Bones are the storehouse of calcium for our body, and for a bone to be strong, calcium is a must. While a child is growing, it is ideal to provide a nourishing diet that is rich in vitamins and minerals including calcium, phosphate, and vitamin D. Inadequate amounts of these vitamins and minerals may lead to deficiency states and one of these conditions is rickets.

Rickets occurs when a child’s bones become weak and soft due to a deficiency of vitamin D.

Dietary Considerations

The first step towards understanding how to make sure a child grows up strong and healthy is to know what foods provide calcium, phosphorus, and vitamin D. Without a diet that includes these foods, a child is at higher risk for developing deficiency state-related conditions like rickets.

Calcium and phosphorus are essential minerals present in foods like milk, cheese, and other dairy products, and green vegetables like spinach and broccoli. Other useful sources of calcium include dried fruits, whole wheat bread, and beans or lentils.

If a diet includes some of these types of foods, then the next concern rests on whether or not the absorption of these minerals within the intestines is adequate. If someone does not have an ample level of vitamin D, they will not be able to absorb calcium or phosphorus from the diet. Vitamin D is abundant in dairy products, fish, fish oils, beef liver, egg yolk, and mushrooms. The body can also synthesize vitamin D when exposed to sunlight. People who do not consume dairy products, are intolerant to milk, or follow a vegetarian diet are all prone to being deficient in vitamin D.

Regulation of calcium and phosphorus

Calcium and phosphorus are the two most abundant minerals in your body. They work together to help create strong bones and teeth.

The body regulates the amounts of calcium and phosphorus in the blood and bones through the influence of a hormone called the parathyroid hormone (PTH). This hormone is released from the parathyroid glands that are located in the neck. When levels of calcium and phosphorous begin to fall, the levels of parathyroid hormone increase, and this in turn causes calcium to be released from the bones. If this process happens too often it negatively impacts the bones and makes them go porous, lose density, and turn brittle.

The most common cause for rickets remains a dietary deficiency of calcium, phosphorus, or vitamin D. Another important cause is a disorder of the intestines that interferes with intestinal absorption. Some of these disorders include Crohn’s disease where the intestines become inflamed, celiac disease in which the lining of the small intestine become damaged, or other conditions like milk allergy. Additionally, because vitamin D is a fat soluble vitamin, any conditions that involve fats not being adequately absorbed in the intestines can lead to rickets. Rickets may also occur in liver disorders like alcohol poisoning, since a diseased liver cannot convert vitamin D into its active form.

Because vitamin D is produced in the skin upon exposure to sunlight, people who live in cold climates with little exposure to sun or work indoors are more likely to develop a vitamin deficiency. Babies who are exclusively breastfed may also develop the deficiency of vitamin D as breast milk is not very rich in vitamin D.

Rickets may also be the result of genetic defects where the body does not properly convert vitamin D. into calcium, leading to the “soft” bone symptoms found in rickets.

Rickets can lead to bone pains, short stature, impaired growth, increased bone fractures, and several skeletal deformities. For example, the curvatures of the backbone can get unusually prominent. Scoliosis is one condition that can occur when sideways curvatures form, and kyphosis, otherwise known as having a “hunchback”; both negatively affect a person’s curvature of the back. The legs may also become curved and bow-shaped.

The breast bone may be pushed forward and lead to a condition known as pigeon chest. Bony prominences in the ribs, called rachitic rosary, may also develop. Children with rickets may show dental deformities characterized by delayed formation and easy decay of the teeth. Muscle cramps and pains are also common.

A doctor is able to diagnose rickets on the basis of a detailed clinical examination and X-rays. A detailed biochemical blood analysis, along with tests for levels of calcium and phosphorus, may be done. For example, blood may be tested for the levels of parathyroid hormone and active forms of vitamin D. Low levels of these elements may signal the onset of rickets. Urine may also be subjected to testing for phosphates.

Treatment

Rickets is treated by enriching the diet with food and liquid sources rich in vitamin D, calcium, and phosphorus. The doctor may treat any concurrent disorders of the intestines, liver, or kidney. Children should be encouraged to go out and get some moderate exposure to sunlight.

Supplements for vitamin D or calcium will likely be recommended. Fortified breakfast cereals or other foods can also help to overcome the deficiency. With an extra boost of vitamin D and calcium along with other methods, rickets becomes corrected over a few months of treatment. Direct injections of vitamins and minerals may be necessary in some advanced cases.

A child with a skeletal deformity due to the condition may require a brace, muscle strengthening exercises, or a surgical correction. If they suffer from a genetic defect that impacted the way in which their kidneys process phosphate, which likely leads to lower levels of phosphate, treating the underlying kidney condition can help to correct any soft bones symptoms that come from the lower level of phosphate.

In families that have a history of rickets or conditions that lead to rickets, genetic counseling is usually required. This can help both the parents and physician confirm if the child will suffer from the condition and how they can best avoid it and treat it.

Rickets can almost always be prevented and is a fairly treatable condition. Make sure a child has a healthy balanced diet with milk, dairy products, beans, fruit, and leafy vegetables. Dietary supplements may be required if diet alone is not sufficient to provide the required quantities of vitamin D, calcium, or phosphorus. This is especially the case with pregnant women, nursing mothers, and people who choose a vegetarian diet. Fortified juices and cereals are a good choice when it comes to preventing rickets in children.

Recommended daily intake of calcium in children is 500 milligrams in those between one to three years of age, 800 milligrams for those aged four to eight years and 1300 milligrams for those who are nine to 18 years in age. Children need 10 micrograms of vitamin D in a day. To help a child better absorb higher phosphorous levels that come from sunlight, it is advised to expose a child to at least 20 minutes of sunlight per day.

Conclusion

Timely detection and treatment of rickets can prevent many permanent skeletal deformities and improve the chances of your child having healthy bones. A healthy diet and adequate exposure to sunlight are simple ways to prevent bones from becoming brittle and weak. Strong bones built in childhood can keep someone strong and moving in old age.