Rickets is a childhood disease that causes softening and weakness of bones and so a child’s bones do not develop correctly or strongly. Rickets causes soft, brittle bones, stunted growth and in severe cases skeletal malformations.

What causes Rickets?

It is usually caused by inadequate levels of vitamin D but also insufficient calcium and phosphorus are contributing factors. Calcium and phosphorus require Vitamin D for absorption and to lay down a good bone matrix. Vitamin D, the “Sunshine Vitamin”; made in your skin from exposure to sunlight but is also available in eggs, oily fish like sardines, and  any fortified foods. What are the symptoms?

• Pain or tenderness in bones particularly the arms, legs, pelvis, or spine
• Stunted growth or short stature
• Bone fractures
• Muscle cramps
• Teeth deformities that include delayed dentition, defects of tooth structure, high incidence of dental caries (cavities)

Who is at risk ?

Children who:

• Are born to mothers with an existing vitamin D deficiency
• Never go outside without sunscreen. Sunscreen blocks the manufacture of Vitamin D in the skin. Children who regularly wear sunscreen will not be making Vitamin D.
• Insufficient sun exposure
• Have naturally dark skin: if your descent is aboriginal, middle Eastern, South-east Asian, Pacific Islander, African or other heritage that has a dark skin colour. Dark skins do not react to sunlight as quickly as fairer skin and so require more vitamin D.
• Are vegetarian/vegan, dairy-free or lactose-free.
• Breastfed infants as breast milk does not contain high levels of vitamin D.
• Cover most of their body for religious or cultural reasons
• Are sick, disabled or unable to spend time outdoors for other reasons

Children between 6 and 36 months old are most at risk but as childhood and adolescence are times of rapid growth of bones, teeth and skeleton they are also at risk. Can Adults get Rickets? In adults Rickets is diagnosed as Osteomalacia. The cause is the same- lack of vitamin D, calcium and phosphorus. How is Rickets diagnosed? Physical examination, blood tests, x-rays and bone scans are how Rickets is diagnosed. Contact your GP for more information.

What can be done to prevent Rickets?

Prevention is the best way to avoid Rickets. Understanding the risk factors for Vitamin D deficiency can offer protection.

• Sunlight – regular exposure is necessary to support Vitamin D production for both adults and children. Sunscreen and covering the skin prevent any Vitamin D production in the skin. The right balance of exposure and protection from sun damage is needed. The recommended amount of sunlight each day:
  • May- August: two to three hours over the week
  • September to April: 10-15 minutes daily before 10am and after 3pm is required.

Always protect your child’s skin from the sun during peak UV times with clothing, shade and/or sunscreen in the summer months when the UVA/UVB  is strong

• Diet – include Vitamin D and calcium rich foods in your child’s diet. These include oily fish (especially sardines, salmon, herring and mackerel), liver and egg yolks. Look for foods that are fortified with vitamin D which includes some margarines, breakfast cereals and milks (including fortified baby formula milk). Read the label to determine if these products are fortified.
• Supplements – are an easy way to ensure that Vitamin D levels are maintained, particularly in the winter months when sun exposure may be challenging. Capsule or drops are readily available. Drops are an easy way to obtain the correct dosage to be administered. Talk to your naturopath, pharmacist or GP about for the right product and dosage for your children and family

Pregnancy and Breastfeeding

It is recommended that Vitamin D requirements be met during pregnancy to avoid deficiency in newborns. Remember that when breastfeeding Vitamin D is low in breast milk and babies should be directly supplemented.      

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References

• https://www.smh.com.au/national/lack-of-sun-causing-rickets-in-australian-children-20180202-p4yzb8.html
• https://www.rch.org.au/kidsinfo/fact_sheets/Rickets/
• https://www.mja.com.au/journal/2012/196/7/incidence-vitamin-d-deficiency-rickets-among-australian-children-australian
• http://www.apsu.org.au/assets/past-studies/Vit-D-protocol-sheet-final-201206.pdf
• https://www.rnoh.nhs.uk/our-services/children-adolescents/vitamin-d-children