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.
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.
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.
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.
Rarely metabolic disease in form of hyperparathyroidism and vitamin D resistance rickets may also cause similar clinical features.
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:
In case of rickets serum calcium/phosphate/Vitamin D will be low and and alkaline phosphatase invariably elevated.
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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