Vitamin D And Rickets In Children: Causes And Treatment Of Rickets

Rickets is a condition which is characterized by softening of the bones, which make them prone to deformities or recurrent fractures. The condition is often attributed to deficiency or faulty metabolism of phosphorus, calcium or vitamin D. While epidemiological estimates suggest that the condition is more frequently observed in developing countries and rare in developed countries (less than 5 per million children).

There are certain risk factors that have been identified with the development of this condition among certain group,

  • Breast feeding mothers not exposed to adequate amount of sunlight
  • Breast feeding infants who are not exposed to adequate amount of sunlight
  • Infants whose diet lacks vitamin D and calcium

Rickets can be classified in different categories based on the causative factor associated with the condition,

  • Nutritional Rickets which is associated with malnutrition
  • Vitamin D resistant rickets
  • Vitamin D dependent rickets, which is classified into Type I and Type II
  • Congenital rickets
  • Newborn rickets

Rickets in children is associated with a host of signs and symptoms which include tenderness of the bones, dental problem, muscular weakness, bowed legs or knocked knees along with pelvic and spinal deformities.

What Causes Rickets In Children?

In principle, Rickets is caused due to the deficiency of vitamin D. Vitamin D plays a pivotal role in the absorption of calcium by the small intestine. The primary source for vitamin D is sunlight, which allows the skin to convert inactive vitamin D into its active form.

  • Lack of vitamin D results in inadequate absorption of calcium resulting in a condition called hypocalcaemia, which in turn leads to dental and skeletal deformities along with a host of neuromuscular symptoms.
  • In rare cases, a X linked dominant disorder called vitamin D resistant rickets can also contribute to skeletal and dental deformities, even in the presence of adequate amount of vitamin D.
  • Some reports suggest that using a strong sun block on children can also lead to inability of ultraviolet rays reaching the skin causing rickets.

How To Treat Rickets In Children?

The regimen for the treatment of rickets is referred to as antirachitic. The focus of the regimen is to complement the nutritional shortage. However in severe cases surgical intervention is inevitable.

  • Increase in intake of dietary calcium, vitamin D and phosphate is recommended as first line of treatment. Cod liver oil is a great source of vitamin D and should be included in the diet.
  • A sufficient amount of exposure to sunlight is also recommended. As per experts, dark skinned people need to be exposed for longer duration of time compared to their fair skinned counterparts. In some cases, ultraviolet light therapy may be beneficial, in which the child is exposed to Ultraviolet B rays.
  • Supplements are also considered useful. Recommended vitamin D intake is about 400 International Units for infants. Further calcium and phosphorous supplements are also important for calcification and maintenance of bones.
  • Homeopathic drugs namely Calcarea Phos and Calcarea Carb taken in low potency thrice a day can be beneficial. These medicines should be consumed for about three to six months as they help alleviate some of the distressing symptoms associated with rickets along with improving general bone health.

According to the American Academy of Pediatrics, vitamin D supplements are essential for all babies on exclusive breast milk. Vitamin D supplements are not required after babies start consuming at least 500 ml of vitamin D fortified formula or milk each day.

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