Rickets is a disease which impairs bone development in young children between the ages of six months and five years. This bone softening disease which was thought to have been completely eradicated in the 1940’s is rearing its ugly head once again. Every year, thousands of children through out the world are being diagnosed with rickets.
Early diagnosis of rickets, especially in children who are younger than eight months, is very important to reduce the chances of morbidity. Studies have shown that children who live in developing countries are more likely to develop this bone mineralization disease than their counterparts who live in affluent countries. An in depth insight into this childhood disease is given below.
What Are Rickets
The weakening or softening of bones among children leads to a medical condition known as rickets. A deficiency in the amount of vital nutrients like phosphate and calcium along with insufficient exposure to sunlight which is a vital source of vitamin D leads to this childhood disease condition.
Children who have rickets are generally bow legged. Besides being bow legged, children with rickets may also display marked spinal curvature. The ankle and wrist bones of these children are abnormally thick as well. The weakening and softening of bones due to improper bone calcification leads to these marked bone deformities.
Types of Rickets
Depending on the factor or factors which are directly or indirectly responsible for the initiation of this disease condition, rickets can be classified as nutritional rickets, vitamin D resistant rickets, vitamin D dependant rickets and congenital rickets.
Children who live in developing countries around the world are extremely likely to develop this type of rickets. Osteomalacia or nutritional rickets occurs due to extreme deficiency of vitamin D. Vitamin D is a fat soluble vitamin. This vitamin is extremely vital for the proper development of bones and teeth in young children. A deficiency of vitamin D can even affect the absorption of other essential minerals like calcium and phosphorous by the body.
Infants who are exclusively breastfed, infants born to mothers suffering from vitamin D deficiency, dark skinned babies and older children who prefer to stay indoors most of the time fall into the high risk category for developing nutritional rickets.
Vitamin D Resistant Rickets
This is the most common type of rickets. Vitamin D resistant rickets develops due to reduced absorption of minerals like phosphorous and calcium from the gastro intestinal tract. Children who suffer from vitamin D deficiency rickets display marked deformities of the lower limbs. These children are much shorter in stature than their counterparts.
Vitamin D Dependant Rickets
Vitamin D dependant rickets is classified as type 1 vitamin D dependant rickets and type 2 vitamin D dependant rickets. An inherent problem in the metabolism of vitamin D which impedes the renal alteration of calcidiol to calcitriol by 1 alpha-hydroxylase enzyme leads to type1 vitamin D dependant rickets. A fault in the vitamin D receptor gives rise to vitamin D dependant rickets type 2.
Mothers who suffer from osteomalacia are twice as likely to give birth to babies who have a higher risk of developing congenital rickets. Children who are diagnosed with congenital rickets may exhibit poor muscle tone, elevated serum alkaline phosphate levels besides suffering from frequent muscle tremors.
Causes of Rickets
Source : http://rickets.stanford.edu/
The primary cause behind rickets is a deficiency of the mineral calcium or lack of vitamin D. But these are not the only causes for rickets. Sometimes an underlying health problem or even genetic condition can cause young children to develop this bone mineralization disease.
Lack of Vitamin D
Our body gets vitamin D through two sources i.e. from the food that we eat and direct exposure to sunlight. Eating a diet that is deficient in vitamin D can give rise to rickets. Some foods which are rich sources of vitamin D include fortified breakfast cereals, eggs and oily fish.
Children who prefer to stay indoors most of the times are extremely likely candidates to develop rickets. Hence children should be encouraged to play for a few hours outdoors every day. Dark skinned children and children who live in extremely cold climes also have a higher incidence of developing rickets.
Children may develop rickets as a result of some genetic defect. Genetic disorder can impair the normal absorption of phosphate by the body. This can lead to softening of the bones and the teeth. Improper mineralization of bones can lead to increased incidence of bone deformities and fractures.
Underlying Health Condition
Underlying health conditions like kidney problems, celiac disease, cystic fibrosis and inflammatory bowel disease may interfere with the normal absorption of vitamin D.
Risk Factors For Rickets
There are numerous factors which can significantly increase a child’s risk of developing rickets.
Children who fall into the high risk category for developing rickets are those between the ages of six and twenty four months. The reason for the increased chances of developing rickets among children in this age group is due to their rapid skeletal growth.
Children who live in the northern latitudes have a higher risk for getting rickets. The reduced sunlight in these regions can lead to deficiency in vitamin D among young children. This in turn gives rise to rickets.
Dark Skin Tone
Children with dark skin tones are not able to synthesize vitamin D with the same degree of efficiency as children with light skin tones.
Children who are born prematurely, young children who are on anti seizure medications and babies who are exclusively breast fed by their mothers also fall into the high risk category for getting rickets.
Signs and Symptoms Of Rickets
Children with rickets may often complain of excruciating pain in their bones. Children diagnosed with this disease may exhibit multiple bone deformities including being bow legged, pigeon breasted or knock kneed.
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Severe bone deformity which is the hallmark of this disease condition means that children afflicted with this disease condition are unable to walk properly. Rickets can affect a child’s normal development. Hence children who have this disease may be shorter in stature and may exhibit developmental delays as well. Children diagnosed with rickets may suffer from numerous dental problems as well.
Treatment Of Rickets
Taking a daily calcium and vitamin D supplement can help to effectively combat the problem of rickets. Similarly a child should be exposed to direct sunlight for at least ten minutes every single day to reduce the chances of developing rickets. Eating a diet that is rich in calcium and vitamin D can also reduce the incidence of rickets.
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