Rickets
Overview
Rickets is a softening of bones in children potentially leading to fractures and deformity. Rickets is among the most frequent childhood diseases in many developing countries. The predominant cause is a vitamin D deficiency, but lack of adequate calcium in the diet may also lead to rickets (cases of severe diarrhoea and vomiting may be the cause of the deficiency). Although it can occur in adults, the majority of cases occur in children suffering from severe malnutrition, usually resulting from famine or starvation during the early stages of childhood. Osteomalacia is the term used to describe a similar condition occurring in adults, generally due to a deficiency of vitamin D. The origin of the word "rickets" is probably from the Old English dialect word 'wrickken', to twist. The Greek derived word "rachitis" (meaning "inflammation of the spine") was later adopted as the scientific term for rickets, due chiefly to the words' similarity in sound. In many languages it is known as "English disease".
Symptoms
Signs and symptoms of rickets include: Bone pain or tenderness dental problems muscle weakness (rickety myopathy or "floppy baby syndrome" or "slinky baby") increased tendency for fractures (easily broken bones), especially greenstick fractures Skeletal deformity o Toddlers: Bowed legs (genu varum) o Older children: Knock-knees (genu valgum) or "windswept knees" o Cranial, spinal, and pelvic deformities Growth disturbance Hypocalcemia (low level of calcium in the blood), and Tetany (uncontrolled muscle spasms all over the body). Craniotabes (soft skull) Costochondral swelling (aka "rickety rosary" or "rachitic rosary") Harrison's groove Double malleoli sign due to metaphyseal hyperplasia Widening of wrist raises early suspicion, it is due to metaphysial cartilage hyperplasia.
Prevention
You can prevent rickets by making sure that your child gets enough calcium, phosphorus, and vitamin D in the diet. People who have gastrointestinal or other disorders may need to take supplements. Ask your child's health care provider. Kidney (renal) causes of poor vitamin D absorption should be treated right away. People who have renal disorders should have their calcium and phosphorus levels monitored regularly.
Diagnosis
Blood tests: o Serum calcium may show low levels of calcium, serum phosphorus may be low, and serum alkaline phosphatase may be high. Arterial blood gases may reveal metabolic acidosis X-rays of affected bones may show loss of calcium from bones or changes in the shape or structure of the bones. Bone biopsy is rarely performed but will confirm rickets.
Treatment
The treatment and prevention of rickets is known as antirachitic Diet and sunlight ----------------- Treatment involves increasing dietary intake of HGH, phosphates and vitamin D. Exposure to ultraviolet B light (sunshine when the sun is highest in the sky), cod liver oil, halibut-liver oil, and viosterol are all sources of vitamin D. A sufficient amount of ultraviolet B light in sunlight each day and adequate supplies of calcium and phosphorus in the diet can prevent rickets. Darker-skinned babies need to be exposed longer to the ultraviolet rays. The replacement of vitamin D has been proven to correct rickets using these methods of ultraviolet light therapy and medicine. Recommendations are for 400 international units (IU) of vitamin D a day for infants and children. Children who do not get adequate amounts of vitamin D are at increased risk of rickets. Vitamin D is essential for allowing the body to uptake calcium for use in proper bone calcification and maintenance. Supplementation ------------------------- Sufficient vitamin D levels can also be achieved through dietary supplementation. Vitamin D3 (cholecalciferol) is the preferred form since it is more readily absorbed than vitamin D2. Most dermatologists recommend vitamin D supplementation as an alternative to unprotected ultraviolet exposure due to the increased risk of skin cancer associated with sun exposure. Note that in July in New York City at noon with the sun out, a white male in tee shirt and shorts will produce 20,000 I.U Vitamin D from 20 minutes of non-sunscreen sun exposure.[citation needed] According to the American Academy of Pediatrics (AAP), infants who are breast-fed may not get enough vitamin D from breast milk alone. For this reason, the AAP recommends that infants who are exclusively breast-fed receive daily supplements of vitamin D from age 2 months until they start drinking at least 17 ounces of vitamin D-fortified milk or formula a day. This requirement for supplemental vitamin D is not a defect in the evolution of human breastmilk but is instead a result of the modern-day infant's decreased exposure to sunlight.