What Is Vitamin-D Deficiency and Rickets in Children?
Rickets is a disease affecting the growing bone and commonly seen in children. It occurs due to failure of bone mineralization. Its management is necessary to maintain the growth of the child. It requires simple investigations and supplementation of vitamin D and calcium. Vitamin D is a fat-soluble vitamin required to regulate minerals like calcium and phosphorus in the body. It is also essential to maintain proper bone structure, as it helps absorb calcium from the food in the intestines. If not, the calcium in our diet will be excreted through the kidneys. Vitamin D deficiency is when the level of vitamin D becomes too low in the body and affects the bone. Vitamin D functions as a hormone, so it is called a prohormone, and all the cells in the body have a receptor for it.
The softening and weakening of bones in children is called rickets. Calcium and phosphate are required for bones' healthy growth and mineralization, and vitamin D is needed to regulate this calcium and phosphate balance. A lack of mineralization of the growth plate in children causes rickets.
What Are the Causes of Vitamin-D Deficiency and Rickets in Children?
Rickets 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.
What Are the Sources of Vitamin D?
Sunlight:
The body synthesis vitamin D in the skin under the stimulus of sunlight (ultraviolet light). Presently, the 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 sunscreen use and children's involvement in indoor activities instead of playing outdoor games.
Other sources:
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Cod liver oil is a good source of vitamin D.
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A naturally rich dietary source of vitamin D is fish.
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Some dairies fortify dairy milk with vitamin D. Although human milk is the primary source of nutrition for the baby, it contains very little vitamin D (less than 20-40 IU/L). Therefore, infants who are only breastfed are at risk of rickets. Hence they require oral supplementation of vitamin D.
What Are the Symptoms of Rickets?
Generalized weakness of an unknown mechanism is observed in most of the patients.
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Craniotabes (thinning of the skull bone and hence the bone becomes soft) is the first manifestation of vitamin D deficiency in the case of an infant. At a later age, it presents as a prominent forehead.
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Deformities such as bowlegs (wide apart knees when a child stands with both feet together) and knock-knees(inability to touch both feet together due to inward angulation of the knee) occur in the weight-bearing bones.
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Chest manifestations are rachitic rosary (beaded chest) and Harrison's sulcus (groove formed in the chest due to inward pull of the softened rib bone).
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Pelvic bone (hip bone) distortion in female children due to rickets may cause problems with childbirth later in life during pregnancy.
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In more severe instances in children older than two years, vertebral softening leads to kyphoscoliosis (abnormal curvature of the spine both forward and sideward).
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Fractures of long bones may occur.
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Rickets may lead to skeletal deformity and short stature.
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Rarely metabolic diseases in the form of hyperparathyroidism and vitamin D-resistant rickets may also cause similar clinical features.
What Are the Investigations for Vitamin D Deficiency and Rickets in Children?
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Radiography (X-ray) looks for evidence of osteopenia (low bone density). This helps in follow-up to look for healing.
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Checking serum levels also helps in the detection. Serum levels of the following:
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Calcium.
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Phosphates.
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Alkaline phosphatase.
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Parathyroid hormone.
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25-hydroxy vitamin D.
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In the case of rickets serum, calcium, phosphate, and vitamin D will be low and alkaline phosphatase will br invariably elevated.
What Is the Treatment for Vitamin D Deficiency?
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Supplementation of vitamin D and calcium.
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Vitamin D can be given in either of the two regimens: a short regimen includes a single daily dose of 600,000 IU of vitamin D. In the gradual method, 5000 to 10,000 IU is given daily for two to three months until levels of alkaline phosphatase decline. However, long-term treatment requires daily treatment, and many patients are not compliant with the therapy. So, the success rate is less when compared to a single-day regimen.
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Along with vitamin D, calcium supplementation is equally important in a 100 to 200 mg/kg/day (milligrams per kilograms per day) dose for at least three months.
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In case of severe deformities, orthopedic correction should be done if indicated.
What Are the Preventive Measures to Avoid Rickets?
Rickets are preventable. Give 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 ultraviolet light penetration) to the body. This will be sufficient to meet the daily need for vitamin D. Along with this, give a vitamin D-rich diet.
What Are the Other Disorders Associated With the Deficiency of Vitamin D?
Osteomalacia:
The softening of bones in adults or children due to problems with bone formation or the bone-building process causes osteomalacia. The most common cause of osteomalacia is vitamin D deficiency.
Osteoporosis:
Osteoporosis is a bone disorder that reduces bone density making it more susceptible to fracture. Sometimes the bones become so brittle that mild forces like bending or coughing can cause fractures.
Conclusion:
Vitamin D is a prohormone required to regulate the minerals which are essential for the body. Rickets is one of the common disorders seen in children, which is generally caused by the deficiency of vitamin D. However it is a preventable disease. An adequate intake of vitamin D is very important and is available in many natural forms. To lead a healthy life, having a proper meal with all the essential nutrients is very important.
