Rickets

Rickets is a condition affecting bone development in children, most commonly caused by vitamin D deficiency, resulting in soft, weak bones that can become deformed. It is preventable with adequate vitamin D and calcium intake.

• Bowed legs or knock knees
• Delayed growth and short stature
• Widening of the wrists and ankles
• Soft skull bones in infants, and delayed closure of the soft spot (fontanelle)
• Bone pain and, in more significant cases, an increased risk of fractures
• Delayed tooth eruption in some cases

• Most commonly caused by vitamin D deficiency, which impairs the body's ability to absorb and use calcium and phosphate for bone formation.
• Risk is increased by limited sun exposure, exclusively breastfed infants without vitamin D supplementation (since breast milk alone is often insufficient), and darker skin, which reduces vitamin D production from sunlight.
• Inadequate dietary calcium intake can also contribute, even with adequate vitamin D.

• Suspected clinically based on the characteristic bone deformities and growth delay in a young child.
• Blood tests showing low vitamin D and calcium/phosphate abnormalities, together with elevated markers of bone turnover, support the diagnosis.
• X-rays, where available, can show characteristic changes at the growing ends of bones.

Vitamin D supplementation, together with adequate dietary calcium, is the primary treatment and leads to significant improvement in bone health over weeks to months.

Dietary counselling encourages adequate intake of calcium-rich foods alongside vitamin D correction.

Bone deformities often improve substantially with treatment in younger children, though established deformities in older children may require longer-term monitoring and, in some cases, orthopaedic assessment.

Addressing the underlying cause — such as ensuring adequate sun exposure and appropriate supplementation for exclusively breastfed infants — helps prevent recurrence.

• Ensure adequate, safe sun exposure for infants and children, balanced with sun-safety practices.
• Provide vitamin D supplementation for exclusively breastfed infants as recommended, since breast milk alone often does not provide sufficient vitamin D.
• Encourage a diet with adequate calcium-rich foods where accessible.
• Seek assessment for any child with bone deformity or delayed growth.