2. What is Rickets?
Rickets is the softening and weakening of bones in
children, usually because of an extreme and prolonged
vitamin D deficiency. Rare inherited problems also can
cause rickets. Vitamin D helps your child's body absorb
calcium and phosphorus from food.
Causes :
The most common cause of rickets is a lack of vitamin
D or calcium in a child's diet. Both are essential for
children to develop strong and healthy bones.
3. Diagnostic Considerations:
Clinical Presentation:
Children with rickets may present with delayed motor milestones, bowing of
legs, and deformities of the spine. The wrists and ankles may be enlarged,
and there may be muscle weakness.
Laboratory Investigations:
Serum levels of 25-hydroxyvitamin D (25(OH)D), calcium, phosphate,
alkaline phosphatase, and parathyroid hormone (PTH) are typically
assessed. Radiographic studies, such as X-rays, can reveal characteristic
findings in the bones.
4. Prevention:
Vitamin D Supplementation:
Ensure that infants receive an appropriate
daily vitamin D supplement, as breast milk
alone may not provide sufficient vitamin D.
The American Academy of Pediatrics (AAP)
recommends a daily vitamin D supplement
of 400 IU for all infants, including those who
are exclusively breastfed.
Dietary Calcium and Phosphate:
Include foods rich in calcium and phosphate
in the child's diet. Good sources include
dairy products, green leafy vegetables, nuts,
seeds, and fortified cereals.
5. Sunlight Exposure:
Encourage safe sun exposure for the synthesis of vitamin D. However, precautions should be
taken to avoid excessive sun exposure and sunburn. The duration of sunlight exposure needed
varies depending on factors such as skin color and geographic location.
Treatment:
Vitamin D Supplementation:
Initial treatment often involves high-dose vitamin D (ergocalciferol or cholecalciferol) to rapidly
correct the deficiency. This is followed by maintenance therapy to prevent recurrence. The
choice of vitamin D formulation and dosage depends on the severity of the deficiency.
Calcium and Phosphate Supplementation:
If there is a concurrent calcium or phosphate deficiency, supplement these minerals as well.
The dosage will be determined based on the individual's needs.
Nutritional Counseling:
Provide guidance on a balanced diet rich in vitamin D, calcium, and phosphate. Encourage the
consumption of dairy products, fortified foods, and other nutrient-dense sources.
6. Monitoring and Follow-up:
Regularly monitor the child's nutritional status and adjust the treatment plan as needed. Follow-up
visits are crucial to assess progress and address any concerns.
Underlying Medical Conditions:
Identify and address any underlying medical conditions that may contribute to the deficiency, such
as malabsorption disorders.
Educate Caregivers:
Educate parents and caregivers on the importance of maintaining a well-balanced diet, proper
supplementation, and sunlight exposure. Emphasize the need for regular pediatric check-ups.
