Rickets in children

Children’s growth and development are impacted by rickets, a medical condition mainly caused by insufficient amounts of calcium, phosphate, or vitamin D. Lack of these nutrients can cause bones to weaken and become pliable, which can result in deformities. These nutrients are necessary for the development of strong bones.

Since rickets symptoms frequently appear gradually, many parents might not immediately notice the early warning signs. These can include conspicuous alterations in the form of the legs or spine, delayed growth, and bone pain.

Thankfully, rickets is treatable and preventable. Kids can recover and grow up strong and healthy with the right diet, lots of sunshine, and medical help if needed. Parents can make sure their kids receive the care they require by being aware of the causes and treatments for rickets.

What is it?

There is no connection between food intake and rickets. Many people were unaware of this until they reached adulthood. While this illness is typical of childhood, there are other factors at play as well, chief among them being the body’s lack of vitamin D. For a baby, this vitamin is crucial during the stage of rapid growth. Deficits cause disruptions in bone mineralization and skeletal system issues.

Typically seen in infants, rickets often resolves on its own with no long-term effects on the child’s health. When a child has systemic osteomalacia, a chronic mineral deficiency of the bones that causes deformation, skeletal dysfunction, joint diseases, and other serious problems, the consequences are more severe. Due to the lack of sunny days, newborns born in the winter and autumn, as well as children with dark skin (Negroid race), are particularly vulnerable to rickets.

When skin is exposed to direct sunlight, vitamin D is produced; if this exposure does not occur or does not occur in sufficient amounts, a deficiency condition will develop.

Rickets was first described by doctors in the 17th century, and at the beginning of the 20th century, a series of experiments on dogs were conducted, which showed that cod fish oil can be used against rickets. At first, scientists believed that the problem was vitamin A, but then, through trial and error, they discovered the very vitamin D, without which the structure of bones is disrupted. Then, in Soviet schools and kindergartens, all children without exception began to be given spoons of nasty and pungent-smelling fish oil. Such a measure at the state level was completely justified – the incidence of rickets in the middle of the last century was quite high and required mass prevention.

According to statistics, rickets affects only 2-3% of infants in Russia today. We are discussing actual cases of rickets. The diagnosis of "rickets" is made far more frequently, and we will talk about these diagnostic issues later on. Thus, six out of ten children in our nation have certain signs of rickets, according to the Ministry of Health.

Even if a child receives a diagnosis of this kind, true rickets may not be present. The most common topics we discuss are overdiagnosis, commonplace "overinsurance" of physicians, and occasionally diseases similar to rickets that are also linked to vitamin D deficiency but cannot be treated with this vitamin. These conditions include nephrocalcinosis, de Toni-Debre-Fanconi syndrome, phosphate diabetes, and several other pathologies.

In any event, expectant parents need to relax and realize that, contrary to popular belief, rickets is not as serious a disease as most Russians think. With the right treatment and care, the prognosis is always good, and the illness is not as widespread as district pediatricians claim in their reports.

To ensure that you don’t overlook your child’s pathology, you should be more informed about some extremely serious cases.

Causes

As was previously mentioned, rickets is caused by a deficiency in vitamin D, a disruption in its metabolism, and metabolic disorders related to calcium, phosphorus, vitamins A, E, and C, as well as group B vitamins. The following conditions may lead to a vitamin D deficiency:

• The child walks little, rarely gets sunbaths. This is especially true for children who live in northern regions, where there is no sun for half a year. It is the lack of sunlight that explains the fact that children who get rickets in late autumn, winter or at the very beginning of spring are sick longer, more severely and more often face negative consequences of the disease. In the southern regions, a child with rickets is a rarity rather than a common pediatric practice, and in Yakutia, for example, such a diagnosis is made in 80% of babies in the first year of life.
• The child does not receive the necessary substance with food. If he is fed cow"s or goat"s milk in the absence of breastfeeding, the balance of phosphorus and calcium is disturbed, which invariably leads to a deficiency of vitamin D. Artificial babies who are fed normal, modern adapted milk formulas usually do not suffer from rickets, because this vitamin is introduced into the composition of such formulas by a variety of baby food manufacturers. A toddler who is breastfed should receive vitamin D from mother"s milk. This will not be a problem if the woman herself is in the sun or, if such walks are impossible, takes medications with the necessary vitamin.
• The child was born prematurely. If the baby was born in a hurry, all of his systems and organs did not have time to mature, and metabolic processes proceed differently. In premature babies, especially those born with low birth weight, the risk of developing true rickets is higher than in healthy children born on time.
• The baby has problems with metabolism and mineral metabolism. At the same time, the child will be spent enough time in the sun, given adapted mixtures or drugs with the necessary vitamin, but signs of the disease will still begin to appear. The root of the problem is in the violation of the absorption of vitamin D, a lack of calcium, which helps it to be absorbed, as well as pathologies of the kidneys, bile ducts and liver. A lack of zinc, magnesium and iron can also additionally affect the likelihood of developing rickets.

