Rickets: Symptoms, Causes, Risk factors, Treatment & Prevention

 

Rickets is a condition in which your child's bones soften and weaken. This causes them to bend and warp, which typically results in bowed legs. It also causes bone pain and increases the risk of a break. The most common cause of rickets is vitamin D deficiency. This happens when your youngster does not get enough vitamin D from their diet or exposure to sunlight.

Rickets is a softening and weakening of bones in children caused by a severe and long-term vitamin D or calcium deficiency. Rare inherited disorders can also lead to rickets.

Vitamin D aids a child's body in absorbing calcium and phosphorus from foods. Lack of vitamin D makes it difficult to maintain enough calcium and phosphorus levels in the bones, which can lead to rickets.

Adding vitamin D or calcium to the diet usually resolves the bone issues linked with rickets. If your child's rickets is caused by another medical condition, he or she may require extra medications or treatment. Certain bone abnormalities induced by rickets may necessitate corrective surgery.

Rare inherited disorders caused by low amounts of phosphorus, the other mineral component in bone, may necessitate further treatments.

Also Read: 10 Vitamin D Rich Food

What is Rickets?

Symptoms of rickets include bowed legs and other bone development issues, such as a curved spine or an unusually shaped head.
Rickets softens and weakens your child's bones, resulting in symptoms such as bowed legs.

Rickets is a disorder that impairs your child's bone development. It softens and weakens your child's bones, allowing them to distort, bend, and fracture more easily. The most prevalent cause of rickets is vitamin D deficiency. Vitamin D aids in the absorption of other essential minerals, such as calcium and phosphorus. Without adequate vitamin D, your child will be unable to absorb enough calcium and phosphorus to form hardy and healthy bones.

Your child can obtain vitamin D from two sources: sunlight and food. Their skin produces vitamin D in response to sunlight. However, many people, particularly those in northern climates, do not absorb enough vitamin D in this way. There are a few foods that naturally contain vitamin D, such as certain types of fatty fish and fish oils. As a result, fortified foods are the primary source of vitamin D for most Americans. This includes:

• Milk and other dairy products.

• Infant Formula

• Cereal and orange juice

Rickets is a rare but treatable condition. If you are concerned about your child's vitamin D levels, consult his or her pediatrician.

Symptoms of Rickets

Rickets weakens and softens your child's bones, causing them to bend and look deformed. The most common sign of rickets is bowed legs. Other rickets symptoms could include:

• Bone pain

• Dental problems, such as cavities

• Growth delays

• Muscle weakness

• Seizures

• Swelling of the ends of their ribs

• Unusual curving of their spine or shape of their skull

• Weak muscle tone

• Widening of knees and ankles (in children who can walk) or wrists (in infants who can crawl)

Rickets causes:

Rickets can be caused by a lack of vitamin D, genetics, or an underlying health issue.

Vitamin D deficiency

Vitamin D deficiency is the most common cause of rickets. This is called nutritional rickets. Vitamin D helps your child's bones absorb calcium and phosphorus. These nutrients are required to develop strong, healthy bones. If your child does not get enough vitamin D from their diet, they may be deficient. This might happen if they:

• Are lactose intolerant?

• Follow a vegan or vegetarian diet

• Exclusively breastfeed

• Have a health condition that inhibits their body's ability to absorb vitamin D, such as Crohn's disease, celiac disease, or ulcerative colitis

Other causes of vitamin D inadequacy include inadequate sun exposure and a lack of calcium in the foods your child consumes.

Genetics

Though uncommon, certain genetic diseases can impair your child's ability to absorb phosphorus or vitamin D. Other disorders damage certain proteins that your child's body uses to synthesize vitamin D.


Underlying health issues.

Rickets can also be caused by underlying health conditions. Children with rare liver, kidney, intestinal, and lung diseases have difficulty absorbing vitamin D and phosphorus.

Risk Factors:

Nutritional rickets can affect any child, but particular populations are more susceptible. This includes:

• Babies who are exclusively breastfed (particularly for more than 6 months). They require a vitamin D supplement if they solely consume breast milk.

• Babies and toddlers aged 6–24 months. Age is the most significant risk factor for rickets.

• Babies were born prematurely. Throughout its growth in the uterus, the fetus accumulates vitamin D reserves. So, if your baby is born prematurely, they do not have these stores.

