SELECTED ARTICLE
Author
Alla Gordina, MD, FAAP 
Article Title
What will my child need if his/her pre-adoptive medical report has a diagnosis of "rickets"? 
Posted Date
12/19/2005 

Short answer:

  • Good physical and laboratory evaluation to determine the cause of the rickets.
  • In the majority of cases, presuming that all the results of the post-adoption evaluations are normal - your child would need just healthy nutrition, regular multivitamins, sunshine and a lot of love.

Long answer:

What is Rickets? Rickets (rik’ets) is believed to be a derivative of the Greek word rhachitis that means spinal complaint. Rickets was first described over 2000 years ago as crooked legs and chest deformities in Roman toddlers, who were neglected and/or inappropriately fed by their mothers. For simplicities' sake we can define rickets as a bone and muscle problem due to vitamin D deficiency. Rickets can be caused by external causes (poor nutrition, lack of sunshine exposure) or by internal causes (diseases and unresponsiveness to vitamin D, loss of minerals and others)

Major symptoms of rickets are:

  • Decreased muscle tone with the normal development of the central and peripheral nervous system,
  • Softness of the middle portion of the long bones, which can cause the bowing of the legs,
  • Craniotabes - softness of the head bones with delayed closure of the fontanels,
  • Abnormal bone formation at the zones of bone growth - "rachitic rosary" - thickening of the sites of attachment of the ribs to the chest bone, widening of the wrists and knees, as well as the "frontal scull bossing" - excessive bone growth at the forehead.
  • Dental caries, which can lead to cavity formation
  • Awkward gait
  • Bone and Muscle pain
  • Increased irritability and sweat production
  • Growth delays.

Rickets itself is not known in causing delays in fine motor and/or mental development. Gross motor delays can be related to muscle weakness, softness of the long bones and to bone and muscle pain. Rickets in Russia vs. Rickets in the United States. Nutritional rickets (pure vitamin D deficiency) is an extremely common condition in the countries of the former Soviet Union. Such rickets there can be seen not only in orphans, but also in some of the homegrown children from families that can provide good nutrition and access to the outdoors and medications.

Even more, cases of real “full blown” rickets in newly adopted children are seen extremely rare (they are usually associated with other medical conditions) In the United States, presently, the most common causes of rickets are extreme prematurity, abnormalities of mineral metabolism, kidney problems and treatment with certain drugs. Such types of rickets do require special medical attention and medications.

Things that can make rickets worse: - prematurity, - poor nutrition, institutionalization, - frequent and prolonged illnesses, - prolonged diarrhea, - and the winter season. Things that can make rickets better: In the orphanages, rickets is usually treated with vitamin D supplementation and ultra-violet irradiation. This is the reason why some adopted children can present with clinical signs of rickets and without any abnormality on their blood tests.

Massages and other types of physical therapy can be used with good results too. Abnormal test results for rickets during the post-adoption evaluations are actually extremely rare. Taking into consideration that rickets, if present in internationally adopted children, is a self-limited condition, most of the times it does not require any special treatment at all. In actuality, very frequently, adoption itself is the best medicine for rickets in post-institutionalized children. N

ormal nutrition (both the quality and quantity, if you can call "normal" the amount of food newly adopted children usually can eat), over the counter children’s multivitamins, sunshine exposure, addressing other medical problems, and a lot of "vitamins" L (love), M (mama), P (papa), and F (family) will usually do the trick. HOWEVER - we still have to exclude the possibility of other types of rickets. This has to be done by your child’s doctor depending on your child’s symptoms. This article was first published at www.welcomegarden.com in July 2002

The information appearing here is intended for educational purposes only. It should not be used as a substitute for professional medical advice tailored to your child's individual needs. If you have questions or concerns regarding your child's physical or mental health, please seek assistance from a qualified healthcare provider.

References
GLOBAL PEDIATRICS is an international adoption medical support service that has specialized in assisting families adopting from the Former Soviet Union through every step of the adoption process for the past ten years. Dr. Gordina's unique professional background and attention to detail ensure the highest possible level of service. She is recognized by her patients and peers as a leader and pioneer in the field and has presented her adoption-related research at sessions of the AAP, JCICS, NACAS and other meetings. Dr. Gordina has both participated in and organized several humanitarian missions to pediatric clinics and orphanages in the Former Soviet Union. For all questions regarding our services please check www.globalpediatrics.net 
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