Rickets

Main

• Vitamin D helps absorb calcium and phosphorus; without it, bones lose density and become soft.
• Early signs — sweating, restless sleep, clammy palms and a wet pillow after feeding or sleep.
• Bone changes — softening of the skull, late closure of the fontanelle, bowing of the legs and deformity of the chest.
• Examination includes a paediatrician's assessment, blood tests for calcium, phosphorus, alkaline phosphatase and radiography.
• Convulsions, severe weakness and difficulty breathing require calling an ambulance rather than a routine visit.

What is rickets

Rickets is a disorder of bone growth and strengthening in children associated with a lack of vitamin D. As a result, the bones become soft and may form incorrectly.

What happens in the body

Vitamin D helps the body absorb calcium and phosphorus from food, and these substances serve as the main material for building bone tissue. When vitamin D is lacking, calcium and phosphorus are absorbed less well in the intestines and enter the blood in insufficient amounts. The body begins to take these minerals from already formed bones in order to maintain their normal level in the blood. Because of this "redistribution", the bones lose density, become soft and yielding to load. This is noticeable in how the shape of the head, chest and legs changes, and how the child sits up, stands up and begins to walk. Bone growth slows down, and already formed areas may bend under the weight of the body. It is important for parents to remember that changes in bone tissue at an early stage are reversible, so timely attention to the first signs helps to avoid persistent deformities.

What causes it to develop

• Insufficient time in the sun: under the action of sunlight, vitamin D is produced in the skin, and without walks its amount decreases noticeably.
• Lack of vitamin D in the diet: if the diet is poor in foods rich in this vitamin, the body does not receive the required amount from outside.
• Early artificial feeding: formula does not always cover a child's need for vitamin D as fully as happens with breastfeeding.
• Disorders of absorption in the intestines: in such conditions, nutrients are absorbed less well, and vitamin D does not reach the tissues in the required volume.
• Hereditary and metabolic diseases: some congenital features disrupt the metabolism of calcium and phosphorus, and then a deficiency develops even with sufficient intake of the vitamin.

Who faces this more often

Most often, vitamin D deficiency and the bone changes associated with it occur in young children, especially in the first months and years of life. This is because it is precisely during this period that bone tissue grows most actively and places increased demands on the intake of calcium and phosphorus. Children who spend little time outdoors during daylight hours receive less sunlight and provide themselves with the vitamin less well. Children with dietary peculiarities or with disorders of the internal organs also fall into the group requiring increased attention. The frequency is also influenced by living conditions: prolonged cloudy weather, a short daylight period and rare walks reduce the natural production of the vitamin in the skin. This is more noticeable in babies born in the cold season, when there is especially little sun. Parents should take these circumstances into account and discuss with the doctor whether the child is getting enough vitamin D from diet and walks.

What symptoms can there be?

Rickets is recognised by changes in the bones, muscles and the child's behaviour, which increase gradually. Parents notice individual signs earlier than the doctor, but only a specialist can assess them as a whole.

How it is noticed at the very beginning

Rickets develops gradually, and the first signs are often noticed by parents or by the doctor during an examination. The child becomes restless, sleeps poorly and sweats heavily during feeding or sleep. The sweating is noticeable from a damp pillow and wet palms after feeding. The restlessness is put down to tiredness, teething or a change in the weather. Because of this, the warning signs remain unnoticed for a long time. Gradually, muscle weakness and an enlarged abdomen are added to them. Parents notice that the child holds their head up less well and sits up later. If such changes persist for weeks, show the child to a paediatrician.

Signs that occur most often

• Softening of the skull bones: the edges of the skull become yielding, and the frontal bosses protrude more noticeably.
• Delayed closure of the fontanelle: the soft area on the crown remains longer than usual, which the doctor assesses during an examination.
• Curvature of the legs and chest: the shape of the limbs and chest changes, this affects the gait and posture.
• Muscle weakness and an enlarged abdomen: the child moves sluggishly, the abdomen protrudes forward because of weak muscles.
• Late teething: teeth appear with a delay and in an unusual order, which parents notice.
• Restlessness and sweating: the child sleeps poorly and sweats, these signs often go together with the bone changes.

When to seek help urgently

Examinations and tests

Examination for suspected rickets is based on a doctor's examination and several laboratory and instrumental methods. Each of them clarifies the picture and helps distinguish rickets from other conditions.

How the examination begins

The examination begins with an appointment with a paediatrician, who assesses the child's growth, physical development and the condition of the bones. The doctor pays attention to the size of the fontanelles, the shape of the skull, chest and limbs, as well as the timing of tooth eruption. The parents' complaints and how the child gained weight and grew in previous months are clarified separately. On the basis of such an examination, a preliminary idea is formed as to whether there are grounds to speak of rickets. Then, to clarify the diagnosis, the doctor prescribes blood and urine tests, as well as X-ray of the bones. A blood test shows the level of calcium, phosphorus and alkaline phosphatase activity, which reflects metabolism in bone tissue. A urine test complements this picture and helps assess how the kidneys excrete metabolic products. Parents should collect in advance all available discharge summaries and results of previous investigations so that the doctor can see the dynamics, and not only the current state.

What is prescribed and what it shows

What is worth preparing for the appointment

• Discharge summaries from the developmental history: records of growth, weight and past conditions help the doctor see the overall picture over the past time.
• Results of previous tests: if blood or urine has already been tested, these data show the dynamics of the indicators and save you from repeats.
• X-ray images and reports: previously taken images of the bones make it possible to compare changes and assess how they developed.
• Observations of the child: records of how the child eats, sleeps and moves complement the examination and clarify the complaints.
• Questions for the doctor: a list formulated in advance helps not to forget anything and to get answers on all worrying points.

