Definition of Nutritional Rickets
Rickets is a serious nutritional disorder in children who do not get sufficient amounts of calcium, phosphorus or vitamin D, which are vital for healthy, growing bones, in their diet. The result is weak bones, bowed legs, and other bone deformities. (1)
Our bodies need vitamin D to help absorb calcium and phosphorus from the food we eat. If your child doesn’t get enough vitamin D nutritional rickets can result. (2) Some children are actually born with rickets, perhaps as a result of their bodies not being able to use vitamin D properly.
This article looks at nutritional rickets.
Rickets was actually eradicated in the United States in the 1930s once scientists discovered the effects of adequate amounts of vitamin D. The incident rate of rickets hasn’t been tracked since then, so it’s difficult to know for sure how many cases are appearing in the United States now. One study estimates nine cases per 1 million children.
However, the Centers for Disease Control and Prevention says it may be more like five cases per 1 million children aged 6 months to 5 years. What is consistent throughout multiple studies is that most of the affected children were black-skinned. (4)
Risk Factors for Nutritional Rickets
There are several risk factors that may make a child more susceptible for developing rickets.
• Exclusive, long-term breastfeeding
Breast milk generally contains less than 20-40 IU/L (international units per litre) of vitamin D. (3) The American Academy of Pediatrics recommends that infants (babies less than 12 months old) get 400 IUs of vitamin D per day. (5)
• Low calcium intake
Children who take in less than 300 mg of calcium per day (about one cup of milk) are at risk for rickets. (1)
• Lack of sun exposure/Use of sunscreen
Our skin produces vitamin D when it’s exposed to ultraviolet B rays. But children are spending less and less time outside, and when they do go outside, they’re wearing sunscreen, which blocks the UVB rays that trigger the skin’s production of vitamin D. (2) People who live in northern areas where there are long periods without sunlight are also at risk.
• Darker skin
“Dark-skinned persons require more sunlight exposure than others to produce the same amount of vitamin D because melanin acts as a neutral filter and absorbs solar radiation.” (4)
• Medical conditions
Conditions such as celiac disease, inflammatory bowel disease, cystic fibrosis, or kidney problems can affect how effectively bodies can absorb vitamin D. (2)
Symptoms and Treatments of Nutritional Rickets
Symptoms of nutritional rickets include:
- Drowsiness
- Low muscle tone
- Seizures
- Delayed development, decreased growth, or “failure to thrive”
- Bowed legs and widening of the wrist and ankle bones
- Stooped posture
- Pain in the spine, pelvis and legs
- Abnormal gait
- Chest and rib deformities due to nodules (bumps) developing at the end of their ribs which can also contribute to lung infections (1) and respiratory failure in children (3)
In the case of nutritional rickets, as opposed to rickets caused by hereditary issues, treatment consists of Vitamin D and calcium supplements, usually 1000-2000 IUs per day of vitamin D and 1000-1500 mg/day of calcium. (1)
This treatment begins to work immediately although recovery may take many months. Bone deformities can get better over time without surgery, however, surgery may be indicated for severely bowed or knock-kneed legs, and other bone deformities. (1)
Chest or pelvic deformities and growth retardation, may be permanent. “In females, pelvic distortion from rickets may cause problems with childbirth later in life.” (3)
Preventing Nutritional Rickets
The key to preventing rickets caused by poor intake levels of vitamin D, phosphorus and calcium is to make sure that your child is getting enough of these vitamins.
• Exclusively breastfed infants should receive 400 IUs of vitamin D through supplements. Nursing moms should also add 4000 IUs of Vitamin D to increase the levels of vitamin D in the breast milk. (1)
This can be done through supplements and eating foods high in vitamin D, such as fish oils, fatty fish (ocean bound), and egg yolks or foods fortified with vitamin D, such as milk, cereal and some fruit juices. (2)
• Infants also need about 400 mg of calcium daily (the equivalent of 1 ½ cups of milk). (1)
Rickets can happen in older children as well, so it is important for them and teenagers to get 1000-1500 IUs of Vitamin D every day and 1500-2000 mg of calcium. (1)
Sources:
1) Rickets. American Academy of Orthopaedic Surgeons. Web. Oct 16, 2013.
http://orthoinfo.aaos.org/topic.cfm?topic=a00577
2) Rickets. MayoClinic. Web. Oct 16, 2013.
http://www.mayoclinic.com/health/rickets/DS00813
3) Rickets. Medscape. Web. Oct 16, 2013.
http://emedicine.medscape.com/article/985510-overview
4) Rickets: Not a Disease of the Past. Nield, Linda S. et. al. American Family Physician. Am Fam Physician. 2006 Aug 15;74(4):619-626. Web. Oct 16, 2013.
http://www.aafp.org/afp/2006/0815/p619.html
5) Child Health 411. Brown, Ari, MD. WebMD. Web. Oct 17, 2013.
http://blogs.webmd.com/child-health-411/2010/02/sunshine-and-vitamin-d-a-catch-22.html
Reviewed October 17, 2013
by Michele Blacksberg RN
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Description: Rickets is a serious nutritional disorder in children who do not get sufficient amounts of calcium, phosphorus, or vitamin D, which are vital for healthy, growing bones, in their diet. The result is weak bones, bowed legs, and other bone deformities.
Page Title: Vitamin D and Calcium - The Cure for Nutritional Rickets