Rickets
Rickets
Failure to calcify osteoid tissue in a growing child, usually due to deficiency of vitamin D, its active metabolites, calcium, phosphorus or other rare causes. This leads to bony deformity. Occurs in ex-premature babies during infancy and in children with developmental disability, on anticonvulsants or not exposed to sunlight. In older children it is caused by renal tubulopathies. Diagnostic criteria include bowing of long bones, widening of metaphyses, cranial bossing, and occasionally convulsions or tetany due to hypocalcaemia
Investigations
- Elevated alkaline phosphatase
- Serum calcium and/or phosphate abnormalities
- X-ray of wrists
General measures
- Prevent vitamin D deficiency
- Exposure to sunlight, at least 3 hours a week (Careful in fair skinned infants)
- Breast milk does not contain adequate vitamin D to prevent deficiency
- Lactating mothers should be on a normal vitamin D containing diet.
Prophylaxis
Premature babies: Vitamin D oral, 800 IU, once daily
Infants who are at high risk and are exclusively breast-fed: Vitamin D oral 400 IU daily PO
Treatment of active rickets
Treat only after confirmation of active rickets on X–ray.
Vitamin D oral, 5 000 IU, once daily, in addition to milk in the diet
Repeat X–ray after 6–8 weeks. If no radiological improvement, further investigation required.
If healing occurs, continue for 3 months and confirm complete healing and adequate diet for the future.
Referral
Rickets presenting in children older than 2 years.
Rickets not responding to Vit D treatment.