Rickets: Causes, Symptoms, Treatment, and Precautions

Rickets is a condition that occurs when the body does not absorb enough calcium and phosphorus for bones to grow normally. The main cause of rickets is vitamin D deficiency, an essential nutrient that helps the body absorb calcium from food.

1. Sources of Vitamin D

a. Synthesis through skin:

• The body can synthesize vitamin D from pre-vitamin D under the action of sunlight.

• Note:

• Direct sunlight on the skin for only 15-20 minutes per day is sufficient.

• It’s best to sunbathe in the early morning or late afternoon, avoiding the intense sun at noon.

• Using sunscreen can hinder vitamin D synthesis.

• 80% of total vitamin D is synthesized through the skin.

b. Dietary sources:

• Animal products: Liver, egg yolk, milk, meat (salmon, tuna, mackerel).

• Plant products: Mushrooms, soybeans, fortified cereals.

Note:

• It’s important to supplement vitamin D from various sources to ensure the body absorbs enough.

• The amount of vitamin D needed by the body depends on age, sex, and health condition.

2. Groups of People Susceptible to Rickets

• Children under 3 years old, especially those from 3 to 18 months old:

• At this age, children are in a rapid bone development phase, requiring higher vitamin D needs.

• Young children often stay indoors, reducing their exposure to sunlight.

• Exclusively breastfed infants may lack vitamin D if mothers do not supplement enough.

3. Mechanism of Vitamin D Deficiency

• Vitamin D deficiency -> Reduced calcium absorption in the intestines -> Decreased blood calcium -> Increased parathyroid hormone (PTH) secretion -> Reduced phosphorus reabsorption in the renal tubules -> Decreased blood phosphorus -> Impaired nervous system function => Excitation, sweating.

• Decreased blood calcium -> Mobilization of calcium from bones into the blood -> Osteoporosis.

4. Causes of Vitamin D Deficiency

• Lack of sunlight exposure: Children staying indoors frequently, not getting regular sun exposure.

• Dietary factors:

• Breast milk low in vitamin D: Mothers not supplementing enough vitamin D during pregnancy and breastfeeding.

• Early introduction of starchy foods: Reduces calcium and vitamin D absorption from food.

• A diet deficient in calcium and vitamin D.

5. Symptoms of Rickets

a. Early rickets (<6 months old):

• Hypocalcemia.

• Bone deformities: Primarily in the skull, softened according to the lying position, frontal bossing, parietal bossing.

• Decreased muscle tone, anemia.

• Laboratory tests: Increased alkaline phosphatase.

b. Classical rickets (>6 months old):

• Hypocalcemia.

• Bone deformities: Rachitic rosary, pigeon chest, bowed legs.

• Decreased muscle tone, anemia.

• X-ray: Enlarged epiphyses, cupped appearance.

6. Treatment of Rickets

a. Classical rickets:

• X-ray showing cupped epiphyses: Use high-dose vitamin D 5000 IU/day for 2-3 weeks.

• Re-evaluation if improvement occurs: 400 IU/day.

• If still deficient: 5000 IU for 2 weeks.

• No need to add calcium supplements.

b. Early rickets (<6 months old):

• Vitamin D administration: 1500-2000 IU/day for 3-4 weeks –> Switch to preventive dose of 400 IU/day until walking.

• Calcium supplementation:

• If maternal deficiency: Take calcium gluconate/lactate 2g/day.

• If infant deficiency: Calcium gluconate 10% at a dose of 1-2 ml/kg intravenously, monitor ECG.

7. Precautions

• Decreased blood calcium in children:

• Blood calcium < 7.0 mg/dl OR

• Ca2+ < 3.5 mg/dl.

• Preventive dose for children <12 months: 400 IU/day.

• Preventive dose for preterm infants and twins: Higher dose in the first 3 months: 1000 IU/day.

• Diet: Supplement calcium from calcium-rich foods like milk, cheese, yogurt, and leafy green vegetables.

• Regular health check-ups: It’s important to take children for regular health check-ups to detect rickets and other health problems early.

8. Conclusion

Rickets is a preventable condition by ensuring sufficient vitamin D intake. It’s essential to supplement vitamin D from various sources, especially sunlight and vitamin D-rich foods.