Classification

There are three stages of rickets according to modern medicine:

• Rickets 1 degree (mild). With this type of rickets, the child notices minor disturbances in the nervous system, minor muscle problems (for example, tone), as well as no more than two symptoms in the skeletal system (for example, relative softening of the cranial bones). Usually, this degree accompanies the very initial stage of rickets.
• Rickets of the 2nd degree (moderate). With this disease, the baby"s symptoms from the skeletal system are moderately expressed, and disorders of the nervous system are also recorded (overexcitation, increased activity, anxiety), sometimes problems with the functioning of the internal organs can be traced.
• Rickets of the 3rd degree (severe). With this degree of the disease, several fragments of the skeletal system are affected, and, in addition, there are pronounced nervous disorders, damage to the internal organs, the appearance of the so-called rachitic heart – the displacement of this important organ to the right due to the expansion of the ventricles and deformation of the chest. Usually, this one sign is enough for the child to be automatically diagnosed with "rickets of the 3rd degree".

Three factors are used to evaluate the course of rickets:

• Acute stage. With it, the child has only bone mineralization disorders and manifestations of disorders from the nervous system. Usually, this stage develops in the first six months of a child"s life.
• Subacute stage. It usually accompanies the second six months of the baby"s independent life. At this stage, not only bone mineralization disorders (osteomalacia) become obvious, but also the proliferation of osteoid tissue.
• Wavy stage (recurrent). During this stage, undissolved calcium salts break off in the bones. This can only be noticed on an X-ray. Usually, this stage can be discussed when, with acute rickets, such salt deposits are found in a child, which indicates that he has already suffered from rickets in an active form, which means that there is a relapse of the disease. This stage is extremely rare.

The time frame in which the illness manifests itself is also crucial in establishing a child’s prognosis and figuring out how much medical attention they will require:

• Initial period. It is believed that it starts when the child is 1 month old and ends when the baby is 3 months old. These are the maximum values. In fact, the initial period of rickets can last two weeks, a month, or a month and a half. During this time, there is a decrease in the phosphorus content in blood tests, although the calcium level may remain quite normal. The period is characterized by signs of the first stage of the disease.
• The period of the height of the disease. Such a period can last a maximum of six months to nine months, as a rule, at the age of 1 year, the height of the disease in a child moves to a “new level”. A decrease in calcium and phosphorus is noticeable in the blood, a deficiency of vitamin D is expressed.
• The period of reparation. This is the recovery period, it can last quite a long time – up to one and a half years. During this time, doctors will see residual signs of rickets on X-rays. A clear calcium deficiency will be traced in blood tests, but this will rather be a favorable sign – calcium goes into the bones, goes to recovery. The phosphorus level will be normal. During this period, due to the loss of calcium into bone tissue, convulsions may be observed.
• Period of residual effects. This period is not limited by a specific time frame, calcium and phosphorus in blood tests are normal. Changes caused by the active stage of rickets can recover on their own, or they can remain.

Children can avoid developing rickets, a condition that weakens and softens bones due to a deficiency of calcium, phosphate, or vitamin D. It may result in painful bone deformities, delayed growth, and other symptoms. Prompt detection and intervention, like augmenting vitamin D consumption and guaranteeing adequate nourishment, can avert grave consequences and foster robust skeletal growth.

