Rickets is a long-term and excessive vitamin D deficiency in children. Rickets causes the bones of children to soften and weaken. Sometimes, although rare, hereditary problems can cause rickets.
What is rickets?
To understand what rickets is, first of all, it is necessary to grasp the importance of vitamin D in the body. Vitamin D is a vitamin that allows calcium and potassium minerals, which are very important for bone health and taken with food, to be absorbed from the intestines, allowing these minerals to be taken into the body. When there is not enough vitamin D, it becomes difficult to maintain calcium and phosphorus levels in the bones. Especially in childhood, when bone development is very rapid, this deficiency may cause rickets.
Adding vitamin D or calcium to the diet often corrects bone problems associated with rickets. If rickets is caused by another underlying medical problem, the child may need additional medications or other treatment. When some skeletal disorders caused by rickets are very advanced, surgical intervention may be required.
Likewise, low levels of phosphorus, another important mineral in bone, may be related to rare hereditary disorders.
What are the symptoms of rickets?
Signs and symptoms of rickets can include:
- Delay in growth
- Delay in motor skills
- Pain in the spine, pelvis, and legs
- Dental structure disorders (easy decay of teeth, intermittent and late teeth, and abscesses)
- Muscle weakness
- Skull being larger than the body
Because rickets causes softening of the growing tissue areas (growth plates) at the ends of the bones in children, it can cause skeletal disorders (deformations) as listed below:
- Crooked or crooked legs (knees pointing towards each other or leg bones bent outward in the form of braces)
- Thickened hands and ankles
- Protruding (projection) of the breastbone
- Causes of rickets
The human body needs vitamin D to get calcium and phosphorus from food. If the child’s body doesn’t get enough vitamin D or his body has problems using vitamin D properly, rickets can occur. Therefore, the causes of rickets can be grouped under two headings as vitamin D deficiency and problems with absorption.
VITAMIN D DEFICIENCY
There are two important sources of vitamin D, namely sunlight and food.
- Sunlight: Human skin produces vitamin D when exposed to sunlight. However, children in developed countries tend to spend less time outdoors. In addition, sunscreens used due to the fear of skin cancer reduce the synthesis of vitamin D by blocking the sun’s rays.
- Foods: Fatty fish such as fish oil, egg yolk, salmon and mackerel contain vitamin D. Vitamin D is also added by food companies to foods and beverages such as milk, cereal, and some fruit juices.
Some children may have diseases that affect their body’s absorption of vitamin D. These diseases can be listed as follows:
- Celiac disease
- Inflammatory bowel disease
- Cystic fibrosis
- Kidney problems
Rickets risk factors
Factors that can increase a child’s risk of rickets include:
- Dark skin: Melanin is a pigment that gives color to the skin. Dark skins have more melanin in their skin structure. But melanin reduces the skin’s ability to produce vitamin D from sunlight. Therefore, dark-skinned babies and children are at higher risk of developing rickets.
- Vitamin D deficiency in the mother during pregnancy: A baby born to a mother with severe vitamin D deficiency may be born with symptoms of rickets or develop symptoms several months after birth.
- Northern latitudes: Less sunlight hits the Earth’s northern latitudes. For this reason, the risk of rickets is higher in children living in geographic areas with less sunlight.
- Premature birth: Babies born prematurely tend to have lower vitamin D levels because they have less time to take in the vitamins in the womb.
- Medications: Some medications given to prevent epileptic seizures or antiretroviral drugs used to treat HIV infections prevent the body from using vitamin D effectively.
- Breastfeeding only: Breast milk cannot provide enough vitamin D to prevent rickets. Babies who are exclusively breastfed should take vitamin D drops as a supplement. Today, the Ministry of Health provides free vitamin D supplements to pregnant and babies from health centers.
What are the complications of rickets?
Left untreated, rickets can cause the following consequences:
- Insufficient growth
- An abnormally curved spine
- Bone deformations
- Tooth defects
- Epileptic seizures
How is rickets prevented?
Sunlight is the best source of vitamin D. In most seasons, 10 to 15 minutes of sun exposure at noon is sufficient for vitamin D. However, those with dark skin and those living in northern latitudes may not get enough vitamin D from sunlight.
Also, care should be taken to avoid direct sunlight, especially for infants and young children, due to concerns about skin cancer.
To prevent rickets, you can add vitamin D-containing foods such as salmon and tuna, fatty fish, fish oil, and egg yolks, or fortified with vitamin D. Many of the foods below have vitamin D added by the manufacturers. You can check the ingredients of these types of foods and check how much vitamin D they have:
- Baby foods
- Breakfast cereals
- Some special bread
- Orange juice
If you are pregnant, you can consult your doctor about vitamin D supplements.
International guidelines on infant development recommend that all babies get 400 IU of vitamin D per day. Because breast milk contains only a small amount of vitamin D, only breastfed babies should be given an additional daily vitamin D supplement. Some bottle-fed babies may need vitamin D supplements if they don’t get enough of their formula.
How is rickets diagnosed?
During the exam, the doctor checks for abnormalities by gently pressing your child’s bones. Your doctor will pay particular attention to the following signs:
- Skull: Babies with rickets usually have softer skull bones and there may be a delay in closing soft spots (fontanelles) called fontanelles.
- Legs: It is natural for healthy babies to have legs in the form of light braces. However, an exaggerated bending of the legs is a finding that suggests rickets.
- Chest bones: Some children with rickets experience flattening of the bones in the rib cage. This causes the breast bones to stay protruding.
- Hand and ankles: Children with rickets often have larger or thicker hands and ankles than normal.
X-rays of the affected bones reveal bone deformities. Blood and urine tests confirm a diagnosis of rickets and are also used to monitor treatment response.
Treatment of rickets
Most cases of rickets can be treated with vitamin D and calcium supplements. Using too much vitamin D without a doctor’s advice can lead to vitamin D poisoning. Therefore, it is very important to follow your pediatrician’s instructions for correct dosing. Your pediatrician will follow your child’s treatment at regular intervals with X-rays and blood tests. If your child has a rare inherited disease that causes small amounts of phosphorus intake, supplements, and special medications may be prescribed. For some cases of clubfoot or spinal deformation, your doctor may recommend special support to properly position the bones as they grow. More severe skeletal disorders may require surgery.
We wish you healthy days.
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