Rickets: symptoms, causes and how to treat it

Definition of rickets

What is rickets?

Rickets is a musculoskeletal disorder in children that causes weak bones, bent legs and other bone deformities.

Generally, children who suffer from rickets because they do not get enough calcium, vitamin D, and phosphorus in the long term. In fact, all these nutrients are very important to support healthy bone growth.

In rare cases, a child who has the disease, also known as rickets or rickettsia, occurs as a result of an inherited disorder that is inherited by family members.

How common is this condition?

Rickets is a bone disorder that can affect both boys and girls. Although it can affect children who are older, this bone disorder mostly occurs in infants and children who have not yet entered school age.

In fact, this disease can also occur in newborns of mothers whose vitamin D levels are low.

Signs & symptoms of rickets

Low levels of vitamin D or other nutrients for bones cannot be seen with the naked eye. However, when this condition has caused disturbances and changes in the body, then the symptoms will appear.

The characteristics of rickets in children or infants that commonly occur are:

• Soft skull bones (craniotabes).
• There is swelling of the skull which is described by excessively protruding forehead (frontal bossing).
• Deformity occurs, namely changes in the shape and structure of the bones, especially in the chest and ribs. The baby or child may have a nodule (lump) at the end of their ribs. This condition is known as the rachitic rosary.This condition can increase the risk of developing lung infections.
• Babies experience delays in the process of closing the skull bones.
• The child's growth is very slow, teeth are easily damaged and he is also slow to crawl, sit and walk.
• Babies or children are easily agitated and have difficulty sleeping well.
• The ends of the long bones (thighbone, femur, calfbone, and upper arm bone) become enlarged. These bone changes are sometimes accompanied by swelling of joints, such as wrists and feet. Pain also accompanies swelling of the bones and joints.
• Abnormal foot shape, if you pay attention to the shape curved inward like the letter O.
• Muscles weaken and often twitch, especially around the wrists and feet.
• In severe cases, the bones with this abnormality become brittle and break easily.
• Over time, children can develop cardiomyopathy, which is an abnormality in the heart muscles.
• If the calcium level in the blood is very low, the child will develop hypocalcemia, which can lead to seizures and intellectual disabilities.

When to go to the doctor

If your little one shows any of the symptoms mentioned, and you are worried that this may indicate rickets, see a doctor immediately.

Every baby or child shows different symptoms of bone abnormalities, and some even experience symptoms that are not described above. So, the best step is to hurry up the doctor's care.

Causes of rickets

Various things that can be the main cause of rickets are:

Vitamin D deficiency

Vitamin D is needed by the body to absorb calcium and phosphorus from food. If the body lacks vitamin D intake, automatically the body's ability to absorb calcium and phosphorus is not optimal. In the end, it will make the body also lack calcium and phosphorus.

A pregnant woman who lacks vitamin D intake is most likely the cause of the baby being born with rickets. Meanwhile, in infants or children, vitamin D deficiency that results in rickets is caused by:

• Lack of sun exposure. The benefits of sunshine, especially in the morning, which on the skin will be converted by the body into vitamin D. If your little one is not exposed to direct sunlight, bone abnormalities can occur.
• Lack of intake of foods containing vitamin D. Source of vitamin D, not only from sunlight, but also from food. Examples of foods that naturally contain vitamin D are fish oil, egg yolks, salmon, milkfish and mackerel.

Health problems in absorbing nutrients

Some children are born with health problems that affect how the body absorbs vitamin D, which can expose them to bone disease. Some of the health problems that can increase the risk of rickets are:

• Celiac disease, which is a reaction by the immune system that mistakes gluten (a protein in wheat) as a threat to the body. This reaction over time damages the lining of the intestine and can interfere with the process of absorption of nutrients.
• Inflammatory bowel syndrome (IBD), which is an intestinal irritation that inflames the intestines so that it interferes with the absorption of nutrients from food and drink.
• Kidney disease can cause decreased levels of vitamin D in the body because the kidneys are unable to change the form of vitamin D that is active optimally.
• Cystic fibrosis, an inherited disorder that can interfere with enzymes in breaking down food, making it difficult for the body to get vitamin D intake.

Risk factors for rickets

Rickets is a bone disorder condition that can happen to everyone, especially children and babies. Apart from age, various other factors can also increase the risk of rickets, including:

1. Dark colored skin

The greatest source of vitamin D is sunlight. Unfortunately, in people with dark skin, the body cannot process sunlight into large amounts of vitamin D.

Meanwhile, people with lighter skin tend to easily process sunlight into vitamin D. Therefore, people with dark skin are more susceptible to vitamin D deficiency from sunlight.

2. Geographical factors

The body will produce more vitamin D if you are often exposed to sunlight. Children who live in locations or countries with low sunlight are at great risk of developing rickets.

