Causes of Rickets

Written by Yao Li Qin
Pediatrics
Updated on January 07, 2025
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Rickets, also known as Vitamin D-deficiency rickets, implies from its name that the cause of the disease is due to insufficient intake of Vitamin D in children, leading to disorders in calcium and phosphorus metabolism and resulting in nutritional disease with skeletal deformities. The incidence of the disease is higher in the north than in the south. Currently, the incidence of mild and moderate rickets is relatively high, while severe cases are less common because people are increasingly paying attention to the supplementation of Vitamin D for children. It is recommended that full-term infants start supplementing with 400 units of Vitamin D daily two weeks after birth, which is the physiological requirement. For premature infants, twins, and extremely low birth weight infants, the daily physiological requirement of supplementation is 800 units per day. After supplementing continuously for three months, it should be adjusted to 400 units per day as per the requirement for full-term infants. With such management, the child will not suffer from rickets. However, if there is no regular supplementation after birth, the lack of Vitamin D can lead to skeletal changes in the child, and once rickets is diagnosed, it requires high doses of supplementation.

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Written by Yao Li Qin
Pediatrics
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Clinical manifestations of rickets

Rickets, also known as vitamin D deficiency rickets, occurs because children do not supplement vitamin D in a timely manner after birth, leading to a deficiency of vitamin D in the body and resulting in a nutritional metabolic disease primarily involving skeletal changes. In the early stages, children mainly show symptoms related to mental and emotional state, such as irritability, crying, excessive sweating, shaking their heads back and forth, and rubbing their heads. Subsequently, symptoms like bald patches on the back of the head and softening of the skull bones may appear. As children grow, they may develop conditions such as a square-shaped skull, beaded ribs, pigeon chest, funnel chest, and bracelet-like deformities around the wrists and ankles. In severe cases, children may later develop X-shaped legs and O-shaped legs. If rickets is suspected, it is crucial to promptly conduct a blood test to measure the vitamin D level. If the level is below normal, it is essential to actively treat the diagnosed rickets.

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Written by Mo Ming Hua
Pediatrics
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If rickets is not treated, what will be the impact?

Rickets, if untreated, mainly involves changes in skeletal deformities and motor function in children. Rickets is primarily caused by a deficiency in vitamin D, which is essential for promoting the absorption of calcium. A deficiency in vitamin D leads to reduced calcium absorption. Lower calcium absorption results in a calcium deficiency in the body, which in turn causes changes in the bones. In the early stages of vitamin D deficiency, the main symptoms are increased neural excitability, which may manifest as startle reactions, irritability, restlessness, and excessive sweating. During the active phase, symptoms of increased nervous system excitability become more pronounced, mainly presenting as skeletal deformities. What aspects do these skeletal deformities affect? One is the softening of the skull, pigeon chest, funnel chest, and changes resembling wristbands and anklets. If the condition worsens further, it can present as X-shaped legs, O-shaped legs, and spinal deformities. Thus, if rickets progresses, it can lead to skeletal deformities and impairments in motor functions, among other issues.

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Written by Li Jiao Yan
Neonatology
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Rickets is caused by a deficiency of what element?

Rickets is a systemic chronic nutritional disease caused by vitamin D deficiency leading to disturbances in calcium and phosphorus metabolism, which results in abnormal bone development. The main cause is a lack of vitamin D, generally related to feeding methods, the addition of cod liver oil, living environment, outdoor activity time, repeated respiratory infections, calcium deficiency during pregnancy, and the season of birth. It is generally recommended to routinely supplement vitamin D and cod liver oil after birth, have regular follow-ups, engage in appropriate outdoor activities, and during pregnancy, it is important to supplement with adequate calcium and vitamin D. Additionally, attention should be paid to children who have repeated respiratory and gastrointestinal diseases, as these can also affect the absorption of vitamin D and calcium and phosphorus. Thus, it is vital to actively prevent other diseases that may affect the absorption of vitamin D and to treat illnesses proactively when they occur.

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Written by Zeng Hai Jiang
Pediatrics
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Rickets and osteoporosis are caused by a lack of what?

Rickets and osteoporosis are both caused by a lack of vitamin D and calcium. Rickets is commonly seen in infants and can present with abnormalities in skeletal development such as "ping-pong ball head", signs of wrist and ankle bracelets, square skull, funnel chest, pigeon chest, X-shaped legs, and O-shaped legs. Osteoporosis is a metabolic bone disease caused by reduced bone formation and increased bone resorption. It can be categorized according to its etiology into senile osteoporosis, postmenopausal osteoporosis, idiopathic osteoporosis, and secondary osteoporosis. Clinically, it can manifest as fatigue, bone pain, and fractures.

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Written by Tong Peng
Pediatrics
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Can rickets with rib eversion in babies be cured?

Babies with rib flaring can be treated, but it requires assessment based on relevant clinical symptoms and laboratory tests. First, it is necessary to understand that rickets is a metabolic bone disease caused by a deficiency of vitamin D, which often results not only in rib flaring but also in square skull, pigeon chest, and either bowlegs or knock-knees. Neurologically, symptoms may include night sweats, easy startling during sleep, and poor sleep quality. When these conditions occur, a physical examination by a specialist is essential, along with comprehensive tests, including measuring the specific levels of vitamin D, and selecting appropriate vitamin D supplements. If the symptoms of rib flaring are severe and accompanied by a noticeable pigeon chest, orthotic supports may also be necessary for correction. If rib flaring affects normal breathing, severe cases may require surgical treatment. Therefore, the extent of severity based on clinical symptoms will dictate the treatment approach—whether it is oral medication, orthotic correction, or surgery.