Rickets

What is rickets?

Rickets is a childhood disease where your child’s bones are too soft, causing their bones to warp, bend and break more easily.

Rickets is different from osteomalacia, which is a similar condition seen in adults. The difference between the two is that rickets happens only in children because their bones are still growing, which causes the classic symptom of bowed or bent bones. Adults’ bones have already finished growing and they don’t have this symptom (unless they had untreated rickets as a child).

What are the signs and symptoms of rickets?

• Bowing of leg bones.
• A widening of knees (in children who can walk) or wrists (in infants who can crawl).
• Bone pain.
• Swelling of the ends of ribs, known as rachitic rosary (pronounced “ra-kit-ic”) because the ends of the ribs look like rosary beads under the skin.
• Pigeon chest (where the breastbone presses outward or upward).
• Growth delays.
• Unusual curving of the spine or shape of the skull.
• Teeth problems, such as cavities.
• Seizures (in severe cases where calcium levels are critically low).

What causes rickets?

Nutrition problems or genetics are usually the cause of rickets.

• Nutritional rickets: This is usually caused by not taking in enough vitamin D, which your body uses to absorb calcium. Some of the causes of this deficiency include:
  • Insufficient exposure to sunlight (which helps your body make its own vitamin D).
  • Lack of vitamin D in your child’s diet. This can happen with vegetarian/vegan diets, lactose intolerance or conditions that limit how much vitamin D your child’s body can absorb (such as Crohn’s disease, celiac disease, cystic fibrosis or ulcerative colitis).
  • A diet very low in calcium.
• Inherited rickets: Several genetic diseases interfere with how your child’s body absorbs vitamin D. Other genetic conditions affect how your body handles phosphorus and also cause rickets. These types of disorders are rare.

Who is at risk?

• Newborns and infants are at the highest risk, especially those who’re breastfeeding (even more so if the breastfeeding parent isn’t getting enough vitamin D) or who were born prematurely.
• Children who don’t get enough sunlight outdoors (windows block the sun’s rays that your body uses to create vitamin D). This is especially true in the wintertime.
• 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).

How is rickets diagnosed?

There are several ways to diagnose rickets. If your child’s pediatrician suspects rickets based on a physical exam or symptoms, they may order one or more of the following tests:

• X-rays.
• Blood testing.
• Urine testing.
• Bone biopsies (very rarely done).
• Genetic testing (for inherited rickets).

Can rickets be cured?

Yes, most cases of rickets (especially nutritional rickets) are curable when caught early. In most cases, changes to diet, added vitamin supplements and more sunlight exposure are enough to cure this disease.

Depending on how severe the case is, your pediatrician may recommend one or more of the following treatments for rickets:

• Diet changes. This usually involves high doses of vitamin D, from either diet or supplements. These doses may be given for several months, depending on the severity of the case and other factors. Your pediatrician may also recommend a standard daily vitamin D supplement once the higher doses aren’t needed.
• Sunlight. Because your body can naturally make vitamin D when you’ve been exposed to sunlight, encouragement to get outside and get some sunshine is likely.
• Surgery. Usually, your child’s bones will straighten out on their own. For especially severe cases, children may need to wear braces to help correct the bending of their bones. In some cases, surgery may also be an option.

For inherited cases of rickets, there are several treatment options depending on the genetic disorder in question. Your pediatrician may refer you to see a specialist to help find a treatment solution.

What are the possible complications that can happen with 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 bone that can keep bones from growing properly. Severe cases that aren’t treated can lead to seizures, heart damage and death.

Can rickets be prevented?

Yes, nutritional rickets can be prevented.

For people who are pregnant and infants:

• People who are pregnant: Take a vitamin D supplement as guided by your physician. The standard recommendation is at least 600 IUs of vitamin D daily. However, your doctor may encourage you to take up to 2,000 IUs daily. They may also advise you to take a calcium supplement to prevent bone loss later in life.
• Infants: Vitamin D supplement drops are available in most pharmacies. All breastfed infants should get 400 IUs of vitamin D daily.

For older children:

• Sunlight: Your body makes vitamin D when exposed to sunlight, so it's harder for people with darker skin to make vitamin D if they spend a lot of time indoors (or for people who only go outside with sunscreen on).
• Vitamin D-rich foods: Several varieties of fish (especially sockeye salmon and rainbow trout) are especially rich in vitamin D. Several foods are also “fortified” with vitamin D, which means that vitamin is added to them. Milk, orange juice and cereals are often fortified this way.

In the case of inherited diseases that cause rickets, the disease itself isn’t preventable. However, if you know you or your child has inherited a genetic disorder, early genetic testing may make it easier to prevent developing rickets as a result.

When should I talk to my doctor or my child’s doctor?

• If your child complains of or shows any of the symptoms listed above, especially widening of their wrists in children who can crawl, or bowing of their legs in children old enough to walk.
• If you have a condition or disease that interferes with how your body uses vitamin D, your doctor or your child’s pediatrician might advise genetic testing if you have one of the related inherited diseases.

How long will your child have this condition?

Nutritional rickets can be treated in weeks or months, depending on the severity of the case. Most symptoms like weakness or pain should improve within a few weeks. The vitamin D deficiency should also improve within six to eight weeks. If your child has any bowing or bending of bones, this can take months to improve (this can happen on its own but may require surgery or braces).

With inherited rickets, vitamin D deficiency is a symptom that can be treated, but the disease that causes it is a life-long condition. Your pediatrician (and specialists, if needed) can help you and your child learn to manage their condition.

What is the outlook 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 children with inherited rickets, the prognosis depends on the specific genetic disorder they have. Still, in many cases, children with this type of rickets can grow into adults who live full, healthy lives.

A note from Cleveland Clinic

Rickets is a childhood disease where your child’s bones are too soft, causing their bones to warp, bend and break more easily. Most cases of rickets are curable. Throughout the process, it’s important to talk to your child about what’s happening to them and help them learn that they have a role in managing their health. Whether it’s for nutritional or inherited rickets, it’s important to empower your child and give them the tools and the knowledge so they can take good care of themselves, too.

Treating the symptoms of an illness like rickets is only part of recovery. Your pediatrician may recommend that you and/or your child see a mental health professional to help you cope with this condition and how others might treat you and your child because of it (especially if your child has visible signs of the disease).

If the underlying cause of the disease is an inherited condition, your pediatrician or specialist may also help you connect with support organizations or groups of families and individuals who are also living with the same disease (or a very similar one). Connecting with others who have a similar experience can help you and your child emotionally, and can also help you learn new and better ways of managing your child’s condition.