3. Lack of vitamin D while in the womb

Babies born to mothers who are severely deficient in vitamin D can be born with symptoms of rickets or develop them within a few months of birth.

4. Nutritional deficiencies

Children have a greater chance of getting this disease if they lack the nutrients the body needs, such as vitamin D, calcium and phosphate.

5. Premature birth

Babies born prematurely or earlier than the due date of birth are more likely to develop this disease.

6. Low calcium

Children with rickets usually consume less than 300 milligrams (mg) of calcium per day, which is usually contained in one glass of milk.

Growing children need from 400 mg (infants) to 1500 mg (developing adolescents) of calcium each day for good bone health.

7. Take drugs

Certain types of anti-seizure drugs and antiretroviral drugs, which are useful for treating HIV infection, have the potential to inhibit the body's ability to use vitamin D.

8. Exclusive breastfeeding

Breast milk does not contain enough vitamin D to prevent rickets. Infants who are exclusively breastfed should receive vitamin D drops, especially in infants with hereditary rickets.

9. Descendants of the family

In rare cases, rickets can be inherited from other family members. This means, this disorder could be caused by genetic factors. This condition usually prevents the kidneys from absorbing phosphate.

Rickets complications

If this disease is not treated promptly medically, several complications may arise, such as:

• Failure to grow normally.
• Spinal abnormalities because the bones around the chest are affected.
• Skeleton deformity.
• Tooth decay.
• Convulsions.

Diagnosis & treatment of rickets

The information described is not a substitute for medical advice. ALWAYS consult your doctor.

During the examination, the doctor will press gently on the child's bones to check for any abnormalities. Usually, there are several parts of the bone that will get special attention from a doctor:

1. Skull bone

Infants and children who have rickets usually have a softer skull. This condition is usually accompanied by the formation of an imperfect crown

2. Foot bones

The legs of healthy babies and toddlers are usually slightly bent and will straighten back up as they get older. However, if the bending is excessive, it deserves special attention.

3. Breastbone

Some children with rickets usually have deformities in the ribs. The ribs may feel flat and cause the sternum to protrude.

4. Wrists and feet

Children with bone deformities often have wrists and feet that are bigger and feel thicker than normal. This also needs to get special medical treatment.

Usually, there are other tests that doctors do to help diagnose rickets, namely:

• X-ray
• Blood test
• Urine test

The doctor will perform tests according to your needs.

What are the ways to treat rickets?

After the child is believed to have rickets, the doctor will recommend a variety of medications to speed up the healing process.

How to treat rickets focuses on returning the lost vitamins and minerals to the body. With this step, it is hoped that the symptoms of rickets will reduce.

For example, if a child is deficient in vitamin D, the doctor will recommend increasing consumption of bone-strengthening foods or foods rich in vitamin D, such as fish, milk, liver, and eggs.

Additional vitamin D and calcium can also be obtained from supplements. Additional vitamin D of 1,000-2,000 international units (IU) per day will usually be prescribed by a doctor.

Make sure you always consult with your doctor about the appropriate supplement dosage for your child's condition. Too much vitamin D and calcium are also harmful to health.

To correct the abnormal bone shape, the child may have to wear a device that can correct the bone shape.

In rare cases, your child may have to undergo bone repair surgery.

Home remedies for rickets

Home care for a baby or child with rickets is not really that different from a doctor's treatment.

You as a parent or caregiver should monitor your child's vitamin D intake, whether from a doctor-prescribed supplement, a daily diet, or sunbathing in the morning sun.

If you have trouble determining a healthy nutritious diet for your little one, don't hesitate to consult a doctor or nutritionist.

Prevention of rickets

This bone abnormality is a disease that can be prevented. Reporting from the Mayo Clinic page, the ways to prevent rickets that you can do are:

Sun

The easiest source of vitamin D to maintain bone health is sunlight. You can get it by sunbathing in the morning every day for 10-15 minutes.

So, inviting your little one to sunbathe is the easiest way to get sunshine, considering that young babies cannot eat foods that contain vitamin D.

However, when sunbathing, make sure your little one's skin is exposed to direct sunlight. The reason is, the body can convert sunlight into vitamin D when the rays directly hit the outermost layer of skin (dermis).

Get a vitamin D diet

Unlike morning sunshine, foods that contain vitamin D are quite limited. Even so, the food choices are quite diverse. You can make these foods as a healthy diet or snack menu.

Some foods naturally contain vitamin D are salmon, tuna, eggs, beef, dairy products (milk, yogurt, and cheese) which are fortified with vitamin D.

Take vitamin D supplements if needed

Prevention of rickets can also be done by pregnant women for their children, namely by taking vitamin D supplements. Consult your doctor before taking these supplements to keep it safe.

Not only the mother, the baby may also need to consider additional vitamin D intake. Especially babies who drink exclusively breast milk. However, you must first consult this with a doctor who deals with your little one's health.