Symptoms

Parents may fail to notice the earliest symptoms of rickets at all. Generally speaking, they can show up as early as one month into the baby’s life, but they usually become noticeable around three months. The nervous system’s operation is always connected to the initial symptoms. These are the following:

• frequent causeless crying, capriciousness;
• shallow and very restless sleep;
• disturbed sleep pattern – the baby often falls asleep and often wakes up;
• excitation of the nervous system manifests itself in different ways, most often as timidity (the baby flinches strongly from loud sounds, bright light, sometimes such flinching occurs without apparent reasons and irritants, for example, during sleep);
• the baby"s appetite at the initial stage of rickets is noticeably impaired, the baby sucks sluggishly, reluctantly, quickly gets tired and falls asleep, and after half an hour wakes up from hunger and screams, but if you give him the breast or formula again, he will again eat very little and get tired;
• the baby sweats a lot, especially in his sleep, with the head and limbs sweating the most, the smell of sweat is rich, sharp, sour in shade. Sweating causes itching, especially in the scalp, the baby rubs against the bed, diapers, the hairline is wiped off, the back of the head goes bald;
• a baby with rickets is prone to constipation, in any case, parents of an infant face such a delicate problem with enviable regularity, even if the child is breastfed.

Although some medical professionals assert that the relative softness and pliability of the fontanelle edges may be an indication of the early stages of rickets, bone changes rarely start at this point. There is no scientific evidence to support this claim.

The disease, also known as blooming rickets, is characterized by changes in bone and muscle at its peak as well as pathological processes in certain internal organs.

At this point, which typically occurs after the child is five or six months old, symptoms are added to the neurological signs listed above. A specialist must evaluate all of these signs.

• the appearance of large or small areas of softening on the bones of the skull, and in severe cases, all the bones of the skull are subject to softening;
• the processes that occur in the bone tissue of the skull change the shape of the head – the back of the head becomes flatter, the frontal and temporal bones begin to protrude, due to which the head becomes somewhat "square";
• teething slows down significantly, sometimes the teeth are cut out of order, which pathologically changes the bite;
• ribs with rickets undergo specific changes, which are called "rickets beads". At the place where the bone tissue turns into cartilage, clearly visible fragments of thickening appear. They are called "rosary beads". They are easiest to feel on the fifth, sixth and seventh ribs;
• the rib bones become softer, due to which the chest is quickly deformed, it looks as if it is compressed on the sides, in severe cases, a change in breathing may be observed;
• changes can also affect the spine, in the lumbar region of which a rachitic hump may appear;

• so-called rachitic bracelets appear on the arms and legs – thickening of the bone tissue in the area of ​​the wrist and the junction between the shin and foot. Externally, such "bracelets" look like circular encircling bone tubercles around the hands and (or) feet, respectively;
• the bones of the phalanges of the fingers can be visually enlarged in a similar way. This symptom is called "rachitic pearl strings";
• the child"s legs also undergo changes, and perhaps the most serious ones – they are curved in the shape of the letter O (this is varus deformity). Sometimes the curvature of the bones looks more like the letter X (this is valgus deformity);
• the shape of the abdomen changes. It becomes large, giving the impression of constant bloating. This phenomenon is called a "frog belly". With rickets, such a visual sign is considered quite common;
• the joints have increased flexibility and instability.

Naturally, all of these modifications have an impact on how well the internal organs function. Pneumonia is more common in children with rachitic deformities of the chest because of the compression of their lungs. A "rachitic heart" can occur from third-degree rickets, in which the heart enlarges and shifts into a different position, usually to the right. In this instance, the heart sounds become muffled, the pressure is typically lowered, and the pulse occurs more frequently than would be predicted based on average statistical norms for children.

The majority of infants with severe rickets exhibit larger liver and spleen sizes on abdominal ultrasonography exams. Both impaired immunity and kidney function issues are possible. The latter issue typically results in a higher frequency of bacterial and viral infections, which can lead to more severe and frequently complicated disease episodes.

Throughout the healing phase, rickets symptoms gradually go away. However, convulsions can occasionally be seen as a result of the blood’s decreased calcium level.

Only a few consequences remain at the final stage, known as residual effects, by which the child is typically two to three years old. These include slight enlargements of the liver and spleen, as well as curvature of the bones.

However, this is not required because there won’t be any repercussions if the rickets was mild.

Diagnostics

Everything is far more complicated than it might seem at first when rickets is diagnosed. All of the aforementioned symptoms are not recognized as indicators of rickets anywhere outside of Russia and the former Soviet Union. Stated differently, a child cannot be diagnosed with rickets based solely on the presence of poor eating habits, insufficient sleep, frequent crying, perspiration, and a bald spot on the back of his head. X-ray results and a blood test for calcium and phosphorus levels are needed for such a decision.

