Rickets

Rickets is the softening and weakening of bones in children, usually because of an extreme and prolonged vitamin D deficiency. Lack of vitamin D results in reduced absorption of calcium and phosphorus. Difficulty maintaining proper calcium and phosphorus levels in bones can cause rickets. This is a disease of the bones that is more common in children who do not get exposure to sunlight. Our skin has a pro-Vitamin D that is converted into vitamin D in the presence of sunlight. Vitamin D protects the child  from getting rickets. However, rickets can also occur due to calcium deficiency with normal vitamin D levels in the body.

 In a typical case  an older infant or a toddler is brought to the doctor  with bowing of legs. The doctor finds widening of the ends of his long bones, near the wrist and ankles. The eruption of teeth is delayed. The fore head appears rather prominent. The anterior frontenelle (the soft spot on the head)is widely open. Some children get Tetany (fits due to calcium deficiency). An X-ray of the wrist shows classical evidence of rickets.

While being aware of the findings, we must remember that all these features can be seen normally in individual children. Thus bowing of the legs in absence of the other fetures of rickets in an infant is normal. The legs may straighten on their own without any treatment.  Teeth may errupt later in some children, who are otherwise normal.. The anterior frontenelle may sometimes normally close towards the end of second year.The head may look big because of the bigger size of the  parent's heads. So let the doctor decide whether the child has rickets or not.

The doctor will prescribe Vitamin D for this condition. In most cases, the improvement is rapid and the X ray returns to normal. Do not give the child  more vitamin D than prescribed by the doctor, he could get vitamin D poisoning. We must make sure that  the child's skin is exposed to morning sunlight for 10 minutes everyday.

Vitamin D Suppliment

Rickets is extremely rare in breastfed children. All the children improve with Vitamin D and sunlight exposure.

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