growth phases of childhood can lead to lasting physical challenges.
While medical advancements have made the condition highly manageable, the Mayo Clinic notes that lifestyle shifts, such as decreased outdoor play and specific dietary patterns, have led to a resurgence in cases. This guide will walk you through how to identify the early warning signs, understand the underlying biological causes, and implement simple prevention strategies to ensure your child develops the strong, healthy bones they need for an active life.
What Causes Rickets In Children?
To understand rickets in children, it is helpful to view Vitamin D as a “key” that unlocks the body’s ability to use essential minerals. Without enough of this key, the body cannot effectively absorb calcium and phosphorus from food—the primary building blocks of the skeleton. When these minerals are insufficient, bones remain soft and pliable rather than hardening, which leads to the characteristic deformities of the condition.
According to the National Institutes of Health (NIH), there are four primary pathways that lead to the development of rickets:
Vitamin D Deficiency: This is the most common trigger. Most Vitamin D is produced when the skin is exposed to sunlight, though it is also found in a limited number of foods. Children who spend most of their time indoors or live in northern latitudes with less intense sun are at a significantly higher risk.
Dietary Mineral Deficiencies: Even with adequate Vitamin D, a diet severely lacking in calcium or phosphorus can prevent bones from mineralizing properly. As noted by Johns Hopkins Medicine, this is often seen in regions where access to dairy products or fortified foods is limited.
Malabsorption Issues: Some children may consume enough nutrients but have underlying health conditions that prevent their bodies from absorbing them. The Mayo Clinic explains that conditions such as Celiac disease, inflammatory bowel disease (IBD), or cystic fibrosis can interfere with how the small intestine processes Vitamin D and minerals.
Genetic Factors: In rare instances, rickets is hereditary. Known as hypophosphatemic rickets, these genetic variations cause the kidneys to process phosphates abnormally, leading to low levels in the bloodstream and subsequent bone weakening.
Identifying the Symptoms
Rickets often develops gradually, which can make the early signs difficult for parents to spot. Because the bones are not mineralizing (hardening) at the rate they should, the symptoms typically manifest most clearly as a child reaches physical milestones like crawling, standing, and walking.
According to the Cleveland Clinic, the symptoms of rickets generally fall into several distinct categories:
Skeletal Deformities:
These are the most visible signs. As a child’s weight increases, the softened bones begin to give way under the pressure of gravity and movement.
Bowed Legs or Knock Knees: A noticeable outward or inward curving of the legs that becomes prominent once the child begins to walk.
The Rachitic Rosary: Visible bumps or “beads” on the ribcage where the bone meets the cartilage.
Thickened Wrists and Ankles: The ends of the long bones often appear wider and more “knobby” than normal.
Physical and Developmental Delays:
Delayed Walking: Children may be slow to reach motor milestones because their legs feel weak or painful.
Growth Failure: The Mayo Clinic notes that rickets can cause delayed growth and small stature because it affects the growth plates at the ends of a child’s bones.
Dental Issues: This can include delayed tooth formation, holes in the enamel, and an increased risk of cavities.
Pain and Weakness:
Bone Tenderness: A child may be fussy when being picked up or may cry when pressure is applied to their legs or ribs.
Muscle Weakness: This often results in a “waddling” gait or difficulty climbing stairs.
In severe cases, a lack of calcium can lead to more serious neurological issues. The NHS (UK) highlights that very low levels of calcium (hypocalcemia) can cause muscle cramps, tingling in the hands and feet, or, in extreme instances, seizures. If you notice any of these physical markers or if your child seems consistently pained during movement, a pediatric consultation is the necessary next step.
Who is at Risk?
The likelihood of developing rickets in children is significantly higher for certain groups due to biological, environmental, and dietary factors. Identifying these risks early allows parents and healthcare providers to implement targeted prevention strategies before bone health is compromised.
According to the CDC (Centers for Disease Control and Prevention), infants who are exclusively breastfed are at an elevated risk because breast milk generally does not provide the 400 IU of Vitamin D required daily for healthy bone development. For this reason, pediatricians typically recommend Vitamin D drops starting in the first few days of life.
Other primary risk factors include:
Darker Skin Pigmentation: Melanin acts as a natural shield against UV rays. As noted by the Mayo Clinic, children with darker skin require more sunlight exposure than those with lighter skin to synthesize the same amount of Vitamin D, making them more vulnerable in less sunny climates.
Geographical Location: Children living in northern latitudes or high-pollution urban areas often lack the direct UVB sunlight necessary for Vitamin D production, especially during the winter months. The NHS points out that staying indoors for long periods or keeping the skin covered for cultural reasons can further increase this risk.
Restrictive or Poorly Planned Diets: Diets that exclude dairy (such as strict veganism) can lead to a deficiency in calcium and phosphorus. The National Institutes of Health (NIH) emphasizes that because very few foods naturally contain Vitamin D, children who do not consume fortified foods (like milk, cereal, or orange juice) must rely on other sources or supplements.
Premature Birth: Babies born before their due date often have lower stores of Vitamin D and calcium, as these nutrients are primarily transferred from the mother during the final weeks of pregnancy.
Maternal Health During Pregnancy: If a mother is severely Vitamin D deficient during pregnancy, her newborn is more likely to be born with low skeletal stores, which can lead to early-onset rickets if not corrected immediately.
