Rickets is a disorder that causes the weakening and softening of bones, causing bone deformities, brittle bones and easy fractures. The primary causes of Rickets are a lack of Vitamin D and the lack of calcium and phosphate. In post-institutionalized children the diagnosis of Rickets is common place because orphanages provide many of the factors needed to create a vitamin D deficiency in children. In the U.S.A. this diagnosis is very rare, with the most common causes being kidney disorders, extreme prematurity, and liver problems. These conditions all have a role in decreasing the vitamin D metabolism and subsequently calcium in the bone, thus causing Rickets.
Children that live in Orphanages have the following causes for their Rickets:
1) Poor nutrition: Children that live in institutions generally have poorly balanced diet deficient in certain vitamins such as Vit. D. The milk that they drink in not fortified with Vitamin D., and vitamin supplements are not provided. It also occurs in people that have a strict vegetarian diet, do not drink milk, or are lactose intolerant, because they can not tolerate milk.
2) Lack of sunshine: Rickets seems to occur more readily in the winter months because the lack of sunshine. Children usually have prolonged indoor confinement during the winter months because of the harsh temperatures outdoors, and the fear that the children will become ill thus causing mini epidemics in the institution. ( flu syndrome, common colds)
3) Malabsorbtion disorders and prolonged diarrhea, caused by intestinal parasites can produce a decrease in the absorption of fat soluble vitamins thus causing a decrease in the vitamin D in the bloodstream. When the body becomes deficient in Vit. D it is unable to properly regulate the calcium and phosphate levels. If the blood levels of these minerals become too low, the other body hormones may stimulate the release of calcium from the bones to compensate in the bloodstream. Over time, the progressive loss of calcium in the bone causes the softening, weakening and destruction of the supportive bony matrix.
Symptoms of Rickets:
1) Bone manifestations: pain and tenderness in the bones (arms, legs, spine, pelvis)
2) Numerous types of classic skeletal deformities: (caused by abnormal bone formations is areas of bone growth)
A) Bowlegged: caused by softening of the middle portion of the long bones causing them to bow. B) Rachitic rosary: bumps in the rib cage C) Pigeon chest: forward protrusion of the breast bone. D) Widening of the wrists and knees E) Frontal skull bossing; Caused by excessive formation of bone in the forhead. F) Craniotabes: soft head bones with a delay in closure of the fontanelle sutures.
3) Increased tendencies to easy bone fractures, sometimes mistaken for child abuse
4) Dental malformations , deformities, and severe cavities with decay.
5) Unexplained fevers especially at night
6) Impaired growth causing a decrease in the adult height.
7) Muscle cramps and restlessness at night
8) Progressive muscle weakness with decreased muscle tone and development
Treatment options: correction to provide the relief of symptoms.
There is usually the mineral replacement of calcium, phosphate and Vitamin D. Adequate replacement will cause the symptoms to disappear. Dietary sources of Vitamin D are, fish, liver and Vitamin D fortified milk. Exposure to moderate amounts of natural sunlight will also help in the treatment of Rickets. If Rickets is not corrected while the children are still growing, the described skeletal deformities and short stature may become permanent. If the deficiency is corrected at an early age, deformities often reduce or disappear with time.
Rickets itself is not a known cause in fine motor and mental delay. Gross motor delays that appear are attributed to muscle weakness, softness in the long bone, and muscle pain. A properly treated child with Rickets should have a good prognosis and future manifestations should be minimal.
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