Rickets in Young Children

Rickets in Young Children

  Autor Eugen Prajinariu Data: 14.08.2006

Rickets in Young Children
Rickets is a childhood disease and may occur at a few months of age, in case you don't follow the proper scheme for prevention with vitamin D. The most frequent is the deficient rickets which may occur in certain conditions that lead to vitamin D deficiency or nutritional deficiency of calcium and phosphorus. The food intake of vitamin D is not enough to satisfy the body's need, therefore it is necessary to supplement this vitamin. 

The breast milk brings the necessary quantity of nutrients, minerals and vitamins for a child who is exclusively breastfed to develop normally. Exception makes the vitamin D which must be supplemented with a prevention scheme against rickets. 

The vitamin D deficiency may be caused by: 
  • insufficient intake (digestive or by injections), improper alimentation favored by the use of cow milk in the first 6 months or excess of flour products; 
  • lack of sun exposure; 
  • digestive malabsorption syndromes (celiac disease, congenital liver diseases or biliary diseases, chronic diarrhea) - diseases when the vitamin D is not absorbed by the gut and are associated with other deficiencies (anemia, height- weight deficiency); 
  • Chronic kidney diseases which lead to a deficiency in the metabolism of vitamin D; 
  • Long anticonvulsant treatments; 
  • vitamin D resistant rickets is familiar, meaning it is inherited from the parents, and the common treatment with vitamin D has no results. 
The calcium and phosphorus deficiency shows especially in premature children who don't benefit from the accumulation of nutrients deposits in the last pregnancy trimester. In these children, the breast milk doesn't bring enough calcium, so it is necessary to supplement it. 
Rickets is characterized by insufficient bone mineralization, which becomes very fragile and suffers structural changes (deformations). This should not be confused with osteoporosis, which is a reduction of the normal bone mineralized tissue. 
Usually, the disease occurs after four months of age. In the first 6 months, the rickets shows by spasmophilia (neuromuscular hyperexcitability, sometimes convulsions or laryngospasm), head sweating and bone deformation (skull, limbs, thorax). After one year old, the symptoms are more severe (spine deformation, reduction of muscular tone, walking disorders). 
Generally, the child looks weak, with delays in the neuromotor development (reflexes, head support, sitting, walking). The bone deformation first occur at head and thorax: curved forehead (Olympian), big skull, soft (Craniotabes), large anterior fontanels at 8 months and proeminent after 18 months; large based thorax, chest tube occlusion, costochondral swelling (beads on the sternum side). The limbs deformities look like bracelets, and the knees become genu varum or genu valgum. Pelvic or spine deformities might occur later. 
The bone changes are radiologically visible and are preceded by changes of the biochemical constants (calcium and phosphates in the blood and urine). The rickets is associated with deficiency anemia and with increased sensitivity to infections, especially to respiratory ones. 
The prevention of rickets is made by administering vitamin D both orally or as injections. The selection of the method is made together with the GP, according to the patients compliance. In ca of oral administration, it is necessary to respect the daily need of vitamin D which is 500 U.I. and which is accomplished through the daily administration of the vitamin, starting with two months and up to one year. The injections are administered in bigger doses once in two months within the first semester of life, and then orally. 
From one year and 6 months to 5 years old, the daily dose must be administered only during the cold season, from September to April (the "r" months). In order to get the expected effect, it is necessary to respect a balanced hygienic and dietary lifestyle which implies varied alimentation, rich in dairy products (especially cheese), sun exposure, helio therapies, ventilated and sunny room, gym exercises. Usually, a healthy child and properly fed doesn't need calcium at the same time with a rickets prevention cure. 
In case the disease occurs, you must treat the rickets by administering vitamin D in bigger doses associated with calcium, according to the disease stage, until recovery, after which you start the prevention scheme. 

Read the English version of this article: Rickets in Young Children