Rickets is weakness and deformity of the bones that occurs from lack of vitamin D. Vitamin D occurs in whole milk, butter, egg yolks, animal fats, and liver, especially fish liver oil. The body also makes its own vitamin D when sunlight shines on the skin. Children who do not eat enough foods with vitamin D, and who do not get enough sunlight, gradually develop signs of rickets.
Rickets is fairly common in some countries, especially in cool mountain areas of Asia and Latin America where babies are kept inside and wrapped up. Rickets is also increasing in crowded cities where children are seldom taken into the sunlight.

What causes rickets?
Most cases of rickets are caused by a lack of vitamin D, but rickets can also be inherited. Vitamin D helps the bones absorb calcium and phosphorus from food. When your child does not get enough vitamin D, his or her bones do not get those necessary nutrients that makes bones strong.

Children ages 6-24 months are at the highest risk of rickets because their bones are growing very rapidly during this period. Your child may also be at risk if he or she:
•    Has dark skin
•    Doesn’t get moderate exposure to sunlight
•    Wears sunscreen at all times when outside
•    Doesn’t eat foods containing vitamin D
•    Breastfeeds without a vitamin D supplements
What are the symptoms of rickets?
The image below shows what some of the symptoms of rickets look like.

Signs and tests:
A physical exam reveals tenderness or pain in the bones, rather than in the joints or muscles.
The following tests may help diagnose rickets:
•    Blood tests (serum calcium) may show low levels of calcium.
o    Tetany (prolonged muscle spasm) may occur if serum levels of calcium are low.
o    Chvostek’s sign may be positive (a spasm of facial muscles occurs when the facial nerve is tapped) indicating low serum levels of calcium.
•    Serum phosphorus may be low.
•    Serum alkaline phosphatase may be high.
•    Arterial blood gases may reveal metabolic acidosis.
•    Bone x-rays may show loss of calcium from bones or changes in the shape or structure of the bones.
•    A bone biopsy is rarely performed but will confirm rickets.
Other tests and procedures include the following:
•    PTH
•    Urine calcium
•    Calcium (ionized)
•    ALP (alkaline phosphatase) isoenzyme
How is rickets treated?
Treatment depends on the type of rickets your child has. Nutritional rickets is treated with vitamin D and calcium, and often improvements occur within a few weeks of treatment. If your child has inherited rickets or has an illness causing the problem, you may need to see a doctor who specializes in rickets.

How to keep your child from getting nutritional rickets?
Be sure your child gets enough vitamin D and calcium. If you breastfeed your baby, your doctor will prescribe a vitamin supplement that includes vitamin D (because human milk only has a small amount of vitamin D). If your baby gets less than 16 ounces of formula per day, he or she will need extra vitamin D.

Your doctor can also help you determine if your older child needs more vitamin D or calcium. Your doctor will also tell you about how much time in the sun is safe for your child. However, it is important to remember that infants and babies should be protected from direct sunlight. To make sure your child is getting enough vitamin D, you should make sure your older child eats foods that are high in calcium, such as milk, cheese, and salad greens.