• Children with darker skin. When your skin is darker, it takes longer to absorb enough sunlight to produce the necessary quantity of vitamin D.

• Children who do not receive enough direct sunshine. Windows restrict the sun's rays, which your child's body utilizes to produce vitamin D, so spending time outside is crucial.

Complications of Rickets:

While rickets is a treatable, and sometimes curable, disease, it is critical to treat it as early as possible. Milder cases of rickets, if not addressed, can lead to long-term disorders that prevent bones from growing normally. Potential complications include:

• Bone fractures.

• Chronic pain.

• Skeletal abnormalities.

How do doctors diagnose rickets?

Your child's pediatrician will inquire about your family's medical history and your child's symptoms. They'll also want to hear about your child's overall health and diet. Your child's provider will also undertake a physical exam. However, they will probably need to do a few tests to confirm the diagnosis.

Tests used

Your child's healthcare professional could prescribe one or more of the following tests:

• X-rays 

• Blood tests

• Urine testing

How are rickets treated?

The most common cause of rickets is a vitamin D deficiency. Nutritional rickets treatment involves:

• High doses of vitamin D and calcium. Treatment begins by increasing your child's vitamin D and calcium intake. They will need to consume meals high in vitamin D and calcium, such as cereal, milk, and fatty fish. Your child's pediatrician will most likely recommend daily vitamin D and calcium supplements.

• Bracing or surgery. Typically, your child's bones will straighten on their own. However, they may need to wear braces to rectify the bending of their bones. In some circumstances, surgery may be a possibility.

If your child develops rickets as a result of a genetic disease or another health condition, their pediatrician may refer them to a specialist.

Can rickets be prevented?

 Yes, you can avoid nutritional rickets.  If you are solely breastfeeding your infant, you should give them vitamin D supplement drops every day.  This is because breast milk does not contain enough vitamin D to support your baby's developing bones.  Most babies require 400 International Units of Vitamin D3 daily.  Consult your baby's pediatrician to determine the appropriate dosage.

Your child's provider might recommend spending time outside in the sun. Your child's skin produces vitamin D when exposed to sunshine, so this is another way for them to acquire enough of the essential ingredient. This source of vitamin D is affected by geographic location and climate, skin pigmentation, and sunscreen use. Many children cannot receive enough vitamin D from sunlight alone.

You cannot avoid rickets induced by a hereditary disease. If you are pregnant or considering becoming pregnant, you should consult a genetic counselor. They may recommend genetic testing.

To avoid rickets, make sure your child eats foods that contain vitamin D naturally—fatty fish like salmon and tuna, fish oil, and egg yolks—or that have been fortified with vitamin D, such as:

• Infant formula

• Cereal

• Bread

• Milk, but not milk-based products like yogurt and cheese

• Orange Juice

References:

• World Health Organization. Nutritional rickets: A review of disease burden, causes, diagnosis, prevention and treatment (https://www.who.int/publications/i/item/9789241516587). 2019 Nov 6. Accessed 5/6/2025.

• Kliegman RM, et al. Vitamin D deficiency (rickets) and excess. In: Nelson Textbook of Pediatrics. 22nd ed. Elsevier; 2025. https://www.clinicalkey.com. Accessed Feb. 18, 2025.

• American Academy of Pediatrics. Vitamin D Deficiency and Rickets (https://www.healthychildren.org/English/healthy-living/nutrition/Pages/Vitamin-D-Deficiency-and-Rickets.aspx). Last updated 7/22/2021. Accessed 5/6/2025.

• Dahash BA, Sankararaman S. Rickets (https://www.ncbi.nlm.nih.gov/books/NBK562285/). 2023 Aug 7. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan. Accessed 5/6/2025.

• American Academy of Orthopaedic Surgeons. Rickets (https://orthoinfo.aaos.org/en/diseases--conditions/rickets). Last reviewed 9/2021. Accessed 5/6/2025.

• National Health Service (UK). Rickets and osteomalacia (https://www.nhs.uk/conditions/rickets-and-osteomalacia/). Last reviewed 8/5/2021. Accessed 5/6/2025.

• Carpenter T. Overview of rickets in children. https://www.uptodate.com/contents/search. Accessed Feb. 18, 2025.