Which doctor should I see?

This section explains which doctor to consult if rickets is suspected in a child, what happens at the first appointment and what areas of care the treatment consists of. It also shows separately which part of the result depends on the regularity of follow-up and the parents' actions.

Which specialist manages this condition

Rickets in a child is managed by a paediatrician, and it is to them that referrals are made when there are changes in the bones, muscle weakness or delayed development. The paediatrician examines the child, assesses height, weight, the shape of the skull, chest and limbs, and checks muscle tone. They ask the parents about feeding, daily routine, time outdoors and past illnesses in order to understand the possible cause of the condition. If necessary, the paediatrician refers the child for additional tests and consultations with other specialists if the picture goes beyond their competence. If there is no relevant specialist nearby, start with the district paediatrician at the polyclinic at your place of residence. They follow the child continuously, see changes over time and, if necessary, involve colleagues. This approach helps avoid losing time and changing doctors at every stage.

What the treatment consists of

• Selection of therapy by the doctor: the paediatrician determines the cause and severity of the condition and on this basis chooses the required direction of care.
• Adjustment of nutrition and daily routine: the diet and daily schedule are restructured so that the child receives what is needed and spends enough time outdoors.
• Physiotherapy and therapeutic exercise: special exercises and procedures help strengthen the muscles and support correct body position.
• Follow-up by the paediatrician and monitoring of tests: the doctor regularly examines the child and, based on test results, assesses how recovery is progressing.
• Surgery for pronounced bone deformities: surgical intervention is discussed when skeletal changes noticeably interfere with movement and do not respond to conservative care.

What depends on the patient themselves

The regularity of follow-up with the paediatrician determines how predictably the child's condition will change and how quickly deviations will be noticed. Parents bring the child for check-ups at the appointed times, not only when their well-being worsens, and this allows the doctor to see the dynamics. At home it is important to follow the recommendations on nutrition, daily routine and physical exercises, because the care only works with constant adherence. Notes on when the child took what was prescribed, how much time they spent outdoors and how they slept help the doctor assess the picture more accurately at the appointment. If new complaints or changes in behaviour appear, the paediatrician should be informed without waiting for the scheduled visit. Missed check-ups and interrupted care make assessment difficult and can undo what has already been achieved. The most practical step is to keep a simple observation diary and take it to every appointment.

What helps prevent an exacerbation?

Preventing an exacerbation of rickets is helped by the family's everyday routine, rather than by individual one-off measures. Below we look at which habits are worth changing, what to keep under control and how often to see a doctor.

What to change in habits

Walks in the fresh air are worth making a daily habit, rather than a rare event at weekends. Regular time outdoors supports the natural formation of vitamin D in the skin under the action of sunlight. The child's rational nutrition is built so that the diet includes foods rich in this vitamin and calcium. If the paediatrician has prescribed a preventive intake of vitamin D, it is given to the child continuously, and not from time to time. A missed walk or dose is easy to notice by the fact that the daily routine goes off track and the child spends more time indoors. It is useful for parents to agree in advance which of the adults is responsible for the walk and nutrition on a particular day. Such a routine reduces the risk of exacerbation and makes visits to the paediatrician more predictable.

What is worth keeping under control

• Walks in the fresh air: their regularity is important all year round, since the intake of vitamin D depends on it.
• The child's nutrition: the diet should be rational, with foods that provide calcium and vitamin D.
• Vitamin D intake: it is carried out as prescribed by the doctor, and it is important for parents not to miss what has been prescribed.
• Paediatrician visits: timely appointments allow changes to be noticed earlier than they become noticeable at home.
• Daily routine: alternating walks, nutrition and rest helps to maintain habits without lapses.

How often to see a doctor

Timely paediatrician visits are needed even when the child looks healthy and does not complain of anything. Prevention of rickets begins from the first months of life, so visits to the doctor during this period are especially important for the family. The paediatrician assesses how the child is growing and developing, and if necessary recommends a preventive intake of vitamin D. Parents should come to the appointment with questions about nutrition and walks, so as to discuss them calmly and in detail. If something has changed at home, for example the routine of walks or the diet, it is better to tell the doctor at the appointment. Regular monitoring does not replace everyday habits, but it helps to notice in time that the routine has gone off track. That is why visits to the paediatrician are planned in advance, rather than postponed until complaints appear.

What is worth remembering

Rickets is a condition that develops gradually and is not always noticeable in its early stages. Below are several conclusions that help parents and adult patients make a balanced decision and not lose time.

Key conclusions

Rickets in a child is a reason for a calm but consistent conversation with a doctor, not for independent experiments. Noticing the first changes is helped by careful observation of how the child moves, sits and stands, and how confidently they hold their head. Rickets rarely manifests as a single sign: it is usually a combination of several features that loved ones notice in everyday life. If rickets is not clarified with a specialist, one can spend a long time explaining the changes by a change in diet or simply by "age", losing time. Rickets requires not a search for those to blame, but a clear plan of observation and regular check-ups with the same doctor. It is important not to postpone the visit if loved ones notice that the child has become less active or is falling behind in mastering skills. Rickets is not a sentence, but it is also not something that passes on its own without the attention of adults. The support in making a decision is not advice from a chat, but an in-person examination and clear guidelines given by the doctor.