The year 2021 saw a 300 percent rise in Rickets disease in India.
Once considered an ailment of the past, Rickets is slowly tiptoeing into the modern era. And why is it concerning? Well, that’s because it shakes the very foundation of a child’s body - the bones. Primarily a result of nutritional deficiencies, the disorder was combated with proper food. But now with the issue making a comeback, we need to be aware. The reasons may be plenty, from extreme sun protection remedies to a lazy indoor life. As for India, the problem was never that common. This was thanks to our tropical weather and the benevolence of the sun. However, malnutrition was always a reality here. Making the disease dominant in low socio-economic backgrounds.
In the recent past, COVID and lockdowns have re-intensified the matter. Not just in poor homes, but also in affluent families with well-nourished kids. And this time, it is the lack of sun exposure and prolonged hours of indoor life that are to blame.
That being said, there is more to this bone disorder than a mere sun-deprived scenario. So, let’s get to the specifics and find the prevention tricks.
What is Rickets? - Overview
Rickets is a skeletal illness that leads to soft and weak bones. It is usually a result of severe Vitamin D deficiency. Vitamin D is responsible for helping the human body absorb calcium and phosphorus. These nutrients are crucial for proper bone health and development. But, with a lack of Vitamin D, the body is unable to maintain sufficient calcium and phosphate levels. This produces hormones that cause these vital minerals to be released from the bones. Thereby leading to frail, deformed bones in the form of Rickets.
The disease is most prevalent in growing children in the age range of 6 to 36 months. Adults may also suffer from a similar condition. It goes by the name of ‘soft bone disease’ or Osteomalacia. The two problems are closely linked. In other words, a child with Rickets will most likely have Osteomalacia.
This bone disorder, characterized by weak bones, can be manifested in diverse ways. They include:
Muscle cramps/ weakness
Pain in legs, hands, or spine
Defective tooth structure/ delayed tooth formation
Holes in the enamel
Dental abscesses (accumulation of pus)
Odd skull shape
Rickets disease is caused by a lack of Vitamin D in the system. So, the related factors are:
Insufficient exposure to sunlight
Prolonged indoor activities
Overuse of sunscreen
Geographical locations with less sunshine (northern latitudes)
Food habits (a vegetarian diet that lacks fish, milk, and eggs)
Genes (a mother with extreme Vitamin D deficiency can give birth to a baby with Rickets symptoms)
Exclusive breastfeeding (breast milk does not have the required amount of Vitamin D for Rickets prevention)
Medical conditions affecting the Vitamin D absorption ability of the body
Celiac disease (an autoimmune disorder to eating gluten)
Inflammatory bowel disease (swelling in the gastrointestinal tract)
Cystic fibrosis (affects lungs and digestive system)
Medicines to treat HIV infections
Are Rickets and Osteoporosis the Same?
It is easy to confuse Rickets/ Osteomalacia with Osteoporosis. After all, they are all disorders that strike the bone tissues and affect the formation of the bones. But there is a difference. Rickets and Osteomalacia are more of a softening of the bone situation. While Osteoporosis is marked by a loss of bone density.
The diagnosis of Rickets is done with a physical examination. Doctors press the bones of the child to check the pain and other abnormalities. They may also recommend tests to confirm the disorder. These include:
Blood tests to find the calcium and phosphate levels in the blood.
X-rays in the bones to locate bone deformities.
In some rare situations, the physician may also decide to go for a bone biopsy. The process requires removing a small portion of the bone for lab analysis.
Treating Rickets requires fulfilling the body’s need for the missing nutrients. So, the doctor may suggest the following:
Take calcium and Vitamin D supplements. Please try to adhere to the recommended dosage. Too much intake of Vitamin D can be harmful.
Increase the exposure to natural sunlight.
Incorporate foods high in Vitamin D like fish, milk, and eggs.
If Rickets have caused some skeletal deformities in your child, then braces may help to position the growing bones. Whereas corrective surgery may be required in severe cases.
For rare inherited Rickets treatment, doctors may recommend specific supplements. They are usually a combination of phosphate and a special type of Vitamin D.
Can Rickets be Cured?
Adequate doses of Vitamin D, phosphate, and calcium can wipe away most of the Rickets symptoms. You can even notice the improvements as early as a week. The skeletal defects also improve or go away with time with correction measures. But, if you delay or leave them untreated during the growth period, they may become permanent.
Final Thoughts - Rickets Prevention Tips
Rickets do have a high probability of being cured. But some instances are more complicated than others. They may lead to long-term abnormalities and seizures, for example. The problem also has a strong impact on the fragile mind of the child. After all, they are facing too many restrictions in their growing years. Unlike other children in the same age group.
Well, while we do not have much of a say when genes are involved, preventing Rickets is possible. Here’s how:
Engage your child in outdoor activities for at least 10 minutes.
However, please note that too much sunlight is also harmful. More so if you live in a country with very hot and humid weather. So, you may limit it to a few times a week. As per the National Health Service of England (NHS), exposing the face and hands in the spring and summer is enough. Also, if you are concerned, avoid direct sun exposure. Just make your child wear protective clothing and sunscreen.
Ensure a balanced diet rich in calcium, phosphorus, and Vitamin D.
For kidney-related concerns, monitor calcium and phosphate levels from time to time.
Last but not least, try to detect the early signs of Rickets in your child. This can help you give your little one proper Rickets treatment at the right time. As we know by now, that is crucial to preventing permanent Rickets complications.
The Author : Dr. Sunil Khattri
Dr. Sunil Khattri MBBS, MS(General Surgery), LLB, is a Medical doctor and is a practicing Advocate in the Supreme Court of India and National Consumer Disputes Redressal Commission, New Delhi.