Rickets

Medically Reviewed By William C. Lloyd III, MD, FACS
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What is rickets?

Rickets is a disease in children that causes the bones to develop softer than normal, resulting in muscle and bone weakness and deformity. Rickets is impaired mineralization of the growth plates of bones. The most common cause of rickets is a lack of vitamin D.

Rickets is uncommon in the United States, but its incidence is increasing. Children at risk for developing soft bones typically possess one or more risk factors associated with low vitamin D and calcium levels. Darker skinned children require more sunlight to make vitamin D and are more at risk if sunlight exposure is limited, such as during the winter months. Children who are lactose intolerant, strictly breastfed, or have a genetic disorder affecting the absorption of vitamin D, are also at risk for rickets.

Rickets is caused by faulty mineralization in the bone-building process. Because vitamin D, calcium, and phosphorus are needed to build strong bones, a lack of these substances will affect the bones. Multiple factors can affect vitamin D levels, including the environment, genetics and diet. The environment can play a role in vitamin D deficiency because sunlight is responsible for the production of vitamin D in the body. Genetic disorders affecting vitamin D absorption can also cause rickets. Not consuming enough milk and dairy products, which are high in vitamin D and calcium, is also associated with developing rickets. Other less common causes of rickets are liver and kidney diseases and cancer.

The signs and symptoms of rickets can be constant or occur periodically. Rickets varies among individuals. Some children with rickets have mild symptoms, such as muscular discomfort, while others may have severe bowing of bones and frequent bone fractures. Fortunately, rickets can be treated with nutritional supplementation to resolve vitamin D, calcium, and phosphorus deficiencies. Lifestyle changes can reduce the risk for rickets and include receiving adequate sun exposure, eating a well-balanced diet that includes milk and dairy products, and taking all medication or supplements as prescribed.

In some cases, rickets can lead to serious bone fractures and should be treated. Seek immediate medical care (call 911) if your child’s rickets includes serious signs and symptoms, such as deformity or dislocation of the joint, extensive swelling, numbness, bone protruding through the skin, or severe pain.

Seek prompt medical care if your child is being treated for rickets but mild symptoms, such as numbness, swelling, or trouble moving, recur or are persistent.

What are the symptoms of rickets?

Rickets causes softened bones and may result in a number of symptoms. The symptoms can vary in intensity from person to person.

Common symptoms of rickets

Your child may experience rickets symptoms daily or just once in a while. At times any of these common symptoms can be severe:

  • Bone deformities, such as bowed legs, abnormally shaped skull, outwardly projecting breastbone, or curvatures of the spine

  • Dental abnormalities, such as deformity, weakened enamel, and increased cavities

  • Developmental motor delay

  • Failure to thrive in infants and children

  • Increased perspiration

  • Muscle spasms

  • Muscle weakness

  • Painful bones, particularly the hip bones

  • Seizure

  • Unusually short stature and delayed growth

  • Very easily fractured bones

Symptoms that might indicate a serious condition

In some cases, rickets can result in broken bones, a serious condition that may cause complications. Seek immediate medical care (call 911) if your child, or someone you are with, has any of these serious symptoms including:

  • Extensive swelling

  • Inability to move a body part

  • Numbness or coldness in the area of the fracture

  • Severe discomfort or pain

  • Visible deformity of the affected joint

What causes rickets?

Rickets is caused by a dysfunction in the bone-building process in children. Because vitamin D is needed to build strong bones, any disorder that affects vitamin D levels in the body will affect development of the bones. The environment can play a role in not having enough vitamin D, as sunlight is responsible for the production of vitamin D in the body. Not consuming enough milk and dairy products, which are high in vitamin D and calcium, is also associated with developing rickets. Other less common causes of rickets are liver and kidney diseases, genetic disorders, and cancer.

What are the risk factors for rickets?

A number of factors increase the risk of developing rickets. Not all children with risk factors will get rickets. Risk factors for rickets include:

  • Breastfeeding without other food sources or supplements
  • Consuming insufficient calcium
  • Darker skin
  • Diet that has little variety or is strictly vegetarian
  • Diet that is low in milk products
  • Diet that is low in phosphate
  • Diet that is low is vitamin D
  • Environmental conditions, such as smog and limited sunlight
  • Family history of vitamin D metabolism disorders
  • Kidney failure
  • Malabsorption syndrome
  • Overuse of sunblock

Reducing your child’s risk of rickets

You may be able to lower your child’s risk of rickets by:

  • Making sure your child consumes recommended amounts of milk and dairy products for his or her age
  • Making sure your child receives enough sun exposure
  • Making sure your child takes calcium supplements if recommended by a health care provider
  • Making sure your child takes vitamin D supplements if recommended by a health care provider

How is rickets treated?

Treatment for rickets begins with seeking medical care from your child’s health care provider. To determine whether your child has rickets, your health care provider will ask you and your child questions, request a sample of your child’s blood, and possibly request diagnostic testing. It is important to make sure your child follows the treatment plan for rickets precisely and takes all the medications as instructed.

The treatment approach for rickets depends on treating the underlying cause for rickets. Treatment will include returning the vitamin D and possibly calcium or phosphorous to normal levels. Administering supplements will help replenish these substances until balance is restored. For children who have vitamin D deficiency disorders, therapy will last longer than for those who have nutritional deficiencies in vitamin D.

What are the potential complications of rickets?

You can help minimize your child’s risk of serious complications by making sure your child follows the treatment plan you and your health care professional design specifically for your child. Complications of rickets include:

  • Bone deformities
  • Chronic bone and muscle pain
  • Growth abnormalities
  • Increased risk for fractured bones
  • Recurrence of rickets
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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2021 Jan 11
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THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
  1. Rickets. PubMed Health, a service of the NLM from the NIH. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001384/
  2. Rickets. American Academy of Orthopaedic Surgeons. http://orthoinfo.aaos.org/topic.cfm?topic=A00577
  3. Domino FJ (Ed.) Five Minute Clinical Consult. Philadelphia: Lippincott Williams & Wilkins, 2013
  4. Misra M, Pacaud D, Petryk A, et al. Vitamin D deficiency in children and its management: review of current knowledge and recommendations. Pediatrics 2008; 122:398