Parenting & Children's Health

Vitamin-D Deficiency and Rickets In Children

Written by
Dr. Babu Lal Meena
and medically reviewed by iCliniq medical review team.

Published on Oct 29, 2015 and last reviewed on Oct 19, 2019   -  3 min read

Abstract

Abstract

Extreme and prolonged vitamin D deficiency in children can result in rickets, which makes their bone soft and weak. This article discusses in detail the causes, investigations, and management of rickets.

Vitamin-D Deficiency and Rickets In Children

Rickets is a disease of growing bone that occurs in children. It occurs due to failure of bone mineralization. It's management is necessary to maintain growth of the child. It requires simple investigations and supplementation of vitamin D and calcium.

Causes

It occurs mostly due to vitamin D deficiency. Vitamin D deficiency rickets occurs when this element is deficient due to lack of sun exposure, insufficient dietary intake or inadequate absorption.

Sources of Vitamin D:

1) Sunlight:

Body synthesizes vitamin D in the skin, under the stimulus of sunlight (ultraviolet light).

Presently industrial revolution has increased the prevalence of rickets. This disease appears as an epidemic in temperate zones due to pollution from factories. The pollution causes blockage of the sunlight and hence rickets.

In some areas of the world there is a custom of wrapping the children in clothes and not exposing their body parts to sunlight, thereby causing rickets. Other reasons are use of sunscreen and involvement of children in indoor activities instead of playing outdoor games.

2) Other sources:

Cod liver oil is a good source of vitamin D.

Natural rich dietary source of vitamin D is fish.

Some dairies fortify dairy milk with vitamin D. Although human milk is the principle source of nutrition for the baby it contains very less vitamin D (less than 20-40 IU/L). Therefore, infants who are only breastfed are at the risk of rickets. Hence they require oral supplementation of vitamin D.

Symtoms of rickets

  • Generalized weakness of an unknown mechanism is observed in most of the patients.
  • Craniotabes (thinning of the skull bone and hence the bone becomes soft) is the first manifestation of vitamin D deficiency in case of infant. In later age it presents as prominent forehead.
  • Deformities such as bowlegs (wide apart knees when a child stands with both the feet together) and knock-knees(inability to touch both the feet together due to inward angulation of the knee) occur in the weight bearing bones.
  • Chest manifestations are rachitic rosary (beaded chest) and Harrisons sulcus (groove formed in the chest due to inward pull of the softened rib bone).
  • Pelvic bone (hip bone) distortion in female children due to rickets, may cause problems with childbirth later in life during pregnancy.
  • In more severe instances in children older than 2 years, vertebral softening leads to kyphoscoliosis (abnormal curvature of the spine both forward and sideward).
  • Fracture of long bones may occur.
  • Rickets may lead to skeletal deformity and short stature.

Rarely metabolic disease in form of hyperparathyroidism and vitamin D resistance rickets may also cause similar clinical features.

Investigations

Radiography (X-ray) to look for evidence of osteopenia (low bone density). This helps in the follow up, to look for healing.

Serum levels of the following:

  • Calcium.
  • Phosphates.
  • Alkaline phosphatase.
  • Parathyroid hormone.
  • 25-hydroxy vitamin D.

In case of rickets serum calcium/phosphate/Vitamin D will be low and and alkaline phosphatase invariably elevated.

Treatment

  • Supplementation of vitamin D and calcium.
  • Vitamin D can be given in either of the two regimen: Short regimen includes a single day dose of 600,000 IU of vitamin D. In the gradual method, 5000-10,000 IU is given daily for 2-3 months until levels of alkaline phosphatase decline. Long term treatment option requires daily treatment and many patients are not compliant to the therapy. So, success rate is less when compared to single day regimen.
  • Along with vitamin D, supplementation of calcium is also equally important in a dose of 100 to 200mg/kg/day for at least 3 months.
  • In case of severe deformities, orthopaedic correction should be done if indicated.

Prevention

Rickets is preventable. Give your baby sunbath for about 15 to 30 minutes daily, depending upon the skin color (more time in babies with a dark complexion, because dark skin blocks penetration of ultraviolet light). This will be sufficient to meet the daily need of vitamin D. Along with this, give a vitamin D rich diet.

Last reviewed at:
19 Oct 2019  -  3 min read

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