Rickets in Children Diagnosis and Treatment
When a healthcare provider suspects rickets in children, they begin with a physical examination to check for bone tenderness, “knobby” joints, or a protruding breastbone. However, because these signs can overlap with other conditions, clinical tests are necessary to confirm the diagnosis.
According to the Mayo Clinic, the standard diagnostic tools include:
Blood Tests: These are essential for measuring the levels of Vitamin D, calcium, and phosphorus. They also check for elevated levels of alkaline phosphatase, an enzyme that indicates active bone stress or softening.
Skeletal X-rays: This is the most definitive way to confirm rickets. Radiologists look for specific markers at the growth plates (the areas of new bone growth), such as widening, fraying, or a “cupped” appearance.
Bone Density Scans: In some cases, a specialized scan may be used to measure the amount of mineral in the bone tissue.
How is Rickets Treated?
The goal of treatment is to replenish the body’s mineral stores so that bones can harden and grow correctly. As detailed by the Cleveland Clinic, the treatment plan typically consists of:
Therapeutic Supplementation: Most children are prescribed high-dose Vitamin D (ergocalciferol or cholecalciferol) and calcium. These doses are significantly higher than standard over-the-counter vitamins and must be monitored by a doctor to prevent “Vitamin D toxicity.”
Nutritional Education: Parents work with a dietitian to ensure the child’s diet includes Vitamin D-fortified milk, eggs, and fish, as well as calcium-rich leafy greens or dairy products.
Corrective Bracing: If the bowing of the legs is severe, a pediatric orthopedist may recommend leg braces to help straighten the limbs while the bones are still flexible and healing.
Surgical Realignment: If the skeletal deformities are permanent or do not resolve with supplements after the child’s growth plates have closed, surgery may be required to realign the bones.
With early intervention, the metabolic issues of rickets can often be corrected within weeks, though it may take several months for the bones to fully reshape themselves.
Rickets in Children Prevention Strategies
Preventing rickets in children is far simpler than treating the condition once skeletal deformities have appeared. By focusing on three key pillars—sunlight, diet, and supplementation—parents can ensure their children have the necessary nutrients for lifelong bone health.
According to the Mayo Clinic and the National Institutes of Health (NIH), the most critical prevention steps include:
Vitamin D Supplementation for Infants: Since breast milk is naturally low in Vitamin D, healthcare providers recommend that all breastfed infants receive 400 IU of liquid Vitamin D daily, starting in the first few days of life. This should continue until the child is weaned to Vitamin D-fortified formula or milk.
Safe Sun Exposure: The body produces the majority of its Vitamin D when the skin is exposed to UVB rays. While sun safety is essential, brief periods of exposure (roughly 10–15 minutes a few times a week) can help maintain healthy levels.
A Mineral-Rich Diet
Once your child starts eating solids, prioritize foods that are naturally high in bone-building nutrients:
Fatty Fish: Salmon and mackerel are excellent natural sources of Vitamin D.
Egg Yolks: A simple, kid-friendly source of essential vitamins.
Fortified Foods: Many cereals, juices, and milk products are enriched with Vitamin D and calcium to ensure adequate intake.
Maternal Health During Pregnancy
Prevention begins before birth. Expectant mothers should ensure they are getting adequate Vitamin D through prenatal care to ensure their baby is born with sufficient mineral stores.
Conclusion
Rickets in children is a condition that reminds us how vital basic nutrition is to a child’s development. While the symptoms can be concerning, the combination of early detection, modern supplementation, and a nutrient-dense diet makes it a highly manageable health issue. By staying proactive about Vitamin D intake and regular pediatric check-ups, you are building a strong foundation for your child’s future growth.
Frequently Asked Questions (FAQ)
Q. Can rickets be fully cured?
A. Yes. In most cases, nutritional rickets is completely curable. By replenishing the body's levels of Vitamin D, calcium, and phosphorus through supplementation and diet, the metabolic issues are corrected. While most skeletal deformities improve as the child grows, severe cases may require physical therapy or, in rare instances, surgery to correct permanent bone curvature.
Q. How much sunlight does my child need to prevent rickets?
A. There is no "one size fits all" answer, as it depends on your geographic location and your child's skin tone. However, the NHS (UK) suggests that for most children, just 10 to 15 minutes of sun exposure on the hands and face a few times a week during the spring and summer is sufficient for the body to produce enough Vitamin D.
Q. Is rickets only caused by a lack of Vitamin D?
A. No. While Vitamin D deficiency is the most common cause, rickets can also occur if a child's diet is severely lacking in calcium or phosphorus. Additionally, as noted by the Mayo Clinic, certain genetic conditions or kidney problems can prevent the body from processing these minerals correctly, leading to "hereditary rickets."
Q. What are the best “kid-friendly” foods for bone health?
A. To support strong bones, focus on a combination of calcium and Vitamin D. Great options include:
Dairy: Yogurt, cheese, and milk.
Fortified Options: Many breakfast cereals and orange juices have added Vitamin D.
Proteins: Egg yolks and canned tuna or salmon.
Greens: Broccoli and kale are excellent plant-based sources of calcium.
Q. Should I give my baby Vitamin D supplements even if I am taking them myself?
A. Yes. Even if a breastfeeding mother takes Vitamin D supplements, the amount passed through breast milk is usually not enough to prevent deficiency in the infant. The National Institutes of Health (NIH) recommends that breastfed infants receive their own specific Vitamin D drops of 400 IU daily to ensure they meet their developmental needs.
