Rickets – Diagnosis and Treatment
Rickets is a condition mostly seen in children that leads to weak or soft bones, often resulting in bone deformities like bowed legs or a curved spine.
Nutritional deficiencies, especially a lack of vitamin D and calcium, mainly cause this problem, and these nutrients are important for bone health and growth.
Genetic disorders or chronic kidney disease can also cause special types like hypophosphatemic rickets or renal rickets.
Children with rickets may have symptoms such as bone pain, muscle weakness, fractures, or a slow rate of growing. Features like rachitic rosary—a bumpiness along the rib cage—and short stature can also appear.
People with darker skin have a higher risk for vitamin D deficiency because their skin does not absorb sunlight as easily, which can lead to rickets if diets do not provide enough vitamin D or calcium.
Osteomalacia is a related condition that affects adults, but rickets often cause more visible skeletal deformities in children.
Diagnosis
Doctors use a mix of exams and tests when they try to find out if a child has rickets. During a physical exam, a healthcare provider may carefully press on different bones to look for signs like:
- Soft skull bones or delayed closure of soft spots (fontanels) in infants
- Severely bowed legs
- Unusual chest shape, such as a breastbone that sticks out
- Large wrists and ankles
Detecting rickets early is sometimes hard, especially in babies. Bone or muscle changes may not appear until the child begins to walk or shows problems with growth.
Laboratory Tests and Imaging
Doctors often order X-rays to look for bone problems such as poor bone mineralization and deformities around growth plates. Blood tests help find low levels of vitamin D, calcium, or phosphate.
These tests may check for:
| Blood Component | What It Shows |
|---|---|
| Vitamin D | Deficiency or problems with metabolism |
| Calcium | Hypocalcemia or deficiency |
| Phosphorus/Phosphate | Low levels (hypophosphatemia) |
| Alkaline Phosphatase | Often high in rickets |
| Parathyroid Hormone | May be increased |
| Calcidiol | Status of vitamin D stores |
Doctors may also use genetic testing for types of rickets related to inherited conditions.
Further Details
In some cases, urine tests or special testing can give extra clues about how the body handles minerals. Sunlight exposure, diet, and a child’s growth history all give important information to help with early diagnosis.
These checks and lab tests allow healthcare professionals to start treatment quickly.
Treatment
Most children with rickets receive vitamin D supplements and extra calcium. Healthcare providers may prescribe oral vitamin D, calcitriol, ergocalciferol, or calciferol.
In cases where a rare inherited problem leads to low phosphorus, doctors may recommend extra phosphorus supplements or other medicines.
Doctors track treatment with blood tests and X-rays. They may give active forms of vitamin D3 if needed. For children with bone or spine issues, doctors sometimes recommend braces or, rarely, surgery.
A balanced diet with fortified foods, like cereal or milk, is also important. Breast milk and formula can play a role, especially for babies. Always follow the dosage instructions because too much vitamin D can be harmful.
Getting Ready for Your Visit
Steps You Can Take Beforehand
Preparing for the appointment helps make the visit go smoothly. It can also help ensure your child receives the best care. Here are some ways to get organized:
- Write down your child’s symptoms. Include details such as when each symptom started and if anything makes them better or worse. List any signs, even if they seem unrelated to bone problems.
- Gather important background information. Make a note of medications, vitamins, and other supplements your child takes. Check if anyone else in your family had similar symptoms or has been diagnosed with bone or vitamin D issues.
- Keep a food diary. List what your child eats and drinks on a regular basis. This includes snacks and any special diets. Good nutrition is important when discussing rickets, vitamin D, and other bone health problems.
- Record physical activities. Note if your child gets sunlight exposure or plays outside often, since this affects vitamin D levels.
A simple table below can help you organize this information:
| Item | Details to Record |
|---|---|
| Symptoms | Type, when they began, any changes |
| Medications and Supplements | Name, dose, how long your child has taken them |
| Family Health History | Bone problems, vitamin D deficiencies, rickets |
| Diet and Nutrition | Meals, types of drinks, snacks, use of formula or supplements |
| Physical Activity and Sun Exposure | Outdoor play, sunscreen use, average time in sunlight |
The American Academy of Pediatrics and the Centers for Disease Control and Prevention recommend parents bring as much health history as possible to help with diagnosis and planning care.
Questions The Healthcare Team Might Ask
During the appointment, the provider will ask questions and may request further details. Being prepared to answer can speed up the visit:
- Has your child been given vitamin D supplements?
- Does your child spend time playing outside? How often?
- Do you usually apply sunscreen to your child? If so, how much and how often?
- At what age did your child learn to walk?
- Has your child had any dental issues, like frequent cavities?
Healthcare providers may also ask about your child’s usual diet and family medical conditions.
These details help medical teams figure out the best next steps for testing or treatment. If you are unsure of an answer, it is okay to say so; just provide as much information as possible.