In reality, pediatricians in Russian clinics—in both big and small cities—diagnose rickets solely on the basis of visible symptoms. You should definitely ask the doctor why more testing has not been recommended if this occurs. It’s critical to draw blood from the child and send him for an X-ray of his extremities if rickets is suspected.

It should be kept in mind that rickets-related alterations to the skeletal system won’t show up on an X-ray until the child is six months old. Usually, the long bones are the most affected. As a result, they photograph the child’s legs. By using this method, there is no need to examine the skull, ribs, or any other bones.

If there are any pathological processes, they will all be easily seen on the leg image.

If the diagnosis is confirmed, you will need to give blood and undergo repeated X-rays during the course of treatment so the physician can monitor your dynamics and identify any concurrent pathologies or complications early on. The symptoms that the doctor diagnosed as rickets should be regarded as typical physiological symptoms if the aforementioned research and diagnostic techniques failed to establish the existence of rickets as such. Since babies begin to turn their heads in a horizontal manner between the ages of two and three months, the back of their heads bald in 99 percent of cases. As a result, the first delicate baby hair is "wiped off" mechanically; this is unrelated to rickets.

Babies all frequently sweat because of their poor thermoregulation. Excessive sweating is more likely to be caused by an incorrect microclimate, too dry air, heat in the baby’s room, and parental mistakes in dressing the child appropriately for the weather than by rickets.

In theory, a pronounced forehead and crooked legs could be inherited individual features of appearance. in addition to a small chest. Furthermore, erratic behavior and increased yelling are typical characteristics of a baby or of inadequate care. The reason it is so crucial to insist on a complete diagnosis is that nearly every rickets symptom also has a physiological and entirely natural cause.

Additionally, the similarity between the disease’s symptoms and those of normal variations explains why children who do not actually have rickets are frequently diagnosed with it.

Treatment

The course of treatment will be determined by the severity, duration, and stage of the rickets. In theory, mild cases of rickets that are discovered by accident don’t require special care. If the child is unable to walk in the sun more frequently, it is sufficient for them to take vitamin D-containing medications. The key is to avoid doing this simultaneously, that is, consuming "Akvadetrim" during the summer, as this raises the risk of an overdose of the drug, which is worse and more dangerous than rickets in and of itself.

A different specialist who can treat the child with competence and responsibility should be sought out if the doctor recommends a double dose of a vitamin D-containing medication in more severe cases of the illness. No matter how severe the illness is, all prescriptions containing the required vitamin must be taken precisely in single age-related doses and never more.

Give the child calcium supplements in addition to these vitamins (if the blood level of this mineral is low).

The most well-known and widely used vitamin D-based products are:

• "Akvadetrim";
• "Vigantol";
• "Alpha-D3-TEVA";
• "D3-Devisol Drops";
• "Colicalciferol";
• food fish oil.

To help parents treat rickets effectively, parents can print out a table of vitamins needed for their child and check it frequently to make sure the child is getting enough of the essential vitamins. This will help avoid dosage confusion. As you can see, babies only require 300–400 IU of vitamin D daily. There is an absolute ban on going against these dosages.

A child diagnosed with rickets needs to have their diet completely changed. Correcting your diet will undoubtedly be assisted by a doctor. The food should be well-balanced and have enough calcium and iron. Generally, there is no need to add anything to a formula if the child is being fed it modified.

The baby’s diet must consist of fish, eggs, liver, and greens while they heal and while any aftereffects are being evaluated.

For a child with signs of rickets, it is important to spend as much time as possible in the fresh air, as well as undergo several courses of therapeutic massage and therapeutic gymnastics. At the initial stages, with a mild degree of the disease, a general strengthening massage is usually prescribed, the purpose of which is to relax the muscles, relieve nervous tension, and improve blood circulation in the tissues. With moderate and severe rickets, massage will also play an important role, but it will need to be done very carefully and cautiously, since bending and unbending the child"s limbs in the joints with pronounced bone changes poses a certain danger to the baby – the likelihood of a fracture, dislocation, subluxation increases. In addition, children with rickets get tired more quickly and more during physical activity.

Traditional massage techniques, such as kneading, stroking, and rubbing, can be performed at home. But everything needs to be done carefully, slowly, and smoothly. Bending the limbs at the joints and bringing the legs together and apart should be part of gymnastics. Parental or massage therapist should try to avoid patting or striking movements during massage and gymnastics as children with rickets are quite shy and react painfully to unexpected sensations or sounds.

This is how the best gymnastics program appears:

• At 1-2 months – lay the baby on his tummy and rock him in the fetal position;
• At 3-6 months – lay him on his tummy, encourage crawling movements, rolls with support, bend and unbend the arms and legs both synchronously and alternately;
• At 6-10 months, add to the already mastered exercises lifting the body from a lying position, holding the baby by the spread arms, and lifting from a lying position to a knee-elbow position;
• From the age of one year, you can use foot massage mats, practicing daily walking on them, squatting for fallen toys.

The child may occasionally be prescribed artificial UV irradiation treatments. To prevent taking too much vitamin D, vitamin D preparations are not taken concurrently with UV procedures. While some parents visit the clinic’s physiotherapy room, others can afford to purchase a quartz lamp for their home and perform the procedures themselves. Ten to fifteen sessions are included in each course of "tanning" under the fake "sun".

The procedures are abandoned and vitamin D preparations are taken in their place if the child’s exposure to UV radiation results in severe skin reddening and allergic reaction symptoms.

A child with rickets is frequently prescribed pine and salt baths by the doctor. Use dry coniferous extract and either regular or sea salt to prepare them. Generally, a course of therapeutic baths is recommended for ten to fifteen days. Depending on the child’s age and unique characteristics, each procedure takes three to ten minutes.

Pine baths were thought to have a potent anti-rachitic effect not too long ago. Modern research, however, has not shown that taking such baths in particular for rickets significantly improves outcomes. Pine and salt baths strengthen the immune system and increase blood circulation, just like they do for many other diseases. Although they may be used in complex therapy, they do not directly treat rickets; the child will not get worse after taking one of these baths.

Additionally, the results of blood tests are used to determine the need for such medications. In cases of low phosphorus, ATP is prescribed; in cases of low calcium, calcium preparations are prescribed.

Consequences

Forecasts for classical rickets are typically optimistic and favorable. The child makes a full recovery. If parents of a child with rickets who has a diagnostic could not follow medical advice or refused treatment for whatever reason, health complications could result.

Future complications from rickets can only be predicted if parents and physicians respond to the disease’s symptoms promptly and appropriately. And there can be a wide range of complications. This includes the curvature of the bones; it is not aesthetically pleasing and particularly uncomfortable if a girl has "wheeled" legs. Curved bones also bear the weight of the body differently, wear out more quickly, are more prone to fractures, and eventually start to thin out. This can lead to severe injuries to the musculoskeletal system, even resulting in disability.

Children with moderate to severe cases of rickets frequently develop dental conditions like caries, periodontal disease, and other oral health issues that require enviable consistency in treatment. Pathologies like flat feet and scoliosis can arise following a severe case of rickets. Due to weakened immunity, children who have experienced severe rickets typically get sick more frequently than their peers because they are more susceptible to viruses and bacteria.

The pelvic bones’ narrowing and deformity is among the most uncomfortable effects of rickets. For girls, this is a very undesirable outcome because the altered pelvic bones will make future natural childbirth challenging.

Early-life rickets is frequently a sign that a cesarean section is necessary.

Cause	Lack of vitamin D
Symptoms	Soft bones, delayed growth, muscle weakness
Prevention	Regular sun exposure, vitamin D supplements
Treatment	Vitamin D and calcium-rich diet, supplements
Age group	Mostly infants and toddlers
Risk factors	Limited sun exposure, poor diet

With careful attention to a child’s diet and lifestyle, rickets is a condition that can be managed and even prevented. A diet high in calcium and vitamin D, combined with adequate sun exposure, is essential for promoting healthy bone development.

The key is early detection. Parents should speak with a medical expert if they observe any symptoms of rickets, such as bone pain, delayed growth, or abnormal bone shape. The effects of rickets can be treated and children’s future health can be strengthened with prompt intervention.

Through proactive and informed parenting, families can minimize the risks of rickets and promote the general health and well-being of their children by fostering a strong and healthy childhood.

Video on the topic

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