Rickets

Rickets is a condition that affects your child’s bone development. It softens and weakens your child’s bones, making them warp, bend and break more easily. The most common cause of rickets is a lack of vitamin D. Vitamin D helps your body absorb other important nutrients, like calcium and phosphorus. Without an ample amount of vitamin D, your child can’t take in enough calcium and phosphorus to make hard, healthy bones.

Your child can get vitamin D from two places: sunlight and food. Their skin makes vitamin D in response to exposure to the sun. But many people, especially those in northern climates, don’t get enough vitamin D this way. A few foods — like certain kinds of fatty fish and fish oils — naturally contain vitamin D, but there aren’t many others. So, most people in the U.S. get their vitamin D from fortified foods. These include:

• Milk and other dairy products
• Infant formula
• Cereals
• Orange juice

Rickets is a rare but treatable condition. Talk to your child’s pediatrician if you’re worried about how much vitamin D your child is getting.

Symptoms of rickets

Rickets weakens and softens your child’s bones, which causes them to bend and look misshapen. The most common symptom of rickets is bowed legs. Other rickets symptoms may include:

• Bone pain
• Dental problems, like cavities
• Growth delays
• Muscle weakness
• Seizures
• Swelling of the ends of their ribs
• Unusual curving of their spine or shape of their skull
• Weak muscle tone
• Widening of knees and ankles (in children who can walk) or wrists (in infants who can crawl)

Rickets causes

A vitamin D deficiency, genetics and underlying health conditions can all cause rickets.

Vitamin D deficiency

A lack of vitamin D is the most common cause of rickets. This is called nutritional rickets. Your child needs vitamin D for their bones to absorb calcium and phosphorus. These nutrients are necessary to grow strong, healthy bones. Your child may have a vitamin D deficiency if they don’t get enough of the vitamin through the foods they eat. This can occur if they:

• Are lactose intolerant
• Follow a vegetarian or vegan diet
• Exclusively breastfeed
• Have a health condition that limits how much vitamin D their body can absorb, like Crohn’s disease, celiac disease or ulcerative colitis

Other causes of a vitamin D deficiency include not getting enough sun exposure and a lack of calcium in the foods your child eats.

Genetics

Though rare, certain genetic diseases can interfere with how your child’s body absorbs phosphorus or vitamin D. Other disorders affect specific proteins that vitamin D uses in your child’s body.

Underlying health conditions

Rickets can also develop due to certain underlying health conditions. Children with rare types of liver, kidney, intestinal and lung diseases have trouble absorbing vitamin D and phosphorus.

Risk factors

Any child can develop nutritional rickets, but there are certain groups who are at a higher risk. These include:

• Babies who are exclusively breastfed (especially for longer than 6 months). They need to receive a vitamin D supplement if they only take in breast milk.
• Babies and toddlers between the ages of 6 and 24 months. Age is the most important risk factor involved in rickets.
• Babies born prematurely. The fetus builds up stores of vitamin D during development in the uterus. So, when your baby is born too early, they don’t have these stores.
• Children who are darker-skinned. It takes longer to absorb enough of the sun’s rays to create the needed amount of vitamin D when your skin is darker.
• Children who don’t get enough direct sunlight. Windows block the sun’s rays that your child’s body uses to create vitamin D, so time outdoors is important.

Complications of rickets

While rickets is a treatable and often curable disease, it’s important to treat it as soon as possible. When not treated, milder cases of rickets can result in long-term conditions that can keep bones from growing properly. Possible complications include:

• Bone fractures
• Chronic pain
• Skeletal deformities

How doctors diagnose rickets

Your child’s pediatrician will ask about your family health history and your child’s symptoms. They’ll also want to know about your child’s overall health and what kinds of foods they eat. Your child’s provider will perform a physical exam, as well. But they’ll likely need to run a few tests to confirm the diagnosis.

Tests that are used

Your child’s healthcare provider may order one or more of the following tests:

• X-rays
• Blood tests
• Urine tests

How is rickets treated?

Most cases of rickets occur due to a vitamin D deficiency. Nutritional rickets treatment includes:

• High doses of vitamin D and calcium. Treatment begins by increasing the amount of vitamin D and calcium your child receives. They’ll need to eat foods rich in vitamin D and calcium, like cereal, milk and fatty fish. Your child’s pediatrician will likely also prescribe daily vitamin D and calcium supplements.
• Sunlight. Because your child’s body can naturally make vitamin D when they’ve been exposed to the sun, your child’s provider may encourage them to get outside and get some sunshine.
• Bracing or surgery. Usually, your child’s bones will straighten out on their own. But they may need to wear braces to help correct the bending of their bones. In some cases, surgery may also be an option.

If your child developed rickets due to a genetic disease or other health condition, their pediatrician may refer you to a specialist.

When should I talk to my child’s healthcare provider?

Reach out to your child’s pediatrician if they have:

• A condition or disease that interferes with how their body uses vitamin D
• Symptoms of rickets, especially widening of their wrists or bowing of their legs

Can rickets be prevented?

Yes, you can prevent nutritional rickets. If you’re exclusively breastfeeding your baby, you should give them vitamin D supplement drops daily. This is because breast milk doesn’t contain enough vitamin D to support your baby’s growing bones. Most babies need 400 International Units of Vitamin D3 daily. Ask your baby’s pediatrician about what dosage they need.

You can prevent nutritional rickets in older children by making sure they eat a variety of vitamin D-rich foods. Several varieties of fish (especially sockeye salmon and rainbow trout) have high amounts of vitamin D. Many foods are also fortified with vitamin D, which means the vitamin is added to them. Milk, orange juice and cereal are often fortified this way. Your child’s healthcare provider may recommend a vitamin D supplement, as well.

Your child’s provider may also recommend time outside in the sun. Your child’s skin makes vitamin D when exposed to sunlight, so this is another way they may get enough of the vital nutrient. This source of vitamin D is impacted based on geographic location and climate, skin pigmentation and sunscreen use. Many children are unable to get sufficient vitamin D through sunlight alone.

You can’t prevent rickets caused by a genetic disorder. If you’re pregnant or thinking about pregnancy, you may want to consider talking to a genetic counselor. They may recommend genetic testing.

How long will my child have rickets?

You can treat nutritional rickets in weeks or months, depending on the severity of your child’s case. Most symptoms — like bone pain or muscle weakness — should improve within a few weeks with treatment. The vitamin D deficiency should also improve within six to eight weeks. If your child has any bowing or bending of bones, this may take months to improve. This can happen on its own but may require braces or surgery.

If your child’s rickets is due to a health condition other than nutrition, you can treat the vitamin D deficiency. But even if you treat it, the disease that causes it is a lifelong condition. Your pediatrician (and specialists, if needed) can help you and your child learn to manage their condition.

What is the outlook (prognosis) for children with rickets?

For children with nutritional rickets, the outlook is typically good. With treatment, their condition should resolve in a matter of weeks or months. Most children treated for nutritional rickets recover completely and grow into healthy adults.

For other causes of rickets, the prognosis depends on the specific disease or condition your child has. Still, in many cases, children with this type of rickets can grow into adults who live full, healthy lives.

What’s the difference between rickets and osteomalacia?

Osteomalacia is the adult form of rickets. A vitamin D deficiency is the most common cause of both. Rickets affects your child’s bone development, which leads to the classic symptom of bowed legs. Adult bones have finished growing, so they don’t have this particular symptom. But they do have bone pain, and their weakened, softened bones break more easily.