Overview of Rickets

Rickets is a fairly common disease in children, manifested by bone dystrophy. The disease is often found in children under 3 years old. The epidemiological area where children with rickets are often found is in mountainous areas, where there is a lot of fog and little sunlight. This leads to a lack of Vitamin D synthesis, affecting the absorption and metabolism of Calcium and Phosphorus, which are essential ingredients to form the skeleton.

However, urban children can also have rickets because they are too tightly covered indoors and do not get regular sunbathing, which also leads to a lack of Vitamin D synthesis.

In addition to the problem of rickets due to Vitamin D deficiency due to insufficient supply, rickets is also caused by Vitamin D metabolism disorders, causing insufficient Vitamin D3, which is involved in bone metabolism.

Causes of Rickets

The main cause of rickets is Vitamin D deficiency. Vitamin D is provided from two sources: exogenous and endogenous.

• Exogenous is from food, breast milk, this source accounts for a very small proportion. Vitamin D is soluble in oil, so if the child’s food does not contain fat, it will lead to reduced absorption of Vitamin D.
• Endogenous is from a precursor under the skin, under the influence of sunlight converted into Vitamin D3, this is the main source to participate in bone metabolism in children. Therefore, rickets is common in children due to Vitamin D deficiency.

Another rarer cause is a lack of Vitamin K2, a protein that transports calcium to form bones, or a lack of some minerals such as calcium, phosphorus, zinc, and magnesium, which are components of bones.

Symptoms of Rickets

• General: Children with rickets often show signs of anorexia and malnutrition
• In the bones: Children with rickets have symptoms in the skull: The fontanel is slow to close (over 1 year old but the fontanel is still wide), the edge of the fontanel is soft, the head circumference is large, there is a forehead bump, a parietal bump. Children have slow tooth growth, cavities, and uneven teeth. At the limbs: Curved limbs, ankle rings, wrist rings. Chicken-shaped chest, may have rib beads. Consequences lead to children with slow motor development such as late crawling, late walking.
• Neurology: Children with rickets often startle, do not sleep deeply, often sweat at night (night sweats) leading to hair loss on the back of the neck. If the condition is severe, children often cry continuously. In some cases of severe rickets, hypocalcemia can cause children to have convulsions and hiccups.

Subjects at risk of Rickets

Children in areas with little sunlight or children who are overprotected and do not get sunbathing are all subjects that may lack Vitamin D due to reduced synthesis in the skin, leading to rickets. In addition, premature babies, or twins and triplets are also susceptible to rickets because they are not provided with enough nutrients while in the womb.

Prevention of Rickets

• To prevent rickets in children, pregnant women also need to pay attention to taking care of themselves and providing adequate nutrition throughout pregnancy, especially in cases of multiple pregnancies where the need is often higher than usual.
• Following a balanced diet and letting children sunbathe regularly in the morning will reduce the risk of rickets.
• For infants, breast milk is a balanced source of nutrition and has a much higher Vitamin D ratio than all other formulas and supplements. When children have started eating solid foods, their diet needs to be balanced to ensure the addition of Calcium and Phosphorus, which are the ingredients that make up the skeleton.
• In foggy areas, where sunlight is not enough to synthesize Vitamin D, children need to be supplemented with oral Vitamin D3. And to absorb Vitamin D well, children’s diets must not be low in fat.

Measures to diagnose Rickets

• Mainly based on clinical examinations and bone X-rays to detect bone disease manifestations as well as accompanying neurological symptoms.
• In addition, blood tests can be performed to measure Vitamin D, Calcium, and Phosphorus to assess deficiencies to guide appropriate treatment.

Measures to treat Rickets

Regular sunbathing in the morning is also a treatment method for children with rickets. In addition, 400 IU of Vitamin D3 can be supplemented daily for children until all symptoms are gone. When children have rickets, they need to be examined and consulted by a Pediatric Nutritionist for specific and appropriate treatment instructions. Avoid using drugs without a doctor’s prescription, which can be harmful to children.