Rickets is a condition that affects bone development in children. It causes the bones to become soft and malformed, which can lead to bone deformities.
Rickets in adults is known as osteomalacia or soft bones.
The most common cause of rickets is a lack of vitamin D and calcium. Vitamin D comes from foods such as oily fish and eggs, and from sunlight on our skin. Vitamin D is essential for a child to form strong and healthy bones.
In rare cases, children can be born with a genetic form of rickets. It can also develop if another condition affects how vitamins and minerals are absorbed by the body.
Read more about the causes of rickets.
Rickets causes the bones to become painful, soft and weak. This leads to deformities of the skeleton, such as bowed legs, curvature of the spine and thickening of the ankles, wrists and knees.
Read more about the symptoms of rickets.
When to seek medical advice
If your child has any symptoms of rickets, such as bone pain, delayed growth or skeletal problems, take them to your GP for a check-up.
Read more about how rickets is diagnosed.
Rickets can easily be prevented by eating a diet that includes vitamin D and calcium and spending some time in sunlight. The hands and face only need to be exposed to the sunlight a few times a week during spring and summer.
Read more information about preventing rickets, including a list vitamin D and calcium sources.
Rickets can be successfully treated in most children by ensuring they eat foods that contain calcium and vitamin D or take vitamin and mineral supplements.
If your child has problems absorbing vitamins and minerals, they may need a higher dose or a yearly vitamin D injection.
Read more about how rickets is treated.
Who is affected?
Rickets was common during Victorian times, but mostly disappeared in the Western world during the 1940s thanks to the fortification with vitamin D of foods such as margarine and cereal.
However, there has been and increase in cases of rickets in the UK in recent years. Children of Asian, African-Caribbean and Middle Eastern origin have a higher risk because their skin is darker and they need more sunlight to get enough vitamin D.
Other groups who are at risk include children born prematurely and children taking medication that interferes with vitamin D. However, any child whose diet does not contain enough vitamin D or calcium can develop rickets.
Symptoms of rickets
Rickets causes a child's bones to become soft, weak and malformed, which can lead to bone deformities.
The signs and symptoms of rickets include:
As your child gets older, the symptoms of rickets may also include:
These symptoms can also affect adults who have soft bones (osteomalacia).
When to seek medical advice
If your child has any symptoms of rickets, such as bone pain, delayed growth, muscle weakness or skeletal problems, take them to your GP for a check-up.
Causes of rickets
Rickets usually occurs because of a lack of vitamin D or calcium. It can also be caused by a genetic defect or another health condition.
Lack of vitamin D and calcium
Over a long time, vitamin D deficiency causes rickets in children and osteomalacia (soft bones) in adults.
Rickets is more common in children of Asian, African-Caribbean and Middle Eastern origin because their skin is darker and needs more sunlight to get enough vitamin D. However, any child who does not get enough sunlight, is frequently covered up or has a diet low in vitamin D or calcium is also at risk of getting rickets.
Babies born prematurely are also at risk of developing rickets because the foetus builds up stores of vitamin D while in the womb. As the amount of vitamin D in breast milk varies, the Department of Health recommends that all pregnant and breastfeeding women should take a daily supplement of 10 micrograms (mcg) of vitamin D.
This ensures that the mother's vitamin D requirements are met and that adequate foetal stores are built up for early infancy.
Rare forms of rickets can also be inherited (passed on from a parent to a child).
Hypophosphatemic rickets is a genetic disorder in which the kidneys and bones deal abnormally with phosphate (calcium phosphate is what makes bones and teeth hard). This leaves too little phosphate in the blood and bones, leading to weak and soft bones.
Other types of genetic rickets affect special proteins in the body that are used by vitamin D.
Occasionally, rickets develops in children with rare forms of kidney, liver and intestinal conditions. These can affect the absorption and metabolism of vitamins and minerals.
If rickets is suspected, your GP may carry out a number of tests including a physical examination, an X-ray and blood tests.
These are described in more detail below:
Most cases of rickets are caused by a vitamin D and calcium deficiency. Therefore, rickets is usually treated by increasing a person's intake of vitamin D and calcium.
Vitamin D and calcium can be increased by:
Sunlight also contains vitamin D, so you may be advised to increase the amount of time your child spends outside.
Read more about sunlight and foods that are rich in calcium and vitamin D.
Your GP will advise you about how much vitamin D and calcium your child will need to take. This will depend on their age and the cause of the rickets. If your child has problems absorbing vitamins, they may need a higher dose.
When rickets occurs as a complication of another medical condition, treating the underlying condition will often cure the rickets. For example, people who have kidney disease and rickets may require dialysis (treatment that replicates many of the kidneys' functions).
If your child has a bone deformity caused by rickets, such as bowed legs or curvature of the spine, your GP may suggest treatment to correct it. This might be a brace to support the affected area of your child's body as their bones grow, or they may need surgery.
People with genetic forms of rickets need slightly different treatment.
For hypophosphatemic rickets (where a genetic defect causes abnormalities in the way the kidneys and bones deal with phosphate), a combination of phosphate supplements and a special form of vitamin D is required.
Children with other types of genetic rickets need very large amounts of a special type of vitamin D treatment.
It is very unusual to get side effects from vitamin D, calcium or phosphate supplements if they are given in the correct dose.
However, if the dose of vitamin D or calcium is too high, it can raise calcium levels in the blood. This can result in a condition called hypercalcaemia. Symptoms of hypercalcaemia include:
See your GP immediately if you or your child has any of these symptoms.
There are several steps you can take to help prevent rickets developing. These include ensuring that your child has a healthy, balanced diet and spends some time outside in the sun.
Sources of vitamin D include:
Sources of calcium include:
If you have a restricted diet - for example if you are vegetarian or vegan - you may not be getting essential vitamins and minerals and may need to take a vitamin supplement (see below).
Sunlight is a good source of vitamin D and it is where most of our vitamin D comes from. The vitamin forms under the skin as a result of sun exposure.
In the UK, about 10-15 minutes of exposure on the hands and face, a few times a week, during the spring and summer is enough.
However, it is very important to be aware that too much sun is bad for your skin. Therefore, you and your children should not spend long periods in the sun and should always use sunscreen with a sun protection factor (SPF) of at least 15.
Babies and young children have very sensitive skin that burns easily so they need to use stronger sunscreen and keep covered up when out in the sun.
Read more about staying safe the sun.
Most people can get all the vitamin D they need through their diet and by getting a little sun.
However, certain groups of people have an increased risk of developing a vitamin D deficiency and may need to take supplements to avoid getting rickets and osteomalacia (the adult form of rickets). These at-risk groups are discussed below.
Pregnant and breastfeeding women
The Department of Health recommends that all pregnant and breastfeeding women should take a daily supplement of 10 micrograms (mcg) of vitamin D.
In the UK, the Department of Health recommends the use of vitamin D supplements for:
It is important that children in high-risk groups take supplements. These include children who do not get enough vitamin D from their diet and those with certain medical conditions such as kidney disease. They may need to take extra supplements to prevent rickets and ensure that they develop strong and healthy bones.
Your GP can advise you about how much vitamin supplementation is needed.
Other risk groups
Other people who have an increased risk of developing a vitamin D deficiency and who may need to take supplements include: