Childhood Rickets: Symptoms and Possible Causes

Rickets is a condition that affects bone development in young children, leading to soft, weak bones and skeletal deformities. Though relatively uncommon in many parts of the world today, rickets still occurs, especially in communities with limited sun exposure or dietary deficiencies. Recognizing rickets in children symptoms early can help families get timely treatment and support healthy growth.

What Is Rickets?

Rickets occurs when bones fail to mineralize properly, leading to softening and weakening. The key nutrients involved are:

• Vitamin D: Helps the body absorb calcium and phosphorus.
• Calcium and phosphorus: Essential minerals for bone strength and structure.

Without enough vitamin D or these minerals, a child’s bones become soft and may bend or break easily.

Why Vitamin D and Minerals Matter

• Vitamin D is produced in the skin on exposure to sunlight. It’s also found in some foods (fatty fish, fortified milk, egg yolks).
• Calcium and phosphorus are abundant in dairy products, leafy greens, nuts and seeds, and fortified foods.

When children don’t get enough of these nutrients, their bones can’t grow normally. In growing kids, this shows up as pain, stiffness, and changes in the shape and strength of bones.

Key Signs: Rickets in Children Symptoms

Watch for these common signs of rickets in children. Not every child will have all of them, but a combination may suggest further evaluation:

Bone and Growth Changes

• Bowed legs or knock knees (legs that curve outward or inward)
• Swollen or tender joints, especially at the wrists, knees and ankles
• A “beaded” appearance at the rib cage (costochondral junctions)
• Delayed closure of the skull’s soft spots (fontanelles) in infants
• Slow overall growth or short stature compared to peers

Muscle and Movement Issues

• Muscle weakness or low muscle tone (“floppy” feeling)
• Delayed motor milestones (sitting, crawling, walking later than expected)
• Difficulty standing or walking; frequent falling

Pain and Discomfort

• Bone pain or tenderness, often in the legs, pelvis, spine or ribs
• Irritability or fussiness in infants and toddlers who can’t describe pain

Dental Concerns

• Delayed tooth eruption
• Soft, poorly formed tooth enamel, leading to early cavities

Other Possible Signs

• Frequent fractures from minor injuries
• Low calcium levels causing muscle cramps or spasms (tetany)
• In severe cases, chest deformities that affect breathing

Possible Causes of Rickets

Understanding what leads to rickets helps families and healthcare providers prevent and manage it effectively.

1. Vitamin D Deficiency

   • Limited sun exposure: Living in northern climates, covering skin outdoors, or using strong sunscreen all reduce vitamin D production.
   • Dark skin: Higher melanin reduces vitamin D synthesis.
   • Strict indoor living: Stay-at-home infants, day care settings with minimal outdoor play.

2. Dietary Shortfalls

   • Breastfed infants without vitamin D supplementation: Breast milk alone may not provide enough vitamin D.
   • Low intake of dairy or fortified foods: Children avoiding milk, cheese or fortified alternatives may miss key sources of calcium and vitamin D.

3. Malabsorption Disorders

   • Celiac disease, cystic fibrosis, inflammatory bowel disease: Conditions that impair nutrient absorption in the gut.
   • Surgical removal of parts of the gut can also reduce absorption.

4. Kidney or Liver Disorders

   • These organs activate vitamin D into its usable form. Chronic kidney or liver disease can limit this process.

5. Genetic Causes

   • Rare inherited forms of rickets (e.g., X-linked hypophosphatemic rickets) affect how the body handles phosphorus, even when vitamin D levels are normal.

Risk Factors to Keep in Mind

Certain children are at higher risk for developing rickets:

• Premature infants (smaller vitamin D stores at birth)
• Exclusive breastfeeding without supplementing vitamin D (recommendation: 400 IU/day from birth)
• Dark-skinned children living in low-sunlight regions
• Children with restricted diets (vegan or food allergies limiting dairy)
• Kids with limited outdoor activity due to medical or lifestyle reasons

Diagnosis: Tests and Exams

If you notice any of the above rickets in children symptoms, a pediatrician will perform:

1. Physical Examination

   • Checking bone shape, tenderness and muscle strength.
   • Measuring growth parameters (height, weight, head circumference).

2. Blood Tests

   • Vitamin D (25-hydroxyvitamin D) levels.
   • Calcium, phosphorus, alkaline phosphatase (bone turnover marker).
   • Parathyroid hormone (regulates calcium levels).

3. Imaging Studies

   • X-rays of wrists, knees or knees to spot bone changes, widening of growth plates or deformities.

4. Additional Tests (if needed)

   • Kidney and liver function tests.
   • Genetic testing for inherited forms of rickets.

Treatment Strategies

Treating rickets aims to correct the nutritional imbalance, relieve symptoms and support normal bone development.

Vitamin D and Mineral Supplementation

• High-dose vitamin D (“loading dose”) followed by maintenance dosing.
• Calcium supplements if dietary intake is insufficient.
• Phosphorus supplements in certain inherited forms of rickets.

Diet and Lifestyle Adjustments

• Encourage a balanced diet rich in dairy or fortified alternatives, leafy greens, fatty fish and eggs.
• Promote safe sun exposure: 10–30 minutes several times a week, depending on skin type and location.
• Physical therapy may help improve muscle strength and mobility.

Orthopedic Care

• In severe bone deformities (e.g., bowed legs) a pediatric orthopedist may recommend braces or corrective surgery.

Regular Monitoring

• Repeat blood tests and X-rays to ensure treatment is working.
• Adjust doses of supplements based on lab results and growth progress.

Prevention Tips

Preventing rickets is often straightforward with proper nutrition and lifestyle:

• Ensure infants receive 400 IU of vitamin D daily, even if breastfed.
• Offer vitamin D-fortified formulas or cereals to toddlers.
• Include calcium-rich foods: milk, yogurt, cheese, fortified plant milks, tofu, sardines.
• Encourage outdoor play and moderate sun exposure, using sun protection when needed.
• Consider a multivitamin for picky eaters, after discussing with your pediatrician.

When to Seek Help

If you spot any signs of rickets in your child—bowed legs, delayed growth or bone pain—early evaluation can prevent complications. You might start with a free, online symptom check, using the doctor approved Ubie Symptom Checker, which can guide you on next steps and whether to call your pediatrician right away.

Speak to a doctor or pediatric specialist about any symptoms that concern you, especially if your child has trouble standing, severe pain, muscle spasms or breathing difficulties. Prompt medical attention ensures the best chances for a full recovery and healthy development.