Rickets

Several elements can increase a child’s chances of developing rickets. These include:

• Children with darker skin are at greater risk due to the higher melanin content in their skin, which limits the body’s ability to produce Vitamin D from sunlight.
• Residing in colder areas of India where sunlight exposure is limited.
• Consuming a diet that lacks adequate amounts of Vitamin D, calcium, and phosphorus.
• Infants who are exclusively breastfed, as breast milk contains only small quantities of Vitamin D.
• Individuals who spend most of their daytime hours indoors and avoid direct sunlight.

A pediatrician is typically the first medical professional to consult for a suspected case of rickets. The doctor will begin by conducting a physical exam, gently pressing on your child’s bones to check for tenderness or abnormalities. Special attention is given to:

• Skull: Babies with rickets often have soft skull bones and delayed closure of fontanels (soft spots).
• Legs: While slight bowing is normal in toddlers, severe bowing may indicate rickets.
• Chest: Some children may develop a flat rib cage or a protruding breastbone.
• Wrist and ankle joints: These areas may appear unusually thick or wide in affected children.

After the initial assessment, the pediatrician may suggest further tests to confirm the diagnosis, including:

• Blood tests: These measure levels of calcium, phosphorus, parathyroid hormone, and alkaline phosphatase (ALP).
• Urinary calcium test: Elevated calcium in the urine, especially when blood calcium is low, is a key diagnostic indicator.
• X-rays of the bones: Used to detect any bone deformities.
• Bone biopsy: Performed in rare cases, where a small sample of bone is removed for lab analysis.
• DEXA scan (bone densitometry): This test assesses bone mineral density through spectral imaging.

To reduce the likelihood of rickets, consider the following preventive strategies:

Sunlight exposure

According to the NHS in England, exposing a child’s hands and face to the sun regularly can help prevent rickets. Limit direct sunlight exposure to under 60 minutes per day (based on skin type), and always use sunscreen if staying out longer. Avoid sun exposure between 10 AM and 4 PM when the rays are most intense.

Nutrient-rich diet

Include foods high in Vitamin D, calcium, and phosphorus in your child’s diet. Sources like oily fish, meat, mushrooms, and egg yolks are beneficial. Adding foods fortified with these nutrients can also help.

Vitamin D can also be obtained through sources like UVB exposure, cod liver oil, viosterol, and halibut-liver oil.

Vitamin D supplements

Health authorities recommend a daily intake of 10 micrograms of Vitamin D for adults, pregnant women, and children over 1 year. For infants under 1 year, a daily dose of 8.5 to 10 micrograms, or 500 ml of infant formula, is advised.

Specialist to Consult

If your child exhibits symptoms like skeletal deformities, slowed growth, bone discomfort, or muscle weakness, consult a doctor promptly.

Adults experiencing similar symptoms should also seek medical advice.

Medical professionals who can help diagnose and manage rickets include:

• Pediatricians
• General physicians
• Orthopedic specialists

The foundation of rickets treatment involves a nutrient-rich diet that includes adequate amounts of Vitamin D, calcium, and phosphorus. Additional treatment methods include:

Surgical intervention

• Though most deformities due to rickets can be managed without surgery, in severe cases, operations may be needed to correct major bone abnormalities such as extreme bowing of the legs. Deformities in the chest or pelvis and significant growth delays may be irreversible.

Stoss therapy

• This treatment involves administering a high single dose of Vitamin D, either orally or via injection, especially for infants under one month old. Oral administration is generally preferred due to faster absorption. This method is considered effective and safe for treating Vitamin D-deficient rickets.

Regular Vitamin D dosing

• Smaller, daily doses of Vitamin D are tailored to the child’s age. Infants under 1 month typically receive 1000 IU daily, while those between 1–12 months receive 1000–5000 IU. Children over 1 year may be given 5000 IU for 2 to 3 months. A maintenance dose of 400 IU daily is then recommended.

Calcium and phosphate supplementation

• For genetically influenced types of rickets, a pediatric endocrinologist and orthopedic specialist should oversee treatment. In cases of Vitamin D-dependent rickets, children may require large doses of calcitriol and calcium. Those diagnosed with familial hypophosphatemic rickets are usually treated with oral phosphate and Vitamin D supplements.

When rickets results from a calcium deficiency, it can trigger seizures, muscle cramps, and breathing difficulties in children. Over time, the condition may lead to more serious issues, such as:

• Stunted growth
• Frequent bone fractures
• Pneumonia (fluid buildup in the lungs)
• Dental hypoplasia (underdeveloped tooth enamel)
• Cardiomyopathy (a condition that limits the heart’s ability to pump effectively)
• Hydrocephalus (excess fluid accumulation in the brain cavities)
• Seizures
• Tooth decay
• Skeletal abnormalities

Ayurveda, an ancient system of natural medicine, has long been used to treat a wide range of health conditions, including rickets. Below are a few Ayurvedic remedies that may support rickets management. Always consult a qualified Ayurvedic practitioner before use.

Pearl Ash (Moti Bhasma)

• Give 125 mg of pearl ash with two teaspoons of honey twice a day. In more serious cases, seek advice from a certified Ayurvedic professional.

Oatstraw Baths

• Boil dried oatstraw in 4 liters of water and use this for bathing your child twice a week.

Dandelion Tea

• Steep dried dandelion leaves in a cup of boiling water for five minutes. Strain and offer the tea to your child.

Nettle Herb Infusion

• Place an ounce of dried nettle in a jar, fill it with one quart of hot water, cover, and let it sit overnight. Strain and consume two cups daily.

Horsetail Tea

• Combine one teaspoon of horsetail tea leaves with two cups of hot water and oatstraw herb. Let it steep for 5 to 7 minutes, strain, and drink after meals.

Medical experts emphasize the vital role of nutrition in both preventing and managing rickets. Here are some key home-care measures to follow:

• Administer 400 IU of Vitamin D daily to children affected by Vitamin D-dependent rickets.
• For breastfed infants, whether exclusively or partially, introduce 400 IU of Vitamin D per day until they begin consuming at least 1 liter of formula daily.
• If your child isn’t breastfed and consumes less than a liter of formula each day, they should still receive 400 IU of Vitamin D supplementation.
• Incorporate foods like milk, cheese, yogurt, meat, and fish into your child’s meals to help boost their intake of Vitamin D, calcium, and phosphorus.
• If your child is lactose intolerant, consider fortified alternatives such as soy milk or orange juice, both of which are high in Vitamin D.

If your child has been diagnosed with rickets, these tips can help you manage the condition effectively:

• Administer daily Vitamin D supplements as prescribed by your healthcare provider.
• Encourage daily sunlight exposure for 10–15 minutes, tailored to your child’s skin sensitivity.
• Offer a balanced diet rich in dairy products, fish, and meat.
• Engage your child in regular physical activities to help strengthen their bones.
• Schedule visits to a qualified physiotherapist for improved mobility and pain relief.

If your child continues to experience muscle cramps or discomfort, consult your doctor for further evaluation. A physiotherapist can also assist in managing symptoms and improving movement.

In certain cases, doctors may suggest using braces to promote straight bone growth and support limb development. Braces might also be used after surgery. While there’s limited scientific evidence supporting bracing as a treatment for rickets, follow your doctor’s recommendations regarding proper usage and consistency.

Although rickets can cause considerable discomfort, the condition is treatable when managed with proper care, a nutritious diet, appropriate therapy, and regular outdoor activity. Caregivers play a crucial role in supporting the child’s recovery and